A three-year comparative study of continuation rates, bleeding patterns and satisfaction in Australian women using a subdermal contraceptive implant or progestogen releasing-intrauterine system

Eur J Contracept Reprod Health Care. 2014 Feb;19(1):5-14. doi: 10.3109/13625187.2013.853034. Epub 2013 Nov 14.


BACKGROUND Long-acting reversible contraceptive methods (LARCs) are safe, highly effective, readily reversible, and require no action on the part of the user following insertion. Early discontinuation may put women at increased risk of unintended pregnancy. METHODS Following insertion of a progestogen-only subdermal implant or intrauterine system (IUS) at Family Planning NSW, women 18 years and older completed a questionnaire about their choice. At 6 weeks, 6, 12, 24 and 36 months by telephone or online they completed a questionnaire about bleeding patterns, side effects, satisfaction, and reasons for discontinuation. RESULTS Two hundred IUS users and 149 implant users were enrolled. The former were generally older, married or in a de-facto relationship, and had children. Forty-seven percent of implant users discontinued within three years compared to 27% of IUS users (p = 0.002). In the first two years amenorrhoea was more frequent in implant users. Frequent bleeding/spotting was more prevalent in the first year of IUS use but over time was twice as prevalent in implant users. Infrequent bleeding/spotting was more common in IUS users. CONCLUSION Both devices are highly effective and acceptable cost-effective methods. While LARCs should be promoted to women of all ages seeking contraception, early discontinuation due to unacceptable bleeding highlights the need for pre-insertion counselling.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Age Factors
  • Amenorrhea / chemically induced*
  • Australia
  • Contraception / methods
  • Contraceptive Agents, Female / therapeutic use*
  • Desogestrel / therapeutic use*
  • Device Removal / statistics & numerical data
  • Drug Implants / therapeutic use*
  • Female
  • Humans
  • Intrauterine Devices, Medicated / statistics & numerical data*
  • Levonorgestrel / therapeutic use*
  • Logistic Models
  • Longitudinal Studies
  • Marital Status
  • Metrorrhagia / chemically induced*
  • Parity
  • Patient Satisfaction / statistics & numerical data*
  • Young Adult


  • Contraceptive Agents, Female
  • Drug Implants
  • etonogestrel
  • Levonorgestrel
  • Desogestrel