A 3-year multicentre randomized controlled trial of etonogestrel- and levonorgestrel-releasing contraceptive implants, with non-randomized matched copper-intrauterine device controls

Luis Bahamondes, Vivian Brache, Olav Meirik, Moazzam Ali, Ndema Habib, Sihem Landoulsi, Luis M Valeria Bahamondes, Rebeca Massai, Juan Carlos Montero, Claudio Villarroel, Laszlo Kovacs, Attila Pal, Sandor Koloszar, Marta Tooth, Kiriwat Orawan, Ayse Akin, Nüket Paksoy Erbaydar, Türküler Erdost, Güldali Aybaş, Sinan BeksacBerna Dilbaz, Ali Haberal, Cuma Kurttekin, Emine Giray, Hale Aktün, Leyla Mollamahmutoglu, Erdoʇan Tümay, Ayşe Evran, Jonathan Kasule, Tsungai Chipato, Johannes Schmidt, Tim Farley, Kelly Culwell, Emily Jackson, Gilda Piaggio, Catherine Hazelden, Ndema Abu Habib, Antonio Lucio Fersurella, Markus Steiner, David Hubacher, Ninky Acevedo, Joy Coker, Orawan Kijkuarn, Daniel Wojdyla, Liana Campodonico, Fernando Burgueno, Alain Pinol, L. Bahamondes, M. Ali, N. Abu Habib, S. Landoulsi

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

STUDY QUESTION Is there any difference in the clinical performance of the 3-year one-rod etonogestrel (ENG)- and the 5-year two-rod levonorgestrel (LNG)-releasing contraceptive implants during 3 years of insertion, and between implant and intrauterine device (IUD) contraception, in particular complaints possibly related to hormonal contraceptives? SUMMARY ANSWER The cumulative contraceptive effectiveness after 3 years and method continuation through 2.5 years were not significantly different between ENG and LNG implants, but both outcomes were significantly worse in the non-randomized age-matched group of IUD users than in the combined implant group. WHAT IS KNOWN ALREADY ENG- and LNG-releasing implants are safe and highly efficacious contraceptives with pregnancy rates reported to be 0.0-0.5 per 100 women-years (W-Y). No head-to-head comparative study of the two implants has been undertaken, and little information is available on comparisons of complaints of side effects of implant and copper IUD users. STUDY DESIGN, SIZE, DURATION This was an open parallel group RCT with 1:1 allocation ratio of the ENG and the LNG implants with non-randomized control group of women choosing TCu380A IUD to address lack of reliable data on common side effects typically attributed to the use of progestogen-only contraceptives. After device(s) placement, follow-ups were at 2 weeks, 3 and 6 months, and semi-annually thereafter for 3 years or until pregnancy, removal or expulsion of the implant/IUD occurred. PARTICIPANTS, SETTING, METHODS The study took place in family planning clinics in Brazil, Chile, Dominican Republic, Hungary, Thailand, Turkey and Zimbabwe. Women seeking long-term contraception were enlisted after an eligibility check and informed consent, and 2982 women were enrolled: 1003, 1005 and 974 in the ENG-implant, LNG-implant and IUD groups, respectively; 995, 997 and 971, respectively, were included in the per protocol analysis reported here. MAIN RESULTS AND THE ROLE OF CHANCE ENG and LNG implants each had the same 3-year cumulative pregnancy rate of 0.4 per 100 W-Y [95% confidence interval (CI) 0.1-1.4]. A weight of >70 kg at admission was unrelated to pregnancy. Method continuation rates for ENG and LNG implants at 2.5 years were 69.8 (95% CI 66.8-72.6) and 71.8 per 100 W-Y (68.8-74.5), and at 3 years 12.1 (95% CI 5.2-22.0) and 52.0 per 100 W-Y (95% CI 41.8-61.2), respectively. Bleeding disturbances, the most frequent reason for method discontinuation, were significantly more common in the ENG group [16.7 (95% CI 14.4-19.3)] than in the LNG group [12.5 (95% CI 10.5-14.9)] (P 0.019). The 3-year cumulative loss to follow-up was lower in the ENG- than in the LNG-implant group, 8.1 (95% CI 6.4-10.2) and 14.4 per 100 W-Y (95% CI 12.1-17.1), respectively. The median duration of implant removal was 50 s shorter among women with ENG than among women with LNG implant (P <0.0001). In the observational comparison between IUD and implant users, the 3-year relative risk for pregnancy in IUD group compared with the combined implant group was 5.7 per 100 W-Y (95% CI 4.4-7.3) (P = 0.0003). The 3-year expulsion rate of the IUD was 17.8 per 100 W-Y (95% CI 14.5-21.9), while the discontinuation rate for bleeding disturbances was 8.5 (95% CI 6.7-10.9). Frequency of complaints of headache and dizziness was not significantly different between implant and IUD users (P = 0.16 and 0.77, respectively), acne and bleeding irregularities were more frequent among implant users (P <0.0001), while heavy bleeding and lower abdominal pain occurred more often among IUD than implant users (P <0.0001). LIMITATIONS, REASONS FOR CAUTION Few women were ≤19 years old or nulligravida, the proportion of implant users >70 kg was

Original languageEnglish (US)
Pages (from-to)2527-2538
Number of pages12
JournalHuman Reproduction
Volume30
Issue number11
DOIs
StatePublished - May 26 2015
Externally publishedYes

Fingerprint

Copper Intrauterine Devices
Levonorgestrel
Contraceptive Agents
Randomized Controlled Trials
Confidence Intervals
Intrauterine Devices
Pregnancy Rate
Contraception
Intrauterine Device Expulsion
Dominican Republic
etonogestrel
Zimbabwe
Pregnancy
Hungary
Chile
Family Planning Services
Progestins
Thailand
Turkey
Informed Consent

Keywords

  • contraception
  • etonogestrel
  • implanon
  • implants
  • Jadelle
  • levonorgestrel
  • randomized clinical trial
  • TCu380A IUD

ASJC Scopus subject areas

  • Rehabilitation
  • Obstetrics and Gynecology
  • Reproductive Medicine

Cite this

A 3-year multicentre randomized controlled trial of etonogestrel- and levonorgestrel-releasing contraceptive implants, with non-randomized matched copper-intrauterine device controls. / Bahamondes, Luis; Brache, Vivian; Meirik, Olav; Ali, Moazzam; Habib, Ndema; Landoulsi, Sihem; Bahamondes, Luis M Valeria; Massai, Rebeca; Montero, Juan Carlos; Villarroel, Claudio; Kovacs, Laszlo; Pal, Attila; Koloszar, Sandor; Tooth, Marta; Orawan, Kiriwat; Akin, Ayse; Erbaydar, Nüket Paksoy; Erdost, Türküler; Aybaş, Güldali; Beksac, Sinan; Dilbaz, Berna; Haberal, Ali; Kurttekin, Cuma; Giray, Emine; Aktün, Hale; Mollamahmutoglu, Leyla; Tümay, Erdoʇan; Evran, Ayşe; Kasule, Jonathan; Chipato, Tsungai; Schmidt, Johannes; Farley, Tim; Culwell, Kelly; Jackson, Emily; Piaggio, Gilda; Hazelden, Catherine; Habib, Ndema Abu; Fersurella, Antonio Lucio; Steiner, Markus; Hubacher, David; Acevedo, Ninky; Coker, Joy; Kijkuarn, Orawan; Wojdyla, Daniel; Campodonico, Liana; Burgueno, Fernando; Pinol, Alain; Bahamondes, L.; Ali, M.; Habib, N. Abu; Landoulsi, S.

In: Human Reproduction, Vol. 30, No. 11, 26.05.2015, p. 2527-2538.

Research output: Contribution to journalArticle

Bahamondes, L, Brache, V, Meirik, O, Ali, M, Habib, N, Landoulsi, S, Bahamondes, LMV, Massai, R, Montero, JC, Villarroel, C, Kovacs, L, Pal, A, Koloszar, S, Tooth, M, Orawan, K, Akin, A, Erbaydar, NP, Erdost, T, Aybaş, G, Beksac, S, Dilbaz, B, Haberal, A, Kurttekin, C, Giray, E, Aktün, H, Mollamahmutoglu, L, Tümay, E, Evran, A, Kasule, J, Chipato, T, Schmidt, J, Farley, T, Culwell, K, Jackson, E, Piaggio, G, Hazelden, C, Habib, NA, Fersurella, AL, Steiner, M, Hubacher, D, Acevedo, N, Coker, J, Kijkuarn, O, Wojdyla, D, Campodonico, L, Burgueno, F, Pinol, A, Bahamondes, L, Ali, M, Habib, NA & Landoulsi, S 2015, 'A 3-year multicentre randomized controlled trial of etonogestrel- and levonorgestrel-releasing contraceptive implants, with non-randomized matched copper-intrauterine device controls', Human Reproduction, vol. 30, no. 11, pp. 2527-2538. https://doi.org/10.1093/humrep/dev221
Bahamondes, Luis ; Brache, Vivian ; Meirik, Olav ; Ali, Moazzam ; Habib, Ndema ; Landoulsi, Sihem ; Bahamondes, Luis M Valeria ; Massai, Rebeca ; Montero, Juan Carlos ; Villarroel, Claudio ; Kovacs, Laszlo ; Pal, Attila ; Koloszar, Sandor ; Tooth, Marta ; Orawan, Kiriwat ; Akin, Ayse ; Erbaydar, Nüket Paksoy ; Erdost, Türküler ; Aybaş, Güldali ; Beksac, Sinan ; Dilbaz, Berna ; Haberal, Ali ; Kurttekin, Cuma ; Giray, Emine ; Aktün, Hale ; Mollamahmutoglu, Leyla ; Tümay, Erdoʇan ; Evran, Ayşe ; Kasule, Jonathan ; Chipato, Tsungai ; Schmidt, Johannes ; Farley, Tim ; Culwell, Kelly ; Jackson, Emily ; Piaggio, Gilda ; Hazelden, Catherine ; Habib, Ndema Abu ; Fersurella, Antonio Lucio ; Steiner, Markus ; Hubacher, David ; Acevedo, Ninky ; Coker, Joy ; Kijkuarn, Orawan ; Wojdyla, Daniel ; Campodonico, Liana ; Burgueno, Fernando ; Pinol, Alain ; Bahamondes, L. ; Ali, M. ; Habib, N. Abu ; Landoulsi, S. / A 3-year multicentre randomized controlled trial of etonogestrel- and levonorgestrel-releasing contraceptive implants, with non-randomized matched copper-intrauterine device controls. In: Human Reproduction. 2015 ; Vol. 30, No. 11. pp. 2527-2538.
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abstract = "STUDY QUESTION Is there any difference in the clinical performance of the 3-year one-rod etonogestrel (ENG)- and the 5-year two-rod levonorgestrel (LNG)-releasing contraceptive implants during 3 years of insertion, and between implant and intrauterine device (IUD) contraception, in particular complaints possibly related to hormonal contraceptives? SUMMARY ANSWER The cumulative contraceptive effectiveness after 3 years and method continuation through 2.5 years were not significantly different between ENG and LNG implants, but both outcomes were significantly worse in the non-randomized age-matched group of IUD users than in the combined implant group. WHAT IS KNOWN ALREADY ENG- and LNG-releasing implants are safe and highly efficacious contraceptives with pregnancy rates reported to be 0.0-0.5 per 100 women-years (W-Y). No head-to-head comparative study of the two implants has been undertaken, and little information is available on comparisons of complaints of side effects of implant and copper IUD users. STUDY DESIGN, SIZE, DURATION This was an open parallel group RCT with 1:1 allocation ratio of the ENG and the LNG implants with non-randomized control group of women choosing TCu380A IUD to address lack of reliable data on common side effects typically attributed to the use of progestogen-only contraceptives. After device(s) placement, follow-ups were at 2 weeks, 3 and 6 months, and semi-annually thereafter for 3 years or until pregnancy, removal or expulsion of the implant/IUD occurred. PARTICIPANTS, SETTING, METHODS The study took place in family planning clinics in Brazil, Chile, Dominican Republic, Hungary, Thailand, Turkey and Zimbabwe. Women seeking long-term contraception were enlisted after an eligibility check and informed consent, and 2982 women were enrolled: 1003, 1005 and 974 in the ENG-implant, LNG-implant and IUD groups, respectively; 995, 997 and 971, respectively, were included in the per protocol analysis reported here. MAIN RESULTS AND THE ROLE OF CHANCE ENG and LNG implants each had the same 3-year cumulative pregnancy rate of 0.4 per 100 W-Y [95{\%} confidence interval (CI) 0.1-1.4]. A weight of >70 kg at admission was unrelated to pregnancy. Method continuation rates for ENG and LNG implants at 2.5 years were 69.8 (95{\%} CI 66.8-72.6) and 71.8 per 100 W-Y (68.8-74.5), and at 3 years 12.1 (95{\%} CI 5.2-22.0) and 52.0 per 100 W-Y (95{\%} CI 41.8-61.2), respectively. Bleeding disturbances, the most frequent reason for method discontinuation, were significantly more common in the ENG group [16.7 (95{\%} CI 14.4-19.3)] than in the LNG group [12.5 (95{\%} CI 10.5-14.9)] (P 0.019). The 3-year cumulative loss to follow-up was lower in the ENG- than in the LNG-implant group, 8.1 (95{\%} CI 6.4-10.2) and 14.4 per 100 W-Y (95{\%} CI 12.1-17.1), respectively. The median duration of implant removal was 50 s shorter among women with ENG than among women with LNG implant (P <0.0001). In the observational comparison between IUD and implant users, the 3-year relative risk for pregnancy in IUD group compared with the combined implant group was 5.7 per 100 W-Y (95{\%} CI 4.4-7.3) (P = 0.0003). The 3-year expulsion rate of the IUD was 17.8 per 100 W-Y (95{\%} CI 14.5-21.9), while the discontinuation rate for bleeding disturbances was 8.5 (95{\%} CI 6.7-10.9). Frequency of complaints of headache and dizziness was not significantly different between implant and IUD users (P = 0.16 and 0.77, respectively), acne and bleeding irregularities were more frequent among implant users (P <0.0001), while heavy bleeding and lower abdominal pain occurred more often among IUD than implant users (P <0.0001). LIMITATIONS, REASONS FOR CAUTION Few women were ≤19 years old or nulligravida, the proportion of implant users >70 kg was",
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author = "Luis Bahamondes and Vivian Brache and Olav Meirik and Moazzam Ali and Ndema Habib and Sihem Landoulsi and Bahamondes, {Luis M Valeria} and Rebeca Massai and Montero, {Juan Carlos} and Claudio Villarroel and Laszlo Kovacs and Attila Pal and Sandor Koloszar and Marta Tooth and Kiriwat Orawan and Ayse Akin and Erbaydar, {N{\"u}ket Paksoy} and T{\"u}rk{\"u}ler Erdost and G{\"u}ldali Aybaş and Sinan Beksac and Berna Dilbaz and Ali Haberal and Cuma Kurttekin and Emine Giray and Hale Akt{\"u}n and Leyla Mollamahmutoglu and Erdoʇan T{\"u}may and Ayşe Evran and Jonathan Kasule and Tsungai Chipato and Johannes Schmidt and Tim Farley and Kelly Culwell and Emily Jackson and Gilda Piaggio and Catherine Hazelden and Habib, {Ndema Abu} and Fersurella, {Antonio Lucio} and Markus Steiner and David Hubacher and Ninky Acevedo and Joy Coker and Orawan Kijkuarn and Daniel Wojdyla and Liana Campodonico and Fernando Burgueno and Alain Pinol and L. Bahamondes and M. Ali and Habib, {N. Abu} and S. Landoulsi",
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month = "5",
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doi = "10.1093/humrep/dev221",
language = "English (US)",
volume = "30",
pages = "2527--2538",
journal = "Human Reproduction",
issn = "0268-1161",
publisher = "Oxford University Press",
number = "11",

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TY - JOUR

T1 - A 3-year multicentre randomized controlled trial of etonogestrel- and levonorgestrel-releasing contraceptive implants, with non-randomized matched copper-intrauterine device controls

AU - Bahamondes, Luis

AU - Brache, Vivian

AU - Meirik, Olav

AU - Ali, Moazzam

AU - Habib, Ndema

AU - Landoulsi, Sihem

AU - Bahamondes, Luis M Valeria

AU - Massai, Rebeca

AU - Montero, Juan Carlos

AU - Villarroel, Claudio

AU - Kovacs, Laszlo

AU - Pal, Attila

AU - Koloszar, Sandor

AU - Tooth, Marta

AU - Orawan, Kiriwat

AU - Akin, Ayse

AU - Erbaydar, Nüket Paksoy

AU - Erdost, Türküler

AU - Aybaş, Güldali

AU - Beksac, Sinan

AU - Dilbaz, Berna

AU - Haberal, Ali

AU - Kurttekin, Cuma

AU - Giray, Emine

AU - Aktün, Hale

AU - Mollamahmutoglu, Leyla

AU - Tümay, Erdoʇan

AU - Evran, Ayşe

AU - Kasule, Jonathan

AU - Chipato, Tsungai

AU - Schmidt, Johannes

AU - Farley, Tim

AU - Culwell, Kelly

AU - Jackson, Emily

AU - Piaggio, Gilda

AU - Hazelden, Catherine

AU - Habib, Ndema Abu

AU - Fersurella, Antonio Lucio

AU - Steiner, Markus

AU - Hubacher, David

AU - Acevedo, Ninky

AU - Coker, Joy

AU - Kijkuarn, Orawan

AU - Wojdyla, Daniel

AU - Campodonico, Liana

AU - Burgueno, Fernando

AU - Pinol, Alain

AU - Bahamondes, L.

AU - Ali, M.

AU - Habib, N. Abu

AU - Landoulsi, S.

PY - 2015/5/26

Y1 - 2015/5/26

N2 - STUDY QUESTION Is there any difference in the clinical performance of the 3-year one-rod etonogestrel (ENG)- and the 5-year two-rod levonorgestrel (LNG)-releasing contraceptive implants during 3 years of insertion, and between implant and intrauterine device (IUD) contraception, in particular complaints possibly related to hormonal contraceptives? SUMMARY ANSWER The cumulative contraceptive effectiveness after 3 years and method continuation through 2.5 years were not significantly different between ENG and LNG implants, but both outcomes were significantly worse in the non-randomized age-matched group of IUD users than in the combined implant group. WHAT IS KNOWN ALREADY ENG- and LNG-releasing implants are safe and highly efficacious contraceptives with pregnancy rates reported to be 0.0-0.5 per 100 women-years (W-Y). No head-to-head comparative study of the two implants has been undertaken, and little information is available on comparisons of complaints of side effects of implant and copper IUD users. STUDY DESIGN, SIZE, DURATION This was an open parallel group RCT with 1:1 allocation ratio of the ENG and the LNG implants with non-randomized control group of women choosing TCu380A IUD to address lack of reliable data on common side effects typically attributed to the use of progestogen-only contraceptives. After device(s) placement, follow-ups were at 2 weeks, 3 and 6 months, and semi-annually thereafter for 3 years or until pregnancy, removal or expulsion of the implant/IUD occurred. PARTICIPANTS, SETTING, METHODS The study took place in family planning clinics in Brazil, Chile, Dominican Republic, Hungary, Thailand, Turkey and Zimbabwe. Women seeking long-term contraception were enlisted after an eligibility check and informed consent, and 2982 women were enrolled: 1003, 1005 and 974 in the ENG-implant, LNG-implant and IUD groups, respectively; 995, 997 and 971, respectively, were included in the per protocol analysis reported here. MAIN RESULTS AND THE ROLE OF CHANCE ENG and LNG implants each had the same 3-year cumulative pregnancy rate of 0.4 per 100 W-Y [95% confidence interval (CI) 0.1-1.4]. A weight of >70 kg at admission was unrelated to pregnancy. Method continuation rates for ENG and LNG implants at 2.5 years were 69.8 (95% CI 66.8-72.6) and 71.8 per 100 W-Y (68.8-74.5), and at 3 years 12.1 (95% CI 5.2-22.0) and 52.0 per 100 W-Y (95% CI 41.8-61.2), respectively. Bleeding disturbances, the most frequent reason for method discontinuation, were significantly more common in the ENG group [16.7 (95% CI 14.4-19.3)] than in the LNG group [12.5 (95% CI 10.5-14.9)] (P 0.019). The 3-year cumulative loss to follow-up was lower in the ENG- than in the LNG-implant group, 8.1 (95% CI 6.4-10.2) and 14.4 per 100 W-Y (95% CI 12.1-17.1), respectively. The median duration of implant removal was 50 s shorter among women with ENG than among women with LNG implant (P <0.0001). In the observational comparison between IUD and implant users, the 3-year relative risk for pregnancy in IUD group compared with the combined implant group was 5.7 per 100 W-Y (95% CI 4.4-7.3) (P = 0.0003). The 3-year expulsion rate of the IUD was 17.8 per 100 W-Y (95% CI 14.5-21.9), while the discontinuation rate for bleeding disturbances was 8.5 (95% CI 6.7-10.9). Frequency of complaints of headache and dizziness was not significantly different between implant and IUD users (P = 0.16 and 0.77, respectively), acne and bleeding irregularities were more frequent among implant users (P <0.0001), while heavy bleeding and lower abdominal pain occurred more often among IUD than implant users (P <0.0001). LIMITATIONS, REASONS FOR CAUTION Few women were ≤19 years old or nulligravida, the proportion of implant users >70 kg was

AB - STUDY QUESTION Is there any difference in the clinical performance of the 3-year one-rod etonogestrel (ENG)- and the 5-year two-rod levonorgestrel (LNG)-releasing contraceptive implants during 3 years of insertion, and between implant and intrauterine device (IUD) contraception, in particular complaints possibly related to hormonal contraceptives? SUMMARY ANSWER The cumulative contraceptive effectiveness after 3 years and method continuation through 2.5 years were not significantly different between ENG and LNG implants, but both outcomes were significantly worse in the non-randomized age-matched group of IUD users than in the combined implant group. WHAT IS KNOWN ALREADY ENG- and LNG-releasing implants are safe and highly efficacious contraceptives with pregnancy rates reported to be 0.0-0.5 per 100 women-years (W-Y). No head-to-head comparative study of the two implants has been undertaken, and little information is available on comparisons of complaints of side effects of implant and copper IUD users. STUDY DESIGN, SIZE, DURATION This was an open parallel group RCT with 1:1 allocation ratio of the ENG and the LNG implants with non-randomized control group of women choosing TCu380A IUD to address lack of reliable data on common side effects typically attributed to the use of progestogen-only contraceptives. After device(s) placement, follow-ups were at 2 weeks, 3 and 6 months, and semi-annually thereafter for 3 years or until pregnancy, removal or expulsion of the implant/IUD occurred. PARTICIPANTS, SETTING, METHODS The study took place in family planning clinics in Brazil, Chile, Dominican Republic, Hungary, Thailand, Turkey and Zimbabwe. Women seeking long-term contraception were enlisted after an eligibility check and informed consent, and 2982 women were enrolled: 1003, 1005 and 974 in the ENG-implant, LNG-implant and IUD groups, respectively; 995, 997 and 971, respectively, were included in the per protocol analysis reported here. MAIN RESULTS AND THE ROLE OF CHANCE ENG and LNG implants each had the same 3-year cumulative pregnancy rate of 0.4 per 100 W-Y [95% confidence interval (CI) 0.1-1.4]. A weight of >70 kg at admission was unrelated to pregnancy. Method continuation rates for ENG and LNG implants at 2.5 years were 69.8 (95% CI 66.8-72.6) and 71.8 per 100 W-Y (68.8-74.5), and at 3 years 12.1 (95% CI 5.2-22.0) and 52.0 per 100 W-Y (95% CI 41.8-61.2), respectively. Bleeding disturbances, the most frequent reason for method discontinuation, were significantly more common in the ENG group [16.7 (95% CI 14.4-19.3)] than in the LNG group [12.5 (95% CI 10.5-14.9)] (P 0.019). The 3-year cumulative loss to follow-up was lower in the ENG- than in the LNG-implant group, 8.1 (95% CI 6.4-10.2) and 14.4 per 100 W-Y (95% CI 12.1-17.1), respectively. The median duration of implant removal was 50 s shorter among women with ENG than among women with LNG implant (P <0.0001). In the observational comparison between IUD and implant users, the 3-year relative risk for pregnancy in IUD group compared with the combined implant group was 5.7 per 100 W-Y (95% CI 4.4-7.3) (P = 0.0003). The 3-year expulsion rate of the IUD was 17.8 per 100 W-Y (95% CI 14.5-21.9), while the discontinuation rate for bleeding disturbances was 8.5 (95% CI 6.7-10.9). Frequency of complaints of headache and dizziness was not significantly different between implant and IUD users (P = 0.16 and 0.77, respectively), acne and bleeding irregularities were more frequent among implant users (P <0.0001), while heavy bleeding and lower abdominal pain occurred more often among IUD than implant users (P <0.0001). LIMITATIONS, REASONS FOR CAUTION Few women were ≤19 years old or nulligravida, the proportion of implant users >70 kg was

KW - contraception

KW - etonogestrel

KW - implanon

KW - implants

KW - Jadelle

KW - levonorgestrel

KW - randomized clinical trial

KW - TCu380A IUD

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UR - http://www.scopus.com/inward/citedby.url?scp=84946401503&partnerID=8YFLogxK

U2 - 10.1093/humrep/dev221

DO - 10.1093/humrep/dev221

M3 - Article

C2 - 26409014

AN - SCOPUS:84946401503

VL - 30

SP - 2527

EP - 2538

JO - Human Reproduction

JF - Human Reproduction

SN - 0268-1161

IS - 11

ER -