title: User characteristics, experiences and continuation rates of copper intrauterine device use in a cohort of Australian women.
abstract: BACKGROUND
  Copper intrauterine device (Cu-IUD) use in Australia is low despite being a highly effective, cost effective non-hormonal contraceptive with reported 12-month continuation rates of 85% compared to 59% for oral contraception.
  
  
  OBJECTIVE
  To describe the characteristics of Cu-IUD users in the Australian context, their experiences of side effects, continuation rates and reasons for discontinuation.
  
  
  METHODS
  Between August 2009 and January 2012 we undertook a prospective cohort study of consecutive women presenting for Cu-IUD insertion to three family planning clinics in Queensland and New South Wales. We used survival analysis for continuation rates and univariate and multivariable analyses to characterise users, their experiences up to three years and reasons for discontinuation.
  
  
  RESULTS
  Of the 211 enrolled women, a third (36.0%) were aged under 30 and a third were nulliparous (36.5%). Efficacy and lack of hormones were the most frequently cited reasons to choose the method. Four women were lost to follow-up. Overall continuation rates were 79.1% at one year and 61.3% at three years. Early discontinuation was reduced in those with two or more children (adjusted hazards ratio 0.22, 95% CI 0.09-0.50). Heavy menstrual bleeding was the commonest reason for removal in 28 of 59 (47.5%) discontinuations due to complications or side effects. One uterine perforation and one method failure resulting in an ectopic pregnancy occurred.
  
  
  CONCLUSIONS
  Cu-IUDs were chosen for their efficacy and lack of hormones by a range of Australian women, including young and nulliparous women. While bleeding-related side effects were relatively common, overall continuation rates were high. Serious complications and failures were rare.
authors.affiliation: Family Planning NSW, Sydney, New South Wales, Australia.|Discipline of Obstetrics, Gynaecology and Neonatology, Central Clinical School, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Deborah
authors.initials: D
authors.lastname: Bateson
authors.affiliation: Family Planning Queensland (now called True Relationships and Reproductive Choice), Brisbane, Queensland, Australia.
authors.forename: Caroline
authors.initials: C
authors.lastname: Harvey
authors.affiliation: Family Planning NSW, Sydney, New South Wales, Australia.
authors.forename: Lieu
authors.initials: L
authors.lastname: Trinh
authors.affiliation: Family Planning NSW, Sydney, New South Wales, Australia.
authors.forename: Mary
authors.initials: M
authors.lastname: Stewart
authors.affiliation: Discipline of Obstetrics, Gynaecology and Neonatology, Central Clinical School, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Kirsten I
authors.initials: KI
authors.lastname: Black
mesh_terms: D000293:Adolescent; D000328:Adult; D002755:Choice Behavior; D003268:Contraception Behavior / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007435:Intrauterine Devices, Copper / Q000009:adverse effects / Q000706:statistics & numerical data*; D008595:Menorrhagia / Q000209:etiology; D008875:Middle Aged; D009517:New South Wales; D010298:Parity; D057240:Patient Preference; D017699:Pelvic Pain / Q000209:etiology; D011446:Prospective Studies; D011793:Queensland; D055815:Young Adult
keywords: bleeding; continuation rates; discontinuation; intrauterine devices