Intrauterine devices — More women eye option
Use of intrauterine contraception is slowly gaining ground among U.S. women. About 45% of respondents to the 2008 Contraceptive Technology Update Contraception Survey say they inserted six or more devices in the last year, compared to 2007's 40% figure. About 40% reported no insertions in 2008, similar to 2007's statistic.
A recently published review sees intrauterine contraception undergoing a renaissance in the United States, with its role expanded as new devices and systems are developed and as old biases among clinicians and women are erased.1
Corinne Rovetti, RNCS, FNP, family nurse practitioner and co-director of the Knoxville (TN) Center for Reproductive Health, a comprehensive reproductive health center, is seeing an increased interest and request for insertion for intrauterine devices (IUDs). Patients are requesting the Copper T 380A intrauterine device (ParaGard IUD, Barr Pharmaceuticals; Pomona, NY) and the levonorgestrel intrauterine system (Mirena LNG IUS, Bayer HealthCare Pharmaceuticals; Wayne, NJ).
"I think, finally, we are moving past the outdated information that kept people fearful of using this method, so the new marketing for these systems has had a positive effect on the increased interest and usage," she says.
Shirley LeBlanc, WHNP-BC, a women's health nurse practitioner at Planned Parenthood of Waco/ Central Texas, says her facility is seeing more insertions of IUDs. More women would choose the method if more flexible payment plans were offered by the manufacturing companies.
Clinicians continue to need updating when it comes intrauterine contraception, according to information presented by Barbara Clark, PA-C, MPAS, a certified physician assistant at Knox OB-GYN, in Galesburg, IL, at the 2008 annual meeting of the Association of Reproductive Health Professionals.2
Myths still exist about intrauterine contraception, according to Clark's presentation. Selection of candidates is unduly restrictive, and misinformation about intrauterine contraception among providers and patients is common, she states.
Confusion still circles around potential candidates for IUD use. The World Health Organization eligibility criteria classes use of IUDs in young women ages 20 and younger, as well as for nulliparous women, as a "2" — which means the advantages of using the method generally outweigh the theoretical or proven risks.3
When talking with patients about intrauterine contraception, question them about where they have received information about the method. A 2008 study that looked at the accuracy of video clips and viewer-posted comments about IUDs on YouTube found that many scientific claims were unsubstantiated and several viewer comments were negative toward the method.4
Who is a suitable candidate for intrauterine contraception? Women of any reproductive age seeking long-term, highly effective contraception, according to Clark. The Copper T IUD is a good method for women who don't want hormonal contraception or want contraception for more than five years, while the LNG IUS represents a good option for women who request less menstrual flow and/or experience dysmenorrhea or dysfunctional uterine bleeding.2
IUDs are underused in the United States, especially by adolescents, reports a recent paper.5 Because adolescents contribute disproportionately to the epidemic of unintended pregnancy, IUDs should be considered as a first-line contraceptive choice regardless of parity, the paper's authors state. The LNG IUS represents a good option for teens due to its noncontraceptive benefits such as decreased menstrual bleeding, dysmenorrhea, and pain associated with endometriosis. More research in the use of the IUD among adolescents should be pursued, the authors advocate.5
- MacIsaac L, Espey E. Intrauterine contraception: The pendulum swings back. Obstet Gynecol Clin North Am 2007; 34:91-111, ix.
- Clark BJB. A clinical update on intrauterine contraception. Presented at the 2008 annual meeting of the Association of Reproductive Health Professionals. Washington, DC; September 2008.
- World Health Organization. Medical eligibility criteria for contraceptive use. Geneva: World Health Organization; 2004.
- Luttrell K, Zite N, Wallace L. Myths and misconceptions about intrauterine contraception on YouTube. Contraception 2008; 78:183-183.
- Gold MA, Johnson LM. Intrauterine devices and adolescents. Curr Opin Obstet Gynecol 2008; 20:464-469.
- The ARCH Foundation is a Charlotte, NC-based not-for-profit foundation established to assist low-income patients who do not have insurance coverage for the Mirena intrauterine contraceptive system. For patients who meet specific eligibility criteria, the ARCH Foundation may be able to provide Mirena free of charge. Confidential messages may be recorded for a patient case coordinator, 24 hours a day, seven days a week. Contact the foundation at P.O. Box 220908, Charlotte, NC 28222-0908. Phone: (877) 393-9071, Monday through Friday 9 a.m. to 5 p.m. Eastern Time. Web: www.archfoundation.com.
- If a patient's insurance provider does not cover the ParaGard intrauterine device, or if she does not have insurance, the ParaGard Patient Payment program allows the patient to pay for the device with 12 monthly payments. Call toll-free (877) 727-2427 for more details.