Influences on women's choice of the levonorgestrel-releasing intrauterine system.

the levonorgestrel-releasing intrauterine system We write to report a recent European survey of factors that motivate women to use or reject the levonorgestrel-releasing intrauterine system (LNG-IUS). The survey comprised focus group sessions to identify barriers that prevent women using the LNG-IUS and individual interviews with current users to identify their reasons for having chosen the LNG-IUS. A total of 297 women from France, Germany, Italy, Poland, Russia, Spain and Turkey were included in Part One of the survey. Two-hour discussion sessions based on a prepared list of topics identifying barriers to using the LNG-IUS were held with groups of six to eight randomly selected eligible volunteers aged 17–45 years (≥18 years in Poland). Participants were currently using a form of contraception other than the LNGIUS and were categorised as (1) nulliparous, but possibly desiring children in the future; (2) parous, planning more children in the future or uncertain; or (3) parous, with no plans for further children. Women who were not prepared to consider using hormonal contraception under any circumstances were excluded. Part Two of the survey comprised individual interviews with 72 current users of the LNG-IUS in France, Germany, Italy, Poland and Spain, using prepared questions to identify their opinions of, and reasons for choosing, this form of contraception Participants were offered a small monetary incentive, in line with local guidelines. Both the focus group sessions and the interviews were open-ended and explored participants’ current and past methods of contraception; reasons for their choices; sources of information, attitudes and knowledge regarding the LNG-IUS; and reasons for choosing or rejecting the LNG-IUS. Verbatim transcripts from the group sessions and interviews were analysed using accepted methodology1 and studied to identify key words and ideas, which were subsequently grouped into a series of themes. In Part One of the survey, two focus group sessions in each country were conducted for each participant category. There were few differences between countries in terms of the most commonly used forms of contraception (oral contraceptives and condoms). The exception to this was Turkey, where the copper IUD predominates. Greater differences were seen between participant categories, reflecting the individual needs of each group. For example, ability to become pregnant soon after the LNGIUS removal was unimportant to those who had completed their families. Factors influencing the potential use of the LNG-IUS that emerged from the focus group discussions are shown in Table 1. The prime concern of participants from Italy, Poland, Russia, Spain and Turkey was the cessation of menstruation, which is known to occur in approximately 20% of LNG-IUS users. These concerns were often found to be based on misinformation (from website chat rooms or personal communications) rather than on advice from doctors. In Part Two of the survey, 72 current LNGIUS users participated in 1-hour interviews. Reasons for having switched to the LNG-IUS included reduced risk of unintended pregnancy, family planning after the birth of a child, tolerability and compliance issues with oral contraceptive pills, or inconvenience of barrier methods. All women had sought advice from their gynaecologist or general practitioner before deciding to use the LNG-IUS but had consulted more easily accessible (although not necessarily accurate) sources of information first, such as friends or the Internet. The chief reasons for having chosen the LNG-IUS were convenience associated with its long-term effect, and low hormone content. These were also identified as desirable attributes of the LNG-IUS by the non-users in the focus groups. Other reasons included elimination of the need for regular contraception, and for women with or planning to have more children, compatibility with breastfeeding and resumption of fertility immediately on removal. Another associated benefit was lighter, shorter, less painful periods. The main reported disadvantage of the LNG-IUS was pain on insertion. This survey investigated the reasons underlying women’s choice of contraception, specifically in relation to the LNG-IUS. Inaccurate or misleading information from anecdotal sources is relied upon by many women whose concerns could be addressed with proactive counselling by their physicians. These findings are consistent with those of Asker et al. who analysed the concerns of women who had never used an IUD.2 Although the two populations in the present investigation were surveyed by different methods, their perceptions of the attributes of the LNG-IUS were broadly similar, with long duration of effect and low hormone content viewed as important. A recent US-based Phase III study of the LNG-IUS in 509 women aged 18–45 years found that precounselling about possible side effects was associated with continued long-term use of the LNG-IUS.3 The present survey highlights the importance of soliciting the views of women and the factors that influence their decisions on contraceptive choice.