(221) Levonorgestrel-releasing Intrauterine Systems And Copper Intrauterine Devices Utilization In France: Changes From The Last Decade

Background: Survey data has suggested an increase of intrauterine device use in France since 2010. While only 52 mg levonorgestrel intra-uterine system (LNG-IUS) was available in 2012, 13.5 mg LNG-IUS has entered the market in 2013, and 19.5 LNG-IUS in 2018. The higher-dose LNG-IUS (52 mg) was associated with an increased risk of depression, while the lower-dose LNG-IUS (13.5 mg) was associated with an increased risk of ectopic pregnancy, raising new safety concerns for users.

Objectives: To describe the evolution of Cu-IUD and LNG-IUS utilization in France from 2012 to 2022 and according to age.

Methods: We conducted a population-based study of all women aged 15 to 49 years living in France at two time points: January 2012 and January 2022. Information on age and contraceptive use was collected from the French National Health Data System (SNDS, includes health claims for 99% of individuals living in France). IUD uptake was defined as date of dispensation, and discontinuation as either start of pregnancy, uptake of another method or maximum duration of use. Women with a current pregnancy or with a history of hysterectomy were excluded. Prevalence of utilization was computed at both time points for all women and for each age range.

Results: While in 2012, 791,231 women aged 15-49 years used Cu-IUD, they were 1,428,837 in 2022, rising from 12% to 21% of women using contraceptives over the period. The increase was largest in women < 30 years (3% to 13%) and remained sustained in older age groups (15% to 30% in women 30-39 years, 19% to 23% in women 40-49 years). Although total utilization of LNG-IUS decreased moderately over the period, from 1,132,081 users in 2012 to 1,007,094 in 2022, or from 17% to 15% of contraceptive users aged 15-49 years, utilization increased slightly in women < 30 years (3% to 5% of contraceptive users), with a moderate fall in women ≥ 30 years (25% to 21% of contraceptive users). The introduction of the two lower-dose LNG-IUS has reshaped utilization. In 2022, 52 mg LNG-IUS accounted for 67% of LNG-IUS utilization, 19.5 mg LNG-IUS for 27% and 13.5 LNG-IUS for 6% of LNG-IUS utilization. In women aged 15-19 years, 19.5 mg LNG-IUS accounted for 66% of global LNG-IUS utilization and for 56% in women aged 20-29 years. In the youngest age group, 13.5 mg LNG-IUS represented 21% of global LNG-IUS use and 18% in women aged 20-29 years. In women ≥ 30 years, 52 mg LNG-IUS remained the leading LNG-IUS, accounting for 60% of LNG-IUS use in women 30-39 years, and 79% of LNG-IUS use in women 40-49 years.

Conclusions: Large uptake of Cu-IUD and the introduction of lower-dose LNG-IUS have reshaped contraceptive use among young women in France. The arrival of lower-dose IUDs calls for further comparative studies with the Cu-IUD in terms of benefits, risk and misuse.