title: Continuation and satisfaction of reversible contraception.
abstract: OBJECTIVE
  To estimate 12-month satisfaction and continuation rates of intrauterine device (IUD) and implant users enrolled in the Contraceptive CHOICE Project and compare these measures with women using the oral contraceptive pills (OCPs).
  
  
  METHODS
  We analyzed 12-month data from the first 5,087 participants enrolled in a prospective cohort study of women in the St. Louis region offered contraception at no cost for 3 years. The primary purpose of CHOICE is to promote the use of long-acting reversible contraception (IUDs and implants) and to reduce unintended pregnancies in our region. This analysis includes those participants who received their baseline contraceptive method within 3 months of enrollment and who reached the 12-month follow-up telephone survey time point (n=4,167).
  
  
  RESULTS
  Sixty-eight percent of our participants chose a long-acting reversible contraception method (45% levonorgestrel intrauterine system, 10% copper IUD, and 13% subdermal implant), 23% chose combined hormonal methods (11% OCPs, 10% vaginal ring, and 2% transdermal patch), and 8% chose depot medroxyprogesterone acetate. Long-acting reversible contraception users had higher 12-month continuation rates (86%) than OCP users (55%). The two IUDs had the highest 12-month continuation rates: levonorgestrel intrauterine system (88%) and copper IUD (84%). Women using the implant also had very high rates of continuation at 1 year (83%). Satisfaction mirrored continuation: more than 80% of users were satisfied with the IUD compared with 54% satisfied with OCPs.
  
  
  CONCLUSIONS
  IUDs and the subdermal implant have the highest rates of satisfaction and 12-month continuation. Given that long-acting reversible contraception methods have the highest contraceptive efficacy, these methods should be the first-line contraceptive methods offered to patients.
authors.affiliation: From the Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
authors.forename: Jeffrey F
authors.initials: JF
authors.lastname: Peipert
authors.forename: Qiuhong
authors.initials: Q
authors.lastname: Zhao
authors.forename: Jenifer E
authors.initials: JE
authors.lastname: Allsworth
authors.forename: Emiko
authors.initials: E
authors.lastname: Petrosky
authors.forename: Tessa
authors.initials: T
authors.lastname: Madden
authors.forename: David
authors.initials: D
authors.lastname: Eisenberg
authors.forename: Gina
authors.initials: G
authors.lastname: Secura
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003267:Contraception / Q000379:methods*; D003271:Contraceptive Agents, Female; D003274:Contraceptive Devices, Female; D003276:Contraceptives, Oral; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007434:Intrauterine Devices; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D013997:Time Factors; D057968:Transdermal Patch; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female; D003276:Contraceptives, Oral