Intrauterine methods move up in acceptance

More women are taking a second look at intrauterine devices (IUDs), and not all of them are considering such use for contraception.

Recently published research indicates that the levonorgestrel intrauterine system (IUS) Mirena (Berlex Laboratories, Montville, NJ), traditionally used for contraception, also reduces menstrual bleeding associated with uterine fibroids.1 Use of the IUS use was associated with significant reduction in menstrual blood loss and an improvement in hematologic parameters during a 12-month study among women with small leiomyomatous uteri.1

"The progestin-releasing IUS’ convenience and high efficacy are strong selling points, with the reduction in menstrual blood loss representing the clincher for many candidates," reports Andrew Kaunitz, MD, professor and assistant chair in the obstetrics and gynecology department at the University of Florida Health Science Center/Jacksonville. "In about one-quarter of women having insertions of the progestin-releasing IUS, the patient has not needed contraception — e.g., not sexually active, patient or partner sterilized — with the reduction in bleeding representing the reason for insertion."

Research using the Mirena IUS indicates decrease in pain and dyspareunia from recto-vaginal endometriomas, and the device may be effective in treatment of adenomyosis as well,2,3 observes Sharon Schnare, RN, FNP, CNM, MSN, clinician at South Kitsap Family Care Clinic in Port Orchard, WA. Research estimates that the levonorgestrel IUS may be nearly as effective as endometrial resection for treatment of endometrial bleeding and may decrease the need for resection by 75%,4 she points out.

"I believe that women facing hysterectomy for menorrhagia should be advised of the availability of the levonorgestrel IUS as an alternative to surgery," she states.

Insertions on the rise

Clinicians report increased use of IUDs. According to Kimberly Carson, RN, clinical services supervisor at the Aberdeen, WA-based Grays Harbor County Public Health, 51 insertions have been performed so far at her facility in 2003, compared to 33 in 2002. She contends that the introduction of the Mirena has added to the upswing.

Carson says some patients at the agency have received free Mirena IUS devices through the auspices of the ARCH (Access and Resources in Contraceptive Health) Foundation, a not-for-profit Charlotte, NC-based organization funded by Berlex Laboratories. The foundation operates a patient assistance program designed to assist low-income patients who don’t have insurance coverage for the device.

Such financial aid is important; while Medicaid in 47 states covers IUD insertion and removal, the device’s price tag may be prohibitive for family planning facilities that serve lower-income women who may not be covered by Medicaid.5 According to A Pocket Guide to Managing Contraception, average wholesale price for the Mirena is $395.6

Cost is the primary factor at Planned Parenthood of Southern Arizona in Tucson; Mirena is not offered as an option due to its cost, says Patti Caldwell, MSW, the agency’s president and CEO.

Indeed, many women are put off by the initial cost of the IUD, observes Schnare. However, women need to understand that the method’s initial cost is offset by its years of use. A new study reveals that the two types of intrauterine contraception, the Mirena IUS and the Copper T 380A IUD (ParaGard Intrauterine Copper Contraceptive, Ortho-McNeil Pharmaceutical, Raritan, NJ), are the top two most cost-effective methods of birth control available to women in the United States.7

Help women see the overall cost benefit of IUD use, says Schnare. When used for five years, the new analysis shows that the three least costly methods are the levonorgestrel-releasing IUS, Copper T 380A IUD, and the three-month injectable [depot medroxyprogesterone acetate (DMPA), also known as Depo-Provera, Pharmacia Corp., Peapack, NJ], with total five-year costs per person of $1,646, $1,678 and $2,195, respectively. The five most effective methods, based on success rates, are tubal ligation (99.7%), the IUS (98.9%), the IUD (98.5%), DMPA (98.3%), and oral contraceptives (96.2%).7

"The currently available Copper T and levonorgestrel-releasing IUDs come as close to a perfect contraceptive as any method currently available, in terms of safety, ease of insertion, reversibility, minimal side effects, and an effectiveness equal to sterilization," observes Allan Rosenfield, MD, dean of the Mailman School of Public Health at the New York City-based Columbia University. "American women generally have received inadequate information about these IUDs, which is a disservice to our patients."

References

1. Grigorieva V, Chen-Mok M, Tarasova M, et al. Use of a levonorgestrel-releasing intrauterine system to treat bleeding related to uterine leiomyomas. Fertil Steril 2003; 79:1,194-1,198.

2. Fedele L, Bianchi S, Zanconato G, et al. Use of a levonorgestrel-releasing intrauterine device in the treatment of rectovaginal endometriosis. Fertil Steril 2001; 75:485-488.

3. Fong YF, Singh K. Medical treatment of a grossly enlarged adenomyotic uterus with the levonorgestrel-releasing intrauterine system. Contraception 1999; 60:173-175.

4. Istre O, Trolle B. Treatment of menorrhagia with the levonorgestrel intrauterine system versus endometrial resection. Fertil Steril 2001; 76:304-309.

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

6. Laurence L. Can the IUD make a comeback? Kaiser Daily Reproductive Health Report. Jun 14, 2001. Accessed at: http://www.kaisernetwork.org/daily_reports/rep_index.cfm.

7. Chiou CF, Trussell J, Reyes E, et al. Economic analysis of contraceptives for women. Contraception 2003; 68:3-10.

Resource

For information on the Access and Resources in Contraceptive Health (ARCH) Foundation, contact:

ARCH Foundation, P.O. Box 220908, Charlotte, NC 28222-0908. Telephone: (877) 393-9071. Fax: (704) 357-0036. Web: www.archfoundation.com.