By Rebecca Bowers

EXECUTIVE SUMMARY

Results of a new study indicate that many young women don’t know that the IUD can be used for emergency contraception or that it is effective. Researchers report that if young women needed emergency contraception, most indicated they would want to know about IUDs in addition to emergency contraceptive pills.

  • IUDs are safe for most women and are effective when used as ongoing contraception. Clinicians should add them to the emergency contraception options they offer to patients who present for emergency contraception after unprotected intercourse.
  • Clinics should seek to provide same-day EC IUD services or rapid-access referral. A 2016 study indicates that many clinicians may not be offering such emergency contraceptive placement.

Are clinicians including information about use of the intrauterine device (IUD) as emergency contraception (EC)? Results of a new study indicate that many young women are not aware that the IUD can be used for EC or that it is effective. Researchers report that if young women needed emergency contraception, most indicated that they would want to know about IUDs in addition to emergency contraceptive pills.

IUDs are effective for emergency contraception, as demonstrated in a 2012 evidence review.2 Results of the 2012 review indicated that 99.86% of women overall did not become pregnant after unprotected intercourse when they received an IUD inserted after intercourse. Since intrauterine devices are safe for most women, and effective and cost-effective when used as ongoing contraception, clinicians should include IUDs in the emergency contraception options they offer patients who present for emergency contraception after unprotected intercourse.2

Results of the current paper are a secondary analysis of data from 1,500 women ages 18-25 years who presented for care at 40 Planned Parenthood health centers between 2011 and 2013. The young women, who did not wish to become pregnant within 12 months, were part of a cluster-randomized trial in which the staff at health centers were randomized to receive additional training about contraceptive counseling and IUD placement or to give standard care. The intervention did not focus specifically on use of the IUD as EC. The women involved in the study completed a survey about demographic information, previous contraceptive use (noted as any contraceptive use and the most effective method used within the previous three months), and awareness of contraceptive methods. The study participants completed quarterly phone or online surveys for one year.1

Researchers assessed participants’ awareness about using the IUD as EC, their interest in more information about EC, and their most trusted source of information. Results of the analysis indicate that at follow-up, few of the young women (7.5%) were aware of using the IUD for EC. However, if they needed EC, most (68%) said they would want to know about IUDs in addition to emergency contraceptive pills, particularly among women who would be very unhappy to become pregnant (adjusted odds ratio [aOR],1.3; 95% confidence interval, 1.0-1.6, P < .05). More than 90% of participants reported that their most trusted source of information for EC was a doctor or nurse, in comparison to the Internet (6%) or friends. Of the women who had heard of IUD as EC, less than half correctly reported that the IUD is more effective than emergency contraceptive pills.1

Suzan Goodman, MD, MPH, associate clinical professor at the University of California, San Francisco, and national training director for the Bixby Center for Global Reproductive Health’s Beyond the Pill Program, says that in her work training providers across the country, she is “always struck” by how few providers offer intrauterine contraception as EC, and how few patients are aware of it.

“Our patients deserve access to the IUD as both emergency and ongoing contraception, and providers should take an active role in increasing awareness,” says Goodman, who served as lead author of the current paper. “It offers the strongest motivation for clinics to provide same-day services or rapid-access referral, and I wanted to provide more data to encourage this.”

Assess Your Practice

According to a 2017 Committee Opinion from the American College of Obstetricians and Gynecologists, clinicians should counsel patients that a copper IUD is the most effective form of EC. The committee opinion states that healthcare providers should consider integrating the provision of copper IUD EC into their practices and allowing same-day provision of IUDs.3

Is your clinic prepared to do same-day IUD placement for EC? In a pilot study in nine family planning clinics, researchers found that clinics could accommodate 77% of patients who wanted an IUD as EC the same day. The rest of the patients returned for IUD placement within the five-day window after unprotected intercourse.4

Research indicates that many clinicians may not be offering IUD placement for emergency contraception. In a 2016 survey, researchers used a mystery caller to contact 199 primary care, family planning, and obstetrician/gynecology clinics in nine U.S. cities. The caller assumed the role of a patient requesting the copper IUD for EC. The researchers found that although two-thirds (68%) of primary care clinics, 87% of family planning clinics, and all obstetrician/gynecology clinics offered the copper IUD, few primary care or obstetrician/gynecology clinics offered it as EC. Less than half (49%) of the family planning clinics offered such service.5

Science Examines IUD EC Options

How about use of the levonorgestrel IUD for EC? Researchers in the Department of Obstetrics and Gynecology at Washington University School of Medicine in St. Louis are now running the LIFE (Levonorgestrel Intrauterine System for Emergency Contraception) trial to examine the device’s use.

The study is designed to evaluate the effectiveness of the levonorgestrel intrauterine system as a method of EC by comparing observed pregnancy rates in those who receive oral levonorgestrel, ulipristal acetate, or the device. Results are expected after 2019.

Robert Hatcher, MD, MPH, professor emeritus of gynecology and obstetrics at Emory University School of Medicine in Atlanta, notes that when a woman needing EC strongly prefers placement of a levonorgestrel IUD, one may be placed, accompanied by provision of an oral dose of Plan B One Step or generic equivalent.

REFERENCES

  1. Goodman SR, El Ayadi AM, Rocca CH, et al. The intrauterine device as emergency contraception: How much do young women know? Contraception 2018; doi:10.1016/j.contraception.2018.04.009.
  2. Cleland K, Zhu H, Goldstuck N, et al. The efficacy of intrauterine devices for emergency contraception: A systematic review of 35 years of experience. Hum Reprod 2012;27:1994-2000.
  3. Committee on Health Care for Underserved Women. Committee Opinion No 707: Access to Emergency Contraception. Obstet Gynecol 2017;130:e48-e52.
  4. Kohn JE, Nucatola DL. EC4U: Results from a pilot project integrating the copper IUC into emergency contraceptive care. Contraception 2016;94:48-51.
  5. Schubert FD, Bishop ES, Gold M. Access to the copper IUD as post-coital contraception: Results from a mystery caller study. Contraception 2016;94:561-566.