Intrauterine method sees upswing in use

More women are choosing long-term birth control through use of intrauterine contraception, say participants in the 2005 Contraceptive Technology Update Contraception Survey. About 35% of participants say they have performed six or more insertions in the past year, up from the 30% level reported in 2004.

Two intrauterine contraceptives are available in the United States: the Mirena levonorgestrel intrauterine system (Mirena LNG IUS, Berlex Laboratories, Montville, NJ) and the Copper T 380A intrauterine device (ParaGard IUD, FEI Women’s Health, North Tonawanda, NY). The ParaGard IUD is approved for 10 years of contraception; the Mirena is approved for five years of birth control.1

Increased interest has allowed facilities to add the method to their contraceptive menus; intrauterine devices soon will be offered at the Southern Iowa Family Planning/Women & Men’s Health Care Clinic in Ottumwa, reports Pam Miller, ARNP, a nurse practitioner at the facility.

Kim Wagenaar, RN, MSN, women’s health coordinator at Lake County Health Department in Waukegan, IL, estimates her facility performs about 100 insertions each year. The cost of providing the Mirena IUS precludes its regular use at the clinic, she reports.

The clinic has been able to perform some IUS insertions with devices provided by the ARCH (Access and Resources in Contraceptive Health) Foundation, a not-for-profit Charlotte, NC-based organization funded by Berlex Laboratories. The ARCH Foundation’s patient assistance program helps financially challenged women obtain LNG IUS contraception.

While clinicians are reporting an uptick in intrauterine contraception use, many women remain unaware of the method’s benefits. In a national survey, 70% of women were unaware of a reversible contraceptive option that is as effective as sterilization.

The Food and Drug Administration (FDA) has just approved updated labeling for ParaGard:

  • The device is approved for nulliparous women in stable relationships from age 16 through menopause.
  • ParaGard no longer is contraindicated for women with a history of sexually transmitted diseases (STDs) or pelvic inflammatory disease (PID) unless a patient currently has acute PID or engages in sexual behavior suggesting a high risk for PID.
  • Mutual monogamy no longer is a user requirement, although use by women in a stable relationship is encouraged.2

What information do you need to present about intrauterine contraceptives? According to information presented at the recent Association of Reproductive Health Professionals’ Reproductive Health 2005 conference, there are many myths about this method. In fact, intrauterine contraceptives:

  • are not abortifacients;
  • do not cause ectopic pregnancies;
  • do not cause pelvic infection;
  • do not decrease the likelihood of future pregnancies.1

In addition, intrauterine contraceptives can be used for women with previous ectopic pregnancies, do not need to be removed for PID treatment, and do not have to be removed if actinomyces-like organisms are noted on a Pap smear.1

Who are appropriate candidates for intrauterine contraception? Women of any reproductive age who are seeking long-term, highly effective contraception can consider the method.1 The ParaGard IUD is a good selection for women who don’t want hormonal contraception, while the Mirena LNG IUS represents a suitable choice for women who request less menstrual flow and/or who experience dysmenorrhea.1

Women who may be poor candidates for intrauterine contraception include those with known/suspected pregnancy, puerperal sepsis, immediate post-septic abortion, unexplained vaginal bleeding, cervical or endometrial cancer, uterine fibroids that distort uterine cavity, and known pelvic tuberculosis.1

Counsel women on potential side effects. During insertion, women may have variable pain and/or cramping and vasovagal reactions, with the possibility of light bleeding and mild cramping during the first few days following the procedure. Intermenstrual bleeding and cramping also may occur during the first few months of device use. Those who choose the Copper T 380A IUD may have heavier or prolonged menses, while women who use the LNG IUS may see a gradual decrease in menstrual flow.1

References

  1. Jones KP, Sutton C. Intrauterine contraception. Presented at the 42nd annual meeting of the Association of Reproductive Health Professionals. Tampa/St. Petersburg, FL; September 2005.
  2. FEI Women’s Health LLC. FDA Approves Expanded Patient Profile for Non-Hormonal Intrauterine Device. Press release. Sept. 13, 2005.