Effectiveness and Acceptability of Copper and Levonorgestrel-Releasing Intrauterine Devices: A Comparative Observational Study

Abstract

Background: Intrauterine devices (IUDs) are among the most effective long-acting reversible contraceptive methods. Copper-bearing IUDs (Cu-IUDs) provide hormone-free contraception, whereas levonorgestrel-releasing intrauterine devices (LNG-IUDs) provide long-term contraception through the local release of levonorgestrel. The two methods differ particularly in their effects on menstrual bleeding and dysmenorrhea. Aim: The study aimed to compare the contraceptive effectiveness, menstrual outcomes, complications, and patient satisfaction associated with Copper-IUD and LNG-IUD use. Materials and Methods: A comparative observational study was conducted among 200 IUD users divided equally into two groups: 100 Copper-IUD users and 100 LNG-IUD users. Outcomes evaluated included pregnancy, device expulsion, pelvic infection, increased menstrual bleeding, dysmenorrhea, and patient satisfaction. Categorical data were expressed as frequencies and percentages. Fisher's exact test was used for low-frequency outcomes, while Pearson's chi-square test was applied to other categorical variables. A P value < 0.05 was considered statistically significant. Results: Of the 200 participants, 127 (63.5%) were aged ≥40 years. Pregnancy occurred in one Copper-IUD user (1.0%) and no LNG-IUD users (P = 1.000). Device expulsion occurred in 6.0% and 3.0% of Copper-IUD and LNG-IUD users, respectively (P = 0.498), while pelvic infection occurred in 3.0% and 2.0%, respectively (P = 1.000). Increased menstrual bleeding was significantly more common among Copper-IUD users than LNG-IUD users (32.0% vs. 8.0%, P < 0.001). Dysmenorrhea was also significantly more frequent in the Copper-IUD group (28.0% vs. 10.0%, P = 0.001). Patient satisfaction was 82.0% among Copper-IUD users and 91.0% among LNG-IUD users (P = 0.063). Conclusion: Both IUD types demonstrated high contraceptive effectiveness and low complication rates. LNG-IUD users experienced significantly less increased menstrual bleeding and dysmenorrhea. Individual preferences, menstrual characteristics, reproductive goals, and medical eligibility should be considered when selecting an IUD