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Long-acting reversible contraceptive use in women with medical comorbidities

Lucy Fu, BS, MD Candidate, Emory University School of Medicine

Project abstract

Unintended pregnancy remains a public health problem in the United States, though most could be prevented by effective contraceptive use. There are a host of reasons for contraceptive failure including user error and decreased access. For women with underlying medical conditions, the contraceptive options are further narrowed due to the comorbidity associated with traditional estrogen-progestin hormone contraceptives.

Long-acting reversible contraceptive (LARC) methods (progestin IUD, copper IUD, and progestin implant) have shown a superior continuation rate (77%) compared with that of traditional non-LARC methods (41%). LARCs also boast a safer profile, which potentially makes them an effective option for preventing unintended pregnancy in women with medical comorbidities.

Since 2008, Emory University has received a grant to provide LARC methods to high-risk patients with decreased access to birth control. We have placed LARCs in over 4000 patients and collected baseline data according to grant-reporting requirements.

The first phase of our study will characterize all patients who received LARCs. The second phase will be a retrospective cohort study of a randomly selected subset of patients. We will review patient charts for existing medical comorbidities to traditional non-LARC methods and compare the continuation rates of LARC methods in these women with continuation rates in women without such comorbidities. If LARC method was discontinued, we will search for the reason for discontinuation (e.g. method failure, complications, side-effects, expulsion, patient request, etc.).

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