title: Association of short-term bleeding and cramping patterns with long-acting reversible contraceptive method satisfaction.
abstract: OBJECTIVE
  We sought to examine the short-term (3- and 6-month), self-reported bleeding and cramping patterns with intrauterine devices (IUDs) and the contraceptive implant, and the association of these symptoms with method satisfaction.
  
  
  METHODS
  We analyzed 3- and 6-month survey data from IUD and implant users in the Contraceptive CHOICE Project, a prospective cohort study. Participants who received a long-acting reversible contraceptive (LARC) method (levonorgestrel-releasing intrauterine system [LNG-IUS], copper IUD, or the etonogestrel implant) and completed their 3- and 6-month surveys were included. Univariable and multivariable analyses were performed to examine the association of bleeding and cramping patterns with short-term satisfaction.
  
  
  RESULTS
  Our analytic sample included 5011 Contraceptive CHOICE Project participants: 3001 LNG-IUS users, 826 copper IUD users, and 1184 implant users. At 3 months, >65% of LNG-IUS and implant users reported no change or decreased cramping, while 63% of copper IUD users reported increased menstrual cramping. Lighter bleeding was reported by 67% of LNG-IUS users, 58% of implant users, and 8% of copper IUD users. Satisfaction of all LARC methods was high (≥90%). LARC users with increased menstrual cramping (relative risk adjusted [RRadj], 0.78; 95% confidence interval [CI], 0.72-0.85), heavier bleeding (RRadj, 0.83; 95% CI, 0.76-0.92), and increased bleeding frequency (RRadj, 0.73; 95% CI, 0.67-0.80) were less likely to report being very satisfied at 6 months.
  
  
  CONCLUSIONS
  Regardless of the LARC method, satisfaction at 3 and 6 months is very high. Changes in self-reported bleeding and cramping are associated with short-term LARC satisfaction.
authors.affiliation: Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO. Electronic address: diedrichj@wustl.edu.
authors.forename: Justin T
authors.initials: JT
authors.lastname: Diedrich
authors.affiliation: Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO.
authors.forename: Sanyukta
authors.initials: S
authors.lastname: Desai
authors.affiliation: Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO.
authors.forename: Qiuhong
authors.initials: Q
authors.lastname: Zhao
authors.affiliation: Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO.
authors.forename: Gina
authors.initials: G
authors.lastname: Secura
authors.affiliation: Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO.
authors.forename: Tessa
authors.initials: T
authors.lastname: Madden
authors.affiliation: Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO.
authors.forename: Jeffrey F
authors.initials: JF
authors.lastname: Peipert
mesh_terms: D000293:Adolescent; D000328:Adult; D003270:Contraceptive Agents / Q000009:adverse effects*; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D007434:Intrauterine Devices / Q000009:adverse effects*; D009120:Muscle Cramp / Q000453:epidemiology / Q000209:etiology*; D017060:Patient Satisfaction; D011446:Prospective Studies; D013997:Time Factors; D055815:Young Adult
chemical_list: D003270:Contraceptive Agents
keywords: contraception; intrauterine device; long-acting reversible contraception; subdermal implant