Title : Comparing the efficacy of levonorgestrel intrauterine device and oral levonorgestrel for emergency contraception: A systematic review and meta-analysis
Abstract:
Background: Emergency contraception (EC) is critical for preventing unintended pregnancies following unprotected or inadequately protected sexual intercourse. While oral levonorgestrel (LNG) pills are the standard FDA-approved EC method, the levonorgestrel intrauterine device (LNG-IUD) is emerging as an alternative, offering both immediate EC and long-term contraception benefits. This study evaluates the efficacy of LNG-IUD compared to oral-LNG for EC.
Methods: A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. PubMed, Scopus, and Medline were searched up to December 16, 2024, using keywords related to postcoital contraception, levonorgestrel, and intrauterine devices. Five studies from two countries, totaling 920 participants, met the population, intervention, comparison, outcome, and settings (PICOS) criteria focusing on women of reproductive age using LNG-IUD or oral LND as EC. Risk of bias was assessed using the mixed methods appraisal tool (MMAT), and a random-effects model was applied due to significant heterogeneity.
Results: The LNG-IUD, when indirectly compared to oral LNG for EC, demonstrated a natural log of the odds risk ratio (ORR) of –0.51 (95% CI: -3.86-2.83, p=0.77), suggesting a lower risk of pregnancy with the LNG-IUD. However, the wide confidence interval and lack of statistical significance, as reflected by the high p value, likely results from limited studies available for this dataset.
Conclusion: This review found no statistically significant difference in efficacy between LNG-IUD and oral-LNG for emergency contraception, likely due to wide confidence intervals and limited data, supporting LNG-IUD as an alternative. LNG-IUD offers comparable efficacy to other EC options and the added benefit of long-term contraception, underscoring the importance of additional direct studies to expand emergency contraception options for women.
