Comparison of levonorgestrel in different forms and copper intrauterine devices for emergency contraception: A systematic review and meta-analysis

Objective: Emergency contraception serves as the only dependable method for women to prevent pregnancy following unprotected sex. Among emergency contraception methods, the copper intrauterine device provides continuous, highly effective contraception for over a decade. This study aimed to evaluate the effectiveness, safety, and side effects of the copper intrauterine device over methods containing levonorgestrel for emergency contraception.

Study design: We conducted a systematic review and meta-analysis and systematically searched PubMed, Embase and the Cochrane Central Register of Controlled Trials databases.

Results: Five studies, involving a total of 1,510 patients, were included in our meta-analysis, with 511 receiving the copper intrauterine device. Our findings indicate that the copper intrauterine device is more effective than methods containing levonorgestrel for emergency contraception (OR = 0.16; 95 % CI = 0.04 to 0.62; P = 0.60; I2 = 0 %). Additionally, levonorgestrel-containing methods were preferable among women who underwent EC compared to the intervention group (OR = 0.29; 95 % CI = 0.15 to 0.55; P < 0.01; I2 = 79 %) and the use of an effective method of contraception after EC was higher in the Cu-IUD group compared to the control group (OR = 2.93; 95 % CI = 1.99 to 4.30; P = 0.38; I2 = 0 %).

Conclusion: The copper intrauterine device is highly effective and offers long-term contraception for women using it as emergency contraception. However, the use of oral levonorgestrel continues to be the method with the highest rate of preference by women.