A Comparative Evaluation of Cut 380A Intrauterine Device Versus Depot Medroxyprogesterone Acetate For Long-Acting...

India's family-planning program increasingly emphasizes long-acting reversible contraceptives (LARCs) to curb unintended pregnancy. Copper T 380A (CuT 380A) intrauterine device (IUCD) and injectable depot medroxyprogesterone acetate (DMPA) are the two program-supported LARCs, yet granular comparative Indian data remain scarce.

We undertook a prospective longitudinal study (November 2016-March 2018) at Safdarjung Hospital, New Delhi. Women choosing CuT 380A or DMPA were enrolled consecutively and stratified by timing of initiation-postpartum, postabortion, or interval. Baseline demographics, adverse events, continuation, discontinuation, expulsion, and pregnancy were recorded at 1, 3, 6, 9, and 12 months. Comparative statistics employed χ² or t-tests; P < 0.05 was significant.

A total of 162 women were analysed (81 per group), with a mean age of approximately 28 years. Baseline characteristics were comparable between groups. At 12 months, continuation was significantly higher with CuT 380A (74.0%) than DMPA (39.5%) (P < 0.001). Correspondingly, cumulative discontinuation was lower in the CuT 380A group (25.9%) compared with the DMPA group (53.0%). Expulsions occurred only in the CuT 380A group (7.4%). Bleeding disturbances were the most common adverse effect in both groups (CuT 380A 17.2%, DMPA 23.4%). Amenorrhoea increased progressively among DMPA users, reaching 29.6% at 12 months. Other adverse events were uncommon. Four pregnancies (4.9%) occurred in the CuT 380A group (two with the device in situ and two following partial expulsion), while no pregnancies were reported in the DMPA group. Overall satisfaction was significantly higher with CuT 380A (76.5% vs 46.9%, p < 0.001).

Both LARCs were safe and highly effective; however, CuT 380A demonstrated superior 12-month continuation and satisfaction, whereas DMPA exhibited a higher drop-out largely driven by bleeding changes and desire for pregnancy. High-quality counselling on anticipated bleeding patterns could further optimize DMPA continuation.