This study is a randomized trial of two IUDs for emergency contraception: the copper IUD, the most effective method of emergency contraception vs. the levonorgestrel IUD, the most preferred IUD which has never been tested as an emergency contraceptive. This research has the potential to increase use of highly effective contraception in a high-risk population and lower the persistently elevated rate of U.S. unintended pregnancy.

Unintended pregnancy has multiple adverse effects on both maternal and child health. The United States continues to have one of the highest rates of unintended pregnancy among developed countries. To combat this problem, we are studying initiation of the highly effective intrauterine device (IUD) for women presenting for emergency contraception (EC). This is an ideal population to initiate highly effective reversible contraception (HERC) as they are at high risk of unintended pregnancy and are acting to reduce that risk. We have recently demonstrated significantly lower pregnancy rates 12 months after presenting for EC among women who selected the copper IUD versus those who selected oral Levonorgestrel (LNG).

Not only is the copper IUD the most effective method of EC, it is considered a top tier anticipatory contraception method and its ability to prevent pregnancy is on par with tubal sterilization (less than 1% in the first year with lower failure rates in subsequent years). However, women selecting intrauterine contraception have shown a strong preference for the LNG IUD. The LNG IUD, is as effective at preventing pregnancy as the Copper IUD, and has some non-contraceptive effects that many women see as benefits such as the reduction or elimination of menstrual bleeding and menstrual related discomfort. Of currently available reversible contraceptives, the LNG IUD has the highest levels of user satisfaction and continuation. However, its effectiveness as an emergency contraceptive remains unknown. A randomized control trial is necessary to assess the safety and efficacy of the LNG IUD as EC. Demonstrating the efficacy, safety, and acceptability of the LNG IUD for EC will improve options for women seeking EC and who desire a highly effective method of contraception.

Inclusion Criteria:

• Females between 18-35 years old
• In need of EC (had unprotected intercourse within 120 hours - 5 days)
• Desire to prevent pregnancy for 1 year
• Fluent in English and/or Spanish
• Have a regular menstrual cycle (21-35 days)
• Know their last menstrual period (+/-3 days)
• Be willing to comply with the study requirements
• Desire to initiate an IUD
• Negative urine pregnancy test

Exclusion Criteria:

• Current pregnancy
• Breastfeeding
• Intrauterine infection within the past three months
• Sterilization
• Already have an IUD or contraception implant (Nexplanon) in place
• Vaginal bleeding of unknown etiology
• Known Gonorrhea or Chlamydia infection in the last 30 days (unless successfully treated at least 7 days prior to study entry)
• Known abnormalities of the uterus that distort the uterine cavity
• Allergy to copper
• Use of oral Emergency Contraception in the preceeding 5 days

Participants randomized to receive either the Copper T380 IUD or LNG20 IUD as emergency contraception

Adverse event data was collected during the year of follow-up collectively and defined as all events requiring additional medical care in the first month of use of IUD.

Definition of adverse events does not differ from definition used by clinical trials.gov.

Adverse events were collected as part of routine follow-up surveys completed by participants and reviewed by PI for determination of Serious Adverse Event collectively and reported collectively as all events requiring additional medical care in the first month of use after IUD insertion.

This was a randomized trial. Implications for clinical care may vary when people choose their treatment options.