title: Satisfaction, early removal, and side effects associated with long-acting reversible contraception.
abstract: OBJECTIVE
  Although intrauterine devices (IUDs) and subdermal implants (SDI) are recommended as first-line contraception for the majority of women by the American College of Obstetrics and Gynecology, these methods of long-acting reversible contraception (LARC) are underutilized. Some concerns regarding their use include cost of placement, side effects, and perception of frequent early removal. This study evaluated satisfaction with LARC, frequency, and reasons behind early removal in a family medicine setting.
  
  
  METHODS
  Women > 18 years seen for placement of removal of an IUD or SDI were identified from billing data and surveyed via telephone to determine satisfaction and side effects with LARC. Additional demographic information was extracted from the electronic health record.
  
  
  RESULTS
  Of the 132 respondents (response rate 61.4%), 58.3% had IUDs and 41.7% had SDIs placed. Early removal occurred in 24.2% of women, and 72.7% were satisfied with their contraceptive choice. Younger and nulliparous women were more likely to have an SDI placed, whereas older and multiparous women chose the IUD. Younger nulliparous women were less likely to have LARC removed early. Pain (more commonly reported with the IUD) and increased frequency in bleeding (more commonly reported with the SDI) were associated with early removal rates.
  
  
  CONCLUSIONS
  Most women who received LARC were satisfied with their contraceptive choice, and only one in four had the LARC removed early. This is significantly better than continuation rates with other contraceptive methods. Younger, nulliparous women were good candidates for LARC, continuing their use more than older, multiparous women. Improved counseling regarding pain and changes in menstrual bleeding patterns may impact early removal of IUDs and SDIs, respectively.
authors.affiliation: Department of Family Medicine, Medical University of South Carolina.
authors.forename: Lori M
authors.initials: LM
authors.lastname: Dickerson
authors.forename: Vanessa A
authors.initials: VA
authors.lastname: Diaz
authors.forename: Jessica
authors.initials: J
authors.lastname: Jordon
authors.forename: Emily
authors.initials: E
authors.lastname: Davis
authors.forename: Svetlana
authors.initials: S
authors.lastname: Chirina
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Goddard
authors.forename: Kristin B
authors.initials: KB
authors.lastname: Carr
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Carek
mesh_terms: D000328:Adult; D017677:Age Distribution; D003268:Contraception Behavior / Q000706:statistics & numerical data; D003271:Contraceptive Agents, Female / Q000008:administration & dosage* / Q000009:adverse effects; D003863:Depression / Q000209:etiology; D004343:Drug Implants / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006201:Hair Diseases / Q000209:etiology; D006261:Headache / Q000209:etiology; D006801:Humans; D007407:Interviews as Topic; D007434:Intrauterine Devices / Q000009:adverse effects / Q000592:standards / Q000706:statistics & numerical data*; D008599:Menstruation Disturbances / Q000209:etiology*; D010146:Pain / Q000209:etiology*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D013022:South Carolina; D013997:Time Factors; D015430:Weight Gain; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female; D004343:Drug Implants