OBJECTIVES: To review published evidence on Comparative Effectiveness and Humanistic Burden of Hormonal LARCs Levonorgestrel-IUD (LNG-IUD) and Etonogestrel Subdermal Implant (ESI).

METHODS: A systematic literature search was performed using MEDLINE via PubMed, LILACS and CENTRAL. A search strategy was formulated and studies up to 2021 were included. Two reviewers independently selected the studies, summarized the data, and assessed the risk of bias. Critical evaluation of included studies was performed using appropriate tools. Systematic reviews and clinical trials in women of childbearing age who received hormone functioning LARCs were eligible for inclusion. Summary effect measures were present in mean differences (MD), homogeneity (I²) and odds ratio (OR).

RESULTS: In a preliminary assessment of eligibility (title and abstract), 793 studies were excluded. In a furthermore detailed analysis (studies in full), we excluded 102 studies for the following reasons: study design and incorrect population. In the end, 3 studies met our inclusion criteria and were selected for data synthesis. In terms of efficacy outcomes, the ESI was more effective compared to LNG-IUD (0.5% to 0.9% for LNG and 0.0% for ESI). In young women, the implant showed superior efficacy in terms of pregnancy rate compared to the IUD (RR=1.44). Evidence of the continuation rate comparison between IMP-ETN and IUD are still controversial (I²>86). In women in the 6-week postpartum period, relevant continuation rates (70% to 100%) at 3, 6, and 12 months were evidenced in favor of ESI. Meta-analysis comparing AEs between IUDs vs ESI but did not show statistically significant differences in terms of safety.

CONCLUSIONS: The ESI was safer and more effective compared to the LNG-IUD. There are significant limitations in the current evidence, mainly due to device based clinical approach.