More women moving to intrauterine device use

Boosted by the 2000 introduction of a new intrauterine device (IUD), participants in the 2002 Contraceptive Technology Update Contraception Survey say they are seeing increased interest in the long-acting family planning method.

When CTU quizzed readers on device insertions and removals in the 2001 survey following the introduction of the Mirena levonorgestrel intrauterine system (IUS) [Berlex Laboratories, Montville, NJ], about 56% of respondents said they had inserted no devices in the past year. About 31% indicated they had inserted one to 10 devices, and 13.1% said they had performed more than 10 insertions. About 3% reported more than 25 insertions.

In the 2002 survey, the number reporting no insertions dropped to 45%, with increases seen in all other categories. Just more than 7% of respondents said they had inserted 25 or more devices, doubling the rate from 2001. Device removals also increased slightly from 2001 numbers; 54% of survey respondents reported they had removed one to five devices in 2002, compared to 47.5% in 2001.

To help providers get up to speed, the Washing-ton, DC-based Association of Reproductive Health Professionals added 20 additional sessions in 2002 for its New Developments in Contraception: Counseling and Insertion Training Featuring the Levonorgestrel Intrauterine System. The program was presented in 153 accredited continuing medical education sessions in 2001; more than 4,300 health care providers participated in the program.

According to Julie O’Neill, CNM, a certified nurse-midwife at Mount Timpanogos Women’s Healthcare in Pleasant Grove, UT, providers are seeing more use of the Mirena and the Paragard Intrauterine Copper Contraceptive (Ortho-McNeil Pharmaceutical, Raritan, NJ; also known as the Copper T380A).

"It is just a matter of the word getting out that both are good options," says O’Neill. "We have a very low-risk population of mostly couples that are mutually monogamous and who have had children."

New publications underscoring the safety of IUDs1,2 as well as the availability of the levonorgestrel intrauterine system (IUS), appear to be increasing interest in and use of IUDs, states Andrew Kaunitz, MD, professor and assistant chair in the obstetrics and gynecology department at the University of Florida Health Science Center/Jacksonville. (CTU reported on the publications in its November 2001 article, "Are you concerned about infection, infertility risks with IUD? You can relax" see p. 125.)

When it comes to contraceptive use of IUDs, Kaunitz says two categories of potential candidates come to mind:

  • women who are referred for tubal sterilization;
  • women in their mid-30s who use oral contraceptives and smoke, and need to switch to a method medically appropriate for this clinical context.

ParaGard compares to sterilization

For women considering sterilization, remember that the ParaGard IUD is labeled for 10 years of protection and has been shown to be effective up to 12 years,3 comparable to that of surgical sterilization, says Kaunitz. The Mirena IUS has been approved for five years of use in the United States.

According to A Pocket Guide to Managing Contraception,4 use the "PAINS" mnemonic to teach early IUD warning signs:

  • Period late (pregnancy); abnormal spotting or bleeding;
  • Abdominal pain, pain with intercourse;
  • Infection exposure (sexually transmitted infection); abnormal vaginal discharge;
  • Not feeling well, fever, chills;
  • String missing, shorter or longer.

The levonorgestrel IUS has important noncontraceptive and off-label applications, according to a new review of the device.5 Kaunitz reports more women in his practice are considering use of the device for such applications as:

  • treatment of menorrhagia stemming from fibroids, or following endometrial biopsy or sonohysterogram;
  • treatment of peri- and postmenopausal vasomotor symptoms in those who have problems with systemic doses of progestins.

Recent research points to use of the levonorges-trel IUS in prevention of endometrial polyps in breast cancer survivors taking tamoxifen.6 In the randomized British clinical trial, researchers enrolled menopausal breast cancer survivors with an intact uterus who had received tamoxifen for more than one year. Participants underwent baseline hysteroscopy and endometrial sampling, with levonorgestrel-releasing IUDs insertions given to half of the women. Participants had follow-up hysteroscopy and endometrial sampling, with IUD removal, at 12 months. At the end of the study, four new polyps were noted in the non-IUD group; in contrast, no participant wearing an IUD was noted to have developed a new polyp.

References

1. 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.

2. Grimes DA. Intrauterine device and upper-genital-tract infection. Lancet 2000; 356:1,013-1,019.

3. United Nations Development Programme, United Nations Population Fund, World Health Organization, World Bank, Special Programme of Research, Development, and Research Training in Human Reproduction. Long-term reversible contraception: 12 years of experience with the TCu 380A and TCu 220C. Contraception 1997; 56:341-352.

4. Hatcher RA, Nelson AL, Zieman M, et al. A Pocket Guide to Managing Contraception. Tiger, GA: Bridging the Gap Foundation; 2001.

5. Hubacher D, Grimes DA. Noncontraceptive health benefits of intrauterine devices: A systematic review. Obstet Gynecol Surv 2002 Feb; 57:120-128.

6. Gardner FJ, Konje JC, Abrams KR, et al. Endometrial protection from tamoxifen-stimulated changes by a levonorgestrel-releasing intrauterine system: A randomised controlled trial. Lancet 2000; 356:1,711-1,717.