Immediate versus delayed initiation of the levonorgestrel‐releasing intrauterine system following medical termination of pregnancy – 1 year continuation rates: a randomised controlled trial

Objective To assess the 1‐year continuation rates and new pregnancies following immediate versus delayed insertion of the levonorgestrel‐releasing intrauterine system ( LNG ‐ IUS ) after medical termination of pregnancy ( MTOP ) up to 20 weeks of gestation. Design A randomised controlled trial. Setting Helsinki University Hospital, Finland, January 2013 to December 2014. Population A total of 267 women requesting MTOP and planning LNG ‐ IUS for post‐ MTOP contraception. Methods Insertion of LNG ‐ IUS occurred immediately (0–3 days) or after a delay (2–4 weeks) following MTOP . Follow‐up visits were at 3 months and 1 year after MTOP . Main outcome measures LNG ‐ IUS use at 1 year after MTOP . Results Women were randomised to immediate ( n  = 134) or delayed ( n  = 133) insertion of the LNG ‐ IUS , and 133 and 131 were analysed; 127 (95.5%) women received immediate insertion and 111 (84.7%) women had delayed insertion of the LNG ‐ IUS (risk ratio [ RR ] 1.13, 95% CI 1.04–1.22). The verified numbers of women continuing the LNG ‐ IUS use at 1 year were 83 (62.4%) and 52 (39.7%) ( RR 1.57, 95% CI 1.23–2.02). The numbers of new pregnancies were 6 (4.5%) and 16 (12.2%) ( RR 0.37, 95% CI 0.15–0.91), and numbers of subsequent TOP s were 4 (3.0%) and 5 (3.8%) ( RR 0.79, 95% CI 0.22–2.87). Conclusions Immediate insertion of the LNG ‐ IUS following MTOP resulted in higher 1‐year continuation rates compared with delayed insertion. In addition, those receiving immediate insertion demonstrated a decreased new pregnancy rate, but no difference in the numbers of another TOP . Tweetable abstract Immediate LNG‐IUS insertion after MTOP results in a higher 1‐year continuation compared with delayed insertion.