(269) Use of Intra-Uterine Devices in France in 2019 and Continuation Use 1 Year After: A Nationwide Observational Study

Publication Number: 943

Background: Since the French “Pill Crisis” in 2012, a growing proportion of French women concerned with contraception are using Copper Intra-Uterine Devices (Cu-IUD) and Levonorgestrel Intra Uterine Systems (LNG-IUS). Cu-IUD is a first-line and an emergency contraception whereas LNG-IUS is a second-line contraception in France, recommended for some gynecological indications (endometriosis, heavy menstrual bleeding). The two types of devices have never been studied separately or in real-life conditions in a nationwide cohort.

Objectives: To assess the profile of Cu-IUD and LNG-IUS users analyzing the association between the choice of type of device in 2019 in France and users characteristics, and to assess the rates of continuation one year after.

Methods: We conducted a national register-based study using data from the French National Health Insurance database (SNDS). This database provides anonymous detailed information on health insurance claims for 99% of the population living in France. We included all French women aged 13-49 years old who got an intra-uterine contraceptive dispensation in 2019. We collected information about sociodemographic characteristics and medical and gynecological history of women at the time of the device dispensation, and indicators of utilization one year after. Logistic regression was then performed to study the association between Cu-IUD/LNG-IUS dispensation and women’s characteristics in a multivariate model using stepwise regression (selection criterion p < 0.05).

Results: A total of 477,705 Cu-IUDs (user’s mean age: 32.5 years [±7.3]) and 355,242 LNG-IUS (mean age: 36.4 [±7.7]) had been dispensed in 2019. After adjustment, having a LNG-IUS dispensation rather than a Cu-IUD dispensation is associated with being aged between 35 and 44 years compared to be aged 25-35 (adjusted Odd Ratio: aOR35-44=2.03[2.01-2.05]), being older than 45 years compared to be aged 25-35 (aOR≥45=3.92[3.85-4.00]), a gynecologist’s prescription (OR=1.10 [1.08-1.11]), living in an area with the most deprived social index (aOR=1.29 [1.27-1.31]) and having a gynecological history (endometriosis, heavy menstrual bleeding, myoma/polyp) (aOR=2.34 [2.26-2.42]). The 1-year continuation rate of LNG-IUS and Cu-IUD was respectively 85.7% and 86.4%. Cu-IUD dispensation was associated with a higher chance of being still a device user one year after.

Conclusions: The choice of having a LNG-IUS or a Cu-IUD dispensation seems to correspond to two different patterns of French women. This study highlights the necessity of analyzing Cu-IUD and LNG-IUS separately to assess the users’ specific behaviors. High estimated continuation rates for both IUDs has been assessed in 2019 using a national database.