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Reasons patients decide to replace or extend their long-acting reversible contraceptive before the full duration of
Francesca E Selmoni1, Anjali Krishnan1, Maya Pai2
1Division of Complex Family Planning, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, 9300 Campus Point Drive, Mail Code 7433, La Jolla, San Diego, CA 92037, United States.
Objectives:
To describe patients' decisions to replace or extend use of their 52 mg levonorgestrel (LNG) intrauterine device (IUD) or their 68 mg etonogestrel (ENG) subdermal contraceptive implant beyond the five-year or three-year FDA-approved duration, respectively, through the full known duration of efficacy.
Study Design:
We recruited patients presenting for replacement of long-acting reversible contraceptive (LARC) from an obstetrics/gynecology academic clinic to participate in a semi-structured interview regarding their decision to replace or extend use of their LARC. The semi-structured interviews included questions to determine factors that impacted their decision to replace or continue the 52 mg LNG IUD or contraceptive 68 mg ENG implant at five years and three years respectively. We also asked about barriers accessing information regarding the longer duration of efficacy for pregnancy prevention.
Results:
We interviewed 30 participants with an average age of 32 (range 21-44). Three themes emerged: 1) Central role of information and trust in clinical guidance 2) Physical and experiential factors directly motivate decisions to replace or extend LARC use 3) Desire for more information to make an informed choice. Participants in this study replaced their LARC earlier than the full duration of pregnancy prevention due to changes in symptom and efficacy concerns. The main reasons for extended use of LARC were avoidance of pain with procedures and trust in the clinician.
Conclusions:
This study highlights the importance of communication improvements from health systems regarding the safety and efficacy of extended use of LARC which may allow patients to make more informed decisions regarding their duration of contraceptive use.
Implications:
Qualitative study examining patients' decisions to replace or extend use of their 52 mg LNG IUD or 68 mg ENG contraceptive implant beyond FDA-approved duration, highlighted the central role of trust in clinical guidance, physical and experiential factors motivate decisions, and desire for more information to make an informed choice.
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