The levonorgestrel intrauterine system: cohort study to assess satisfaction in a postpartum population in Kenya

Contraception. 2015 Apr;91(4):295-300. doi: 10.1016/j.contraception.2015.01.009. Epub 2015 Jan 16.


Background: The levonorgestrel intrauterine system (LNG IUS) may become the next long-acting contraceptive to be introduced in public sector programs of resource-poor countries. Whereas service provision for subdermal implants and intrauterine devices is growing, little is known about how the LNG IUS might fit in.

Study design: We conducted a cohort study of 313 women in Kenya who were 6-12 weeks postpartum when they started using these methods: subdermal implant (205), LNG IUS (93), and copper intrauterine device (15). Participants returned for visits at 6 and 12 months to share information on bleeding patterns, side effects, satisfaction, and continued use of the products. We used Kaplan-Meier techniques to estimate method continuation rates and chi-square tests of association to identify differences in experiences with the methods.

Results: The 12-month continuation rate for the LNG IUS was 89.1 (95% confidence interval [CI] = 86.9-94.9) and statistically equivalent to that of the subdermal implant (91.8: 95% CI = 80.6-94.0). Nearly 87% of LNG IUS users were very satisfied with the method at 6 months compared to 75% of implant users; this gap closed somewhat at 12 months as satisfaction levels of implant users rose. At 12 months 78% of LNG IUS users felt that their bleeding pattern was highly acceptable compared with about 66% of implant users.

Conclusions: This study found that the LNG IUS compared favorably to the subdermal implant in terms of satisfaction levels and continued use. The LNG IUS will provide another long-acting option for postpartum women.

Implications: The LNG IUS may soon be purchased by international donor agencies for use in public sector programs in sub-Saharan Africa and other resource-poor countries. The results of this study suggest that the product will be successful in future introduction activities.

Keywords: Acceptability; Africa; Comparison; Continuation rates; Levonorgestrel intrauterine system; Long-acting reversible contraception.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Case-Control Studies
  • Cohort Studies
  • Contraceptive Agents, Female / therapeutic use*
  • Drug Implants
  • Female
  • Humans
  • Intrauterine Devices, Copper
  • Intrauterine Devices, Medicated*
  • Kenya
  • Levonorgestrel / therapeutic use*
  • Patient Acceptance of Health Care
  • Patient Satisfaction*
  • Postpartum Period
  • Prospective Studies
  • Young Adult


  • Contraceptive Agents, Female
  • Drug Implants
  • Levonorgestrel