P037 Why do women discontinue long acting reversible methods of contraception? – findings from an integrated sexual health clinic

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IntroductionLong acting methods of contraception, namely the progestogen only implant and the intra-uterine devices are reliable methods of contraception, favoured by commissioners of integrated sexual health. However in practice, a number of women discontinue these for a variety of reasons thus leading to reduced cost effectiveness. We aimed to determine the number of discontinuations among those who had them fitted in the integrated sexual health clinic and the reasons for doing so.MethodsRetrospective analysis of the case notes on the electronic database for all women who had an implant, copper intra-uterine device or the Mirena intra-uterine device during September 2014 was collected. Reasons noted by the clinician for removing the device and any adjuvant therapy that was prescribed was noted.ResultsA total of 183 women had one of the three methods fitted during this period. Of these 36% had them removed after a median of 2.16 years. Of those who had the implant fitted, 49% had them removed after a median of 1.84 years. Vaginal bleeding was quoted as the reason for removal in 51% of the women. Of the 25% of the women who had the Mirena IUD removed, vaginal bleeding was the reason in 44%. Variety of reasons were noted among the 36% of women who had copper IUD fitted.DiscussionOur findings has shown that vaginal bleeding was the predominant reason for discontinuation for the implant and Mirena IUD. This has shown that appropriate management of irregular vaginal bleeding may lead to longer retention of long acting methods of contraception.

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