Many women unaware of facts regarding IUDs

While use of intrauterine devices (IUDs) represents a highly effective form of birth control, many women still are not getting proper information about it, results of a new survey indicate.1 Only one-fifth of the women surveyed knew that intrauterine devices were more effective in preventing pregnancy than oral contraception, while only 29% knew that IUDs are cheaper over time than pills.

Researchers from the University of Washington in Seattle and the University of Pittsburgh surveyed more than 1,600 women ages 18-50 who visited one of four primary care clinics in Pennsylvania between October 2008 and April 2010. What prompted the team to look into women’s perceptions regarding the IUD?

Rates of IUD use among women on the rise, but they still are low compared to other commonly used methods such as the birth control pill, says the paper’s lead author Lisa Callegari, MD, clinical assistant professor in the Department of Obstetrics & Gynecology at the University of Washington. Prior research has indicated that one important reason for low IUD usage is women’s persistent misperceptions about the device, which date back to concerns about an early IUD, the Dalkon Shield, says Callegari.2

To be able to target counseling interventions, the researchers wanted to better understand women’s specific misperceptions with regard to effectiveness, safety, and cost of IUDs versus the birth control pill, says Callegari. In addition, no prior studies had examined IUD perceptions among women visiting primary care clinics to see an internal medicine or family medicine physician, she points out. “This population may have a higher rate of medical comorbidities such as diabetes and hypertension than women who see gynecologists, and therefore may particularly benefit from IUDs, which have few medical contraindications,” Callegari states.

More than half of the women (57%) knew that intrauterine contraception does not increase the risk of sexually transmitted infections, the study found. Few of the women surveyed had discussed IUDs with a healthcare provider. Five percent of the women were using an IUD, and another 5.8% had used one previously.1

Clear misperceptions

What can providers do to clear misperceptions about intrauterine contraception? All it takes is a minute or two of conversation, says one of the study co-authors, Eleanor Bimla Schwarz, MD, MS. Most women are aware they know little about IUDs, and most are interested in learning more about “the contraceptive my patients tend to like the best,” says Schwarz, who serves as associate professor of medicine, epidemiology, and obstetrics, gynecology, and reproductive sciences and director of the Women’s Health Services Research Unit at the University of Pittsburgh.

“I do refill oral contraceptives when women ask for them, but before doing so, I always pause to make sure my patients know that they have other options which are about 20 times as effective and safer for many women,” Schwarz explains. “I generally encourage women to try an IUD to see if they like it, saying, ‘If for any reason you don’t, we can pull it right out, and you can get right back on your pills.’”

Talk with women about the efficacy of intrauterine contraception, says Robert Hatcher, MD, MPH, professor emeritus of gynecology and obstetrics at Emory University School of Medicine in Atlanta. The copper-T IUD (ParaGard IUD, Teva North America, North Wales, PA) and the levonorgestrel intrauterine contraceptive (Mirena LNG IUC, Bayer HealthCare Pharmaceuticals, Wayne, NJ) are in the top tier of contraceptive effectiveness, along with surgical sterilization and implants, he notes.3

According to Contraceptive Technology, the overall pregnancy rate with all methods of tubal sterilizations in the United States is 1.3% at five years and 1.9% at 10 years. The first-year pregnancy rate for the Copper T IUD is between 0.5% and 0.8%, with the cumulative pregnancy rate at seven years at 1.4% to 1.6%. The first-year pregnancy rate for the LNG IUC is at 0.1% to 0.2%; at seven years of continuous use, the cumulative pregnancy rate is at 0.5% to 1.1%. Thus, the effectiveness of the copper T IUD is comparable to tubal sterilization, while the LNG IUC appears to be superior.3

“The fact is the failure rate of the Mirena IUD is well under the failure rate of tubal sterilization,” says Hatcher. “The same holds true for the contraceptive implant.”

Providers missing facts

Patients aren’t the only ones missing important information on the safety and efficacy of current IUDs. According to a survey of 635 office-based providers and 1,323 Title X clinicians, about 30% of respondents had misconceptions about the safety of IUDs for nulliparous women.4

Intrauterine contraception is safe for nulliparous women. The American College of Obstetricians and Gynecologists issued a 2012 committee opinion stating that long-acting reversible contraceptives such as the intrauterine device (IUD) and the contraceptive implant are safe, effective, and appropriate options for adolescents.5 (See “Long-acting methods safe for teens — include options in your counseling,” December 2012, p. 133.)

Help nulliparous young women achieve success with IUDs. Because more than one-half of such women report discomfort with IUD insertion, anticipatory guidance regarding pain and provision of analgesia during IUD insertion should be considered.6 Such approaches as supportive care, nonsteroidal anti-inflammatory drugs (NSAIDS), narcotics, anxiolytics, or paracervical blocks may be used.5

The more providers talk about IUDs, the better chance women will have more accurate information about the method, the new study shows. Women who had discussed IUDs with a provider had approximately twice the odds of having accurate perceptions, compared to women who had not discussed IUDs with a provider.1

“Health care providers therefore have a critical role to play in providing women with high quality counseling that enables them to make informed decisions about their contraceptive options,” say study authors.

References

1. Callegari LS., Parisi SM, Schwarz EB. Perceptions of intrauterine contraception among women seeking primary care. Contraception 2013, Doi:10.1016/j.contraception.2013.02.004.

2. Forrest JD. U.S. Women’s perceptions of and attitudes about the IUD. Obstet Gynecol Surv 1996; 51:S30-34.

3. Dean G, Schwarz EB. Intrauterine contraceptives. In: Hatcher RA, Trussell J, Nelson AL, et al. Contraceptive Technology: 20th revised edition. New York: Ardent Media; 2011.

4. Tyler CP, Whiteman MK, Zapata LB, et al. Health care provider attitudes and practices related to intrauterine devices for nulliparous women. Obstet Gynecol 2012; 119(4):762-771.

5. American College of Obstetricians and Gynecologists. Committee Opinion #539. Adolescents and long-acting reversible contraception: implants and intrauterine devices. Obstet Gynecol 2012;120(4):983-988.

6. Andersson K, Odlind V, Rybo G. Levonorgestrel-releasing and copper-releasing (Nova T) IUDs during five years of use: a randomized comparative trial. Contraception 1994; 49:56-72.