## Analysis of IUCD Discontinuation Rates ### Correct Statements **Key Point:** Copper IUCDs work primarily through a spermicidal effect and prevention of sperm capacitation, with secondary effects on the endometrium. [cite:Park 26e Ch 8] **Key Point:** LNG-IUS (Mirena) has an extremely low failure rate of 0.2 per 100 woman-years, making it one of the most effective reversible contraceptives available. [cite:Park 26e Ch 8] **Key Point:** Copper IUCDs inserted within 5 days of unprotected intercourse provide emergency contraception with >99% efficacy and are the most effective emergency contraceptive method. [cite:Park 26e Ch 8] ### The Incorrect Statement **High-Yield:** The most common reason for IUCD discontinuation is **side effects (primarily menorrhagia with copper IUCDs and irregular bleeding with LNG-IUS)**, NOT expulsion. Expulsion rates are typically 2–8% in the first year, while side effect-related discontinuation is much higher (15–30% in some studies). [cite:Park 26e Ch 8] ### Comparison of IUCD Discontinuation Causes | Cause | Frequency | Notes | | --- | --- | --- | | Side effects (bleeding, pain, spotting) | 15–30% | Most common reason for discontinuation | | Expulsion | 2–8% | More common in nulliparous women and younger age groups | | Pregnancy (method failure) | <1% | Rare; indicates defective device or malposition | | Infection/PID | <1% | Rare; not increased if asymptomatic at insertion | | User choice/other | Variable | Includes desire for pregnancy, change in contraceptive preference | **Clinical Pearl:** Counseling patients about expected bleeding patterns (heavier, longer periods with copper; irregular spotting with LNG-IUS) before insertion significantly improves continuation rates.
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