Long-acting reversible contraception (LARC) after medically induced abortion

The total number of induced abortions has declined, but the 32–45% proportion of repeat abortions has remained stable. Medical abortion has replaced the surgical method and up to 97% of abortions are medically induced today in Finland. Long-acting reversible contraception (LARC), i.e., intrauterine devices and contraceptive implants, is very effective. Initiation of LARC methods at the time of the surgical abortion results in better initiation and continuation rates and prevents both subsequent unplanned pregnancies and induced abortions compared to delayed initiation of LARC. Insertion of an intrauterine device at the time of the medical abortion was not studied before this thesis study. The first aim of this thesis study was to assess the feasibility and safety of immediate (0–3 days) and delayed (2–4 weeks) insertion of a levonorgestrel-releasing intrauterine device (LNG-IUS) after medically induced abortion in a randomized controlled trial. The second aim of this thesis study was to analyze the effect of planned LARCs and LARCs initiated shortly after a medical abortion on subsequent, unwanted pregnancies and abortions in a retrospective cohort setting. The study was conducted in Helsinki University Hospital, Finland. A total of 264 adult women participated in the randomized controlled trial. The LNG-IUS was inserted more often in the immediate-insertion group compared to the delayed-insertion group (127 [96%] vs. 111 [85%)], p=0.004). Per-protocol insertions (only after an uncomplicated medical abortion and in a predefined timeframe) occurred in 116 (87%) vs. 101 (77%) cases, p=0.82. In per-protocol analysis, three-month expulsion rates were 24 (21%) vs. 4 (4%), p