Where is intrauterine contraception offered?

Intrauterine contraception is safe and effective, but many clinicians continue to exclude it from their list of contraceptive options. About 40% of respondents to the 2007 Contraceptive Technology Update survey say they inserted six or more intrauterine devices (IUDs) in the last year, compared to 2006's 45% figure. The drop in insertions reverses the 10% jump recorded in 2006 and the 5% increase noted in 2005. About 40% reported no insertions in 2007, similar to previous years' figures.

It is disappointing that more clinicians aren't offering women IUDs, says Susan Wysocki, RNC, NP, president and chief executive officer of the Washington, DC-based National Association of Nurse Practitioners in Women's Health. "Surely, there are many more than six women in every clinician's practice who want a very reliable, safe, completely reversible contraceptive method that they don't have to think about for years, so why are so few clinicians offering these women an intrauterine contraceptive?" observes Wysocki. "Cost may be a barrier in some cases, but it seems worth it to work out ways to make it more available."

Some clinicians such as Philip Ivey, MD, a physician at Southwest Women's Health in Casa Grande, AZ, and Peter Marks, MD, an obstetrician/gynecologist at Primary Care Partners — Southeast OB/GYN in Grand Rapids, MI, also report upticks in use of intrauterine contraception in their facilities. "I was the only person who would insert an IUD when I came to town in 2000," says Ivey. "Now other providers are willing to try."

Intrauterine contraception use has increased at the Lee County Health Department in Fort Myers, FL, says Cindy Romeis, RNC, ARNP, ACHND, assistant community health nurse director. The facility has offered the Copper T 380A intrauterine device (ParaGard IUD; Duramed, a subsidiary of Barr Pharmaceuticals, Pomona, NY) for many years, and soon will have a limited supply of the levonorgestrel intrauterine system (Mirena LNG IUS; Bayer HealthCare Pharmaceuticals, Wayne, NJ).

The World Health Organization eligibility criteria classes use of IUDs in young women age 20 and younger, as well as for nulliparous women, as a "2," in which the advantages of using the method generally outweigh the theoretical or proven risks.1 The ParaGard IUD is now approved for use for nulliparous women in stable relationships from ages 16 through menopause. Research indicates that the previous use of a copper IUD is not associated with an increased risk of tubal occlusion among nulligravid women.2 Women with a history of sexually transmitted diseases or pelvic inflammatory disease (PID) are no longer contraindicated for use of ParaGard, unless a patient currently has acute PID or engages in sexual behavior suggesting a high risk for the disease, the labeling states.

For HIV-positive women, the WHO gives a classification of "3," in which the theoretical or proven risks usually outweigh the advantages of using the method.1 Results from a prospective cohort study of HIV-infected and noninfected women in Nairobi, Kenya, suggest, however, that the IUD may be an appropriate contraceptive method for HIV-infected women with ongoing access to medical services.3

Results of a recently published study indicate that IUDs were acceptable and not associated with a significant increase in gynecologic infections in women at high risk for sexually transmitted infections and pregnancy. Researchers performed a retrospective chart review of a cohort of women who attended an urban university-based obstetrics and gynecology resident clinic to develop the analysis. One-third of the women who received an IUD had a history of sexually transmitted disease before the insertion.4

Expand your contraceptive knowledge base by participating in intrauterine contraception educational opportunities offered by the Association of Reproductive Health Professionals. The organization offers a continuing medical education program, A Clinical Update on Intrauterine Contraception. (ARHP speakers are available to present this medical education lecture at your event, including clinical conferences or grand rounds sessions. Speaker honoraria and travel expenses will be covered by ARHP. To request a lecture, visit the web page, www.arhp.org/IUC.) The organization also offers patient information on intrauterine contraception options.

"ARHP believes that IUDs represent an excellent opportunity in the U.S. to reduce unintended pregnancy and will be working over the next several years to help raise awareness about this method," says Wayne Shields, ARHP chief executive officer.

The crisis surrounding the Dalkon Shield intrauterine device (IUD) during the 1970s and early '80s drove the U.S. market for the IUD to a standstill, and it still has not fully recovered, states a recently published editorial on intrauterine contraception.5 "The Dalkon Shield is no longer relevant," states Wysocki. "However, the importance of offering women all methods to choose from remains."

References

  1. World Health Organization. Medical Eligibility Criteria for Contraceptive Use. Geneva: World Health Organization; 2004.
  2. Hubacher D, Lara-Ricalde R, Taylor DJ, et al. Use of copper intrauterine devices and the risk of tubal infertility among nulligravid women. N Engl J Med 2001; 345:561-567.
  3. Morrison CS, Sekadde-Kigondu C, Sinei SK, et al. Is the intrauterine device appropriate contraception for HIV-1-infected women? BJOG 2001; 108:784-790.
  4. Campbell SJ, Cropsey KL, Matthews CA. Intrauterine device use in a high-risk population: Experience from an urban university clinic. Am J Obstet Gynecol 2007; 197:193.e1-6; discussion 193.e6-7.
  5. Barbieri RL. We should encourage more women to use the modern IUD. OBG Management 2007; 19:14-15.