title: Comparative contraceptive effectiveness of levonorgestrel-releasing and copper intrauterine devices: the European Active Surveillance Study for Intrauterine Devices.
abstract: OBJECTIVE
  The objective was to measure the rate of unintended pregnancies in women using levonorgestrel-releasing intrauterine systems (LNG IUSs, releasing 20 mcg LNG daily) and copper intrauterine devices (IUDs) in a typical population of IUD users and to describe associated complications.
  
  
  METHODS
  A multinational, prospective, non-interventional cohort study of new users of LNG IUS and copper IUDs was performed. Following a baseline survey, study participants and their physicians completed one follow-up questionnaire after 12 months. A multifaceted four-level follow-up procedure minimized loss to follow-up. Patient-reported outcomes were validated by the treating physicians.
  
  
  RESULTS
  A total of 61,448 women with a newly inserted IUD were enrolled in six European countries between 2006 and 2012. The copper IUD cohort contained more than 30 different types. Validated 1-year follow-up information for 58,324 users between 18 and 50 years of age (70% using LNG IUS, 30% using copper IUDs) was collected. A total of 118 contraceptive failures occurred (26 LNG, 92 copper). Both types of IUD were highly effective, with overall Pearl indices of 0.06 [95% confidence interval (CI): 0.04-0.09] and 0.52 (95% CI: 0.42-0.64) for LNG IUS and copper IUDs, respectively. The adjusted hazard ratio for LNG IUS vs. copper IUDs was 0.16 (95% CI: 0.10-0.25). Tenty-one pregnancies (7 LNG IUS, 14 copper IUD) were ectopic, yielding an adjusted hazard ratio for ectopic pregnancy of 0.26 (95% CI: 0.10-0.66).
  
  
  CONCLUSIONS
  The contraceptive failure rate was low with both IUDs. However, the LNG IUS was associated with a significantly lower risk of pregnancy, including ectopic pregnancy, than the copper IUDs.
  
  
  CONCLUSIONS
  To our knowledge, this is the first large-scale, multinational, prospective epidemiological study to measure and compare the contraceptive effectiveness of LNG IUSs and copper IUDs during routine clinical practice. Clinicians and patients should be aware of differences in rates of unintended pregnancies and associated complications in relation to IUD us.
authors.affiliation: ZEG-Berlin, Chausseestrasse 115, 10115 Berlin, Germany. Electronic address: k.heinemann@zeg-berlin.de.
authors.forename: Klaas
authors.initials: K
authors.lastname: Heinemann
authors.affiliation: ZEG-Berlin, Chausseestrasse 115, 10115 Berlin, Germany.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Reed
authors.affiliation: ZEG-Berlin, Chausseestrasse 115, 10115 Berlin, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Moehner
authors.affiliation: ZEG-Berlin, Chausseestrasse 115, 10115 Berlin, Germany.
authors.forename: Thai Do
authors.initials: TD
authors.lastname: Minh
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003271:Contraceptive Agents, Female / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007435:Intrauterine Devices, Copper; D007436:Intrauterine Devices, Medicated; D016912:Levonorgestrel / Q000627:therapeutic use*; D008875:Middle Aged; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000453:epidemiology*; D049168:Pregnancy, Unplanned; D016016:Proportional Hazards Models; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female; D016912:Levonorgestrel
keywords: Copper; EURAS IUD; Ectopic pregnancy; Intrauterine device (IUD); Levonorgestrel (LNG)