Comparative Effectiveness and Early Discontinuation of Jadelle versus PPIUCD in Multiparous Women

Abstract

Background: Long-acting reversible contraceptives (LARCs) are a priority for postpartum family planning in Pakistan. Jadelle (levonorgestrel subdermal implant) and PPIUCD (copper intrauterine device) are the two most commonly used options in healthcare system of Pakistan. Comparative real-world data from this population are limited.

Objective: To compare contraceptive effectiveness, bleeding pattern changes, 3-month continuation rates, and early discontinuation between Jadelle and PPIUCD among postpartum women at tertiary care hospital Karachi.

Methods: A prospective comparative study enrolled 100 postpartum women (50 per group). Jadelle was inserted within 48 hours of delivery. PPIUCD (CuT 380A) was inserted postplacental, transcervically within 48 hours, or during caesarean section. Participants were followed up at 1, 2, and 3 months using structured proformas.

Results: Jadelle users were younger (mean 32.2 vs. 34.8 years, p=0.001). Heavy/irregular bleeding at 1 month was more common with Jadelle (70% vs. 50%, p=0.03) but both groups converged by 3 months. Device expulsion occurred exclusively in PPIUCD (16%, p<0.001). Three-month continuation was significantly higher with Jadelle (80% vs. 64%, p=0.048). Menstrual irregularity was the sole reason for Jadelle discontinuation; PPIUCD discontinuation was driven by expulsion (16%), social pressure (8%), and desire to conceive (4%).

Conclusion: Both methods are effective at 3 months with no in-situ failures. Jadelle demonstrated superior short-term continuation. Targeted pre-insertion counselling is essential for each method: menstrual changes for Jadelle and expulsion risk for PPIUCD.

Keywords: ;   early discontinuation   long-acting reversible contraception; ; levonorgestrel implant; jedelle ;PPIUCD.