Intrauterine method use is moving upward

Look back to results of the 2004 Contraceptive Technology Update Contraception Survey: Just 30% of survey respondents said they inserted six or more intrauterine contraceptives in the past year. Now results of the 2009 survey indicate about 54% of survey respondents say they inserted a similar number of devices.

"What I notice in my practice is that more of my patients are proactively indicating an interest in IUD [intrauterine device] use," comments Andrew Kaunitz, MD, professor and associate chair in the Obstetrics And Gynecology Department at the University of Florida College of Medicine — Jacksonville. "When I bring up the option of IUD use, patients appear more aware and receptive than five years ago."

What has led to the upswing in use? Advertising has led more women to consider the Copper T-380A intrauterine device (ParaGard Copper T 380A IUD; Duramed Pharmaceuticals, Pomona, NY) or the Mirena levonorgestrel intrauterine system (LNG IUS; Bayer HealthCare Pharmaceuticals, Wayne, NJ), say clinicians. Dodie Delaney, ANP, a nurse practitioner at Fairbanks (AK) Regional Public Health Center, says television advertising for Mirena has led more women to inquire about intrauterine contraception.

Survey Profile

"Yes, the IUD demand has been steadily growing," agrees Crystal Wilmhoff, CNP, a nurse practitioner at Planned Parenthood Southwest Ohio Region in Cincinnati. "Women want a long-term method of birth control that is hassle-free."

Frayda Diamond, CNM, WHNP, a Montgomery Village, MD, clinician serving in private practice and hospital-sponsored clinic settings, says she is seeing more IUD insertions because she is talking about the method more with her patients.

Women have moved past the stigma associated with the Dalkon Shield, says Pat Jewell, CNM, a certified nurse midwife at Kalihi-Palama Health Center in Honolulu. The Dalkon Shield has been off the market since 1974, when numerous safety issues led the Food and Drug Administration to call for its removal. Women are now hearing more positive reactions to IUDs, she notes.

Some clinicians might continue to cling to old myths about intrauterine contraception. One of the most persistent myths is that a woman with an IUD in place is at higher risk of developing pelvic inflammatory disease. Results from large studies, conducted by the World Health Organization (WHO), indicate that this is not the case.1

Confusion still circles around potential candidates for IUD use. Results of a 2008 survey of 1,246 physicians, nurse practitioners, and physician assistants serving more than 100 contraceptive patients per year in the California state family planning program show that fewer than half of clinicians (46%) consider nulliparous women appropriate candidates for IUD use.2 The WHO eligibility criteria categorizes use of the Copper-T and the LNG IUS in young women age 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 The ParaGard IUD is now approved for use for nulliparous women in stable relationships from age 16 through menopause.

In the same 2008 study, only 39% of providers believed that post-abortion women could safely use IUDs.2 Evidence indicates there is no difference in complications for immediate vs. delayed insertion after a therapeutic abortion.4 Immediate post-abortal device insertion is a safe, practical, and underutilized intervention than can reduce repeat unintended pregnancy and repeat abortion by two-thirds, according to researchers.5

If women are considering surgical sterilization, review the reversible option of intrauterine contraception with them. Research indicates that the characteristic most often associated with post-sterilization regret is the youthfulness of the patient; women under 30 are twice as likely to regret their decision as those who are older than 30 at the time of sterilization.6

"For young women who have had children and who are considering sterilization, we talk to them about the fact that there are alternatives to sterilization that are reversible," says Lenore Cappelluti, MSN, WHNP-BC, a nurse practitioner at Sheppard Air Force Base in Wichita Falls, TX. "We discuss both the Mirena and ParaGard."

References

  1. Jacobstein R. Long-acting and permanent contraception: An international development, service delivery perspective. J Midwifery Womens Health 2007; 52:361-367.
  2. Harper CC, Blum M, de Bocanegra HT, et al. Challenges in translating evidence to practice: The provision of intrauterine contraception. Obstet Gynecol 2008; 111:1,359-1,369.
  3. World Health Organization. Medical Eligibility Criteria for Contraceptive Use. 4th ed. Accessed at whqlibdoc.who.int/publications/2009/9789241563888_eng.pdf.
  4. Grimes DA, Lopez LM, Schulz KF, et al. Immediate postabortal insertion of intrauterine devices. Cochrane Database of Systematic Reviews 2004; DOI: 10.1002/14651858. CD001777.pub2.
  5. Goodman S, Hendlish SK, Reeves MF, et al. Impact of immediate postabortal insertion of intrauterine contraception on repeat abortion. Contraception 2008; 78:143-148.
  6. Wilcox LS, Chu SY, Eaker ED, et al. Risk factors for regret after tubal sterilization: 5 years of follow-up in a prospective study. Fertil Steril 1991; 55:927-933.