title: Reasons for Brazilian women to switch from different contraceptives to long-acting reversible contraceptives.
abstract: OBJECTIVE
  Long-acting reversible contraceptives (LARCs) include the copper-releasing intrauterine device (IUD), the levonorgestrel-releasing intrauterine system (LNG-IUS) and implants. Despite the high contraceptive efficacy of LARCs, their prevalence of use remains low in many countries. The objective of this study was to assess the main reasons for switching from contraceptive methods requiring daily or monthly compliance to LARC methods within a Brazilian cohort.
  
  
  METHODS
  Women of 18-50 years of age using different contraceptives and wishing to switch to a LARC method answered a questionnaire regarding their motivations for switching from their current contraceptive. Continuation rates were evaluated 1 year after method initiation. Sample size was calculated at 1040 women. Clinical performance was evaluated by life table analysis. The cutoff date for analysis was May 23, 2013.
  
  
  RESULTS
  Overall, 1167 women were interviewed; however, after 1 year of use, the medical records of only 1154 women were available for review. The main personal reason for switching, as reported by the women, was "fear of becoming pregnant" while the main medical reasons were nausea and vomiting and unscheduled bleeding. No pregnancies occurred during LARC use, and the main reasons for discontinuation were expulsion (in the case of the IUD and LNG-IUS) and a decision to undergo surgical sterilization (in the case of the etonogestrel-releasing implant). Continuation rate was ~95.0/100 women/year for the three methods.
  
  
  CONCLUSIONS
  Most women chose a LARC method for its safety and for practical reasons, and after 1 year of use, most women continued with the method.
authors.affiliation: Human Reproduction Unit, Department of Obstetrics and Gynecology, School of Medical Sciences and the National Institute of Hormones and Women's Health, University of Campinas (UNICAMP), Campinas, SP, Brazil.
authors.forename: Jéssica M
authors.initials: JM
authors.lastname: Ferreira
authors.forename: Fabiana R
authors.initials: FR
authors.lastname: Nunes
authors.forename: Waleska
authors.initials: W
authors.lastname: Modesto
authors.forename: Mayara P
authors.initials: MP
authors.lastname: Gonçalves
authors.forename: Luis
authors.initials: L
authors.lastname: Bahamondes
mesh_terms: D000293:Adolescent; D000328:Adult; D001938:Brazil; D003268:Contraception Behavior / Q000706:statistics & numerical data*; D003271:Contraceptive Agents, Female / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007436:Intrauterine Devices, Medicated / Q000706:statistics & numerical data*; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female
keywords: Brazil switchers; Contraceptive methods; Decision making; Hormonal contraceptives