Hemoglobin measurement prior to initiating copper intrauterine devices: a systematic review

U.S. Selected Practice Recommendations for Contraceptive Use, 2024

The 2024 U.S. Selected Practice Recommendations for Contraceptive Use (U.S. SPR) addresses a selected group of common, yet sometimes complex, issues regarding initiation and use of specific contraceptive methods. These recommendations for health care providers were updated by CDC after review of the scientific evidence and a meeting with national experts in Atlanta, Georgia, during January 25-27, 2023. The information in this report replaces the 2016 U.S. SPR (CDC. U.S. Selected Practice Recommendations for Contraceptive Use, 2016. MMWR 2016;65[No. RR-4]:1-66). Notable updates include 1) updated recommendations for provision of medications for intrauterine device placement, 2) updated recommendations for bleeding irregularities during implant use, 3) new recommendations for testosterone use and risk for pregnancy, and 4) new recommendations for self-administration of injectable contraception. The recommendations in this report are intended to serve as a source of evidence-based clinical practice guidance for health care providers. The goals of these recommendations are to remove unnecessary medical barriers to accessing and using contraception and to support the provision of person-centered contraceptive counseling and services in a noncoercive manner. Health care providers should always consider the individual clinical circumstances of each person seeking contraceptive services. This report is not intended to be a substitute for professional medical advice for individual patients; when needed, patients should seek advice from their health care providers about contraceptive use.

Bleeding profile and safety of a levonorgestrel 13.5 mg intrauterine device versus Nova T copper 380 mm2 intrauterine device: Results of a 3-year, single-center, randomized phase 4 study

OBJECTIVE

To assess the bleeding profiles of the levonorgestrel 13.5 mg intrauterine device (LNG13.5-IUD) and Nova T copper 380 mm2 IUD (Cu380-IUD).

STUDY DESIGN

Single-center, evaluator-masked, randomized study conducted in women aged 18-45 years starting these methods. Primary outcomes were number of bleeding days, self-reported bleeding intensity, Pictorial Blood Assessment Chart (PBAC) score, and blood biochemical values at baseline, months 3, 6, 12, 24, and 36 per 90-day reference periods except for PBAC (months). Secondary objectives were presence/duration/intensity of dysmenorrhea and tolerability.

RESULTS

We included 106 women aged 32.5 ± 6.7 years: 55 with LNG13.5-IUD and 51 with Cu380-IUD. Data for LNG13.5-IUD versus Cu380-IUD at baseline and month 36 (both respectively) were as follows: (1) median (25th; 75th percentile) number of bleeding days: 12 (9.0; 15.0) versus 12 (9.0; 15.0), p = 0.82, and 4 (0; 13.7) versus 15 (14.2; 20.0), p < 0.001; (2) mean bleeding intensity: 1.7 for both, p = 0.66, and 0.7 and 2.2, p < 0.001. Forty percent versus 0% presented with amenorrhea at month 36; (3) mean PBAC score (95% Confidence interval (CI): 50.7 (16.6; 84.7) versus 130.4 (95.7; 165.0) at month 1, and 7.9 (-26.7; 42.6) versus 126 (90.7; 161.2), p < 0.001; (4) median (25th; 75th percentile) ferritin levels (Ug/L) 33 (19; 53) versus 30 (19; 45), p = 0.70, and 59 (42; 84) versus 21 (8; 39). We did not observe changes or differences between groups in hemoglobin and hematocrit. The duration and intensity of dysmenorrhea were significantly lower with LNG13.5-IUD versus Cu380-IUD. Adverse events were those expected.

CONCLUSIONS

LNG13.5-IUD is associated with a significant reduction in blood loss and dysmenorrhea compared with Cu380-IUD.

IMPLICATIONS

Women eligible for a levonorgestrel 13.5 mg intrauterine device (IUD) or a copper 380 mm2 IUD should be informed of the differences in bleeding profiles-one of the main causes for IUD discontinuation-so they can compare this information against their bleeding expectations.

A non-inferiority analysis of hemoglobin levels in postpartum IUD users in Bangladesh

OBJECTIVE

The objective of this study was to compare postpartum hemoglobin (Hb) between postpartum intrauterine device (PPIUD) and non-PPIUD users.

METHODS

A sample of 3697 postpartum women (475 PPIUD users, 3222 non-PPIUD users) from 5 tertiary referral hospitals in Bangladesh were assessed at multiple time points between 6 weeks and 12 months postpartum. Non-inferiority linear regression analysis compared changes in Hb levels at 29-52 weeks postpartum between the two groups. Non-inferiority was declared if the lower 95% confidence interval of the estimated difference in Hb change since delivery between PPIUD and non-PPIUD users was greater than -0.05 g/dL.

RESULTS

At approximately 9 months postpartum, 276 women in the PPIUD group (58.1%) and 1086 women in the comparison group (33.7%) attended follow-up. In total, 57.9% of PPIUD users and 61.0% of non-PPIUD users had taken iron supplementation. Change in Hb was 0.02 g/dL (95% CI: -0.16, 0.19) higher in the PPIUD users than the comparison group. The lower limit of the 95% CI was greater than -0.05g/dl, providing good evidence that PPIUD users were non-inferior to the comparison group in their Hb levels.

CONCLUSION

In the presence of offering iron supplementation, and an uptake of just over 60%, no difference in anemia was observed between the PPIUD and control group.

Association between type of contraceptive use and haemoglobin status among women of reproductive age in 24 sub-Saharan Africa countries

BACKGROUND

Little is known whether contraceptive methods differentially modify women's risk of anaemia or not. We compared the haemoglobin status of women currently using different fertility regulation methods in sub-Saharan Africa (SSA) where anaemia is a major concern.

METHODS

We conducted the study based on the secondary data of 24 nationally representative demographic and health surveys carried out recently in SSA. The data of 105 532 women were included in the analysis. In the original surveys, respondents were selected using multistage sampling techniques and haemoglobin was determined using the HemoCue analyser. The association between method of contraception and anaemia status was determined via a mixed-effects logistic regression model adjusted for potential confounders. The outputs are presented using adjusted odds ratio (AOR) with 95% CI.

RESULTS

The mean (±SD deviation) haemoglobin was 12.3 (±1.7) g/dl and 36.7% of the women had anaemia. Current use of modern contraceptives, as compared with non-use, was associated with a 25% reduction (AOR=0.75 (95% CI: 0.73 to 0.78)) in the odds of anaemia. Comparison among individual modern methods showed, as compared with current barrier methods users, use of injectables (AOR=0.62 (95% CI: 0.57 to 0.67)), oral contraceptive pills (OCP) (AOR=0.62 (95% CI: 0.57 to 0.66)) and implants (AOR=0.63 (95% CI: 0.58 to 0.70)) were significantly associated with reduced odds of anaemia. With reference to women with less than 12 months of use, the odds were significantly reduced by about a quarter among women with more than 12 months of OCP or injectables use.

CONCLUSION

The use of hormonal contraceptives is associated with lower odds of anaemia.