More women are looking at intrauterine devices

Are more women at your family planning facility requesting information on intrauterine contraception? Chances are you are seeing an increase in interest: Almost 30% of respondents to the 2004 Contraceptive Technology Update Contraception Survey say they have performed six to 25 intrauterine device (IUD) insertions in the last year, up slightly from 2003’s figures.

The popularity of the levonorgestrel intrauterine system (Mirena IUS, Berlex Laboratories, Montville, NJ) led to an increase in the number of IUD insertions, confirms Joe Childress, MD, an obstetrician/ gynecologist in private practice in San Antonio. Women in the United States have two choices when it comes to intrauterine contraception: the Mirena and the Copper T 380A IUD (ParaGard, FEI Women’s Health, North Tonawanda, NY).

More IUD insertions are being performed at the Pinal County Health Department, a public health facility in Florence, AZ, reports Carolyn Brown, RNP, nurse practitioner. The facility uses ParaGard IUDs.

"The number of IUDs has increased," agrees Gayle Krevel, RN, MS, CLC, supervisor of women’s health at the Winnebago County Health Department, a public health facility in Rockford, IL, "We are not using the Mirena at this time."

More than 25 years have passed since the era of the Dalkon Shield, an intrauterine contraceptive whose manufacture was halted in the mid-1980s due to product liability issues. Women are now taking a fresh look at the method.1  

Is cost an issue?

According to package labeling, the ParaGard IUD offers 10 years of contraception; the Mirena is approved for five years of contraception.2 While upfront costs for both devices can range between $300-$500, intrauterine birth control offers the greatest net cost benefits of any contraceptive over a five-year period.2

"Higher price is an issue, even though we try to let them know that over time, the price is negligible," says Judy Nicksich, women’s health care nurse practitioner at Western Wyoming Family Planning, a not-for-profit family planning agency in Rock Springs, WY.

FEI Women’s Health offers a four-part credit card payment program and is developing a patient assistance program to help low-income women who don’t have insurance coverage for the device.

"Women who do not have contraceptive coverage can take advantage of a credit card payment plan for Mirena that will allow them to pay for the system in four monthly, interest-free payments rather than paying the entire cost up front," states Kimberly Schillace, company spokeswoman. "In addition, for physicians who wish to purchase Mirena for patients, payment terms have been extended."

The ARCH (Access and Resources in Contraceptive Health) Foundation, a not-for-profit Charlotte, NC-based organization funded by Berlex Laboratories, operates its own patient assistance program to help financially challenged women obtain Mirena contraception.

"This [program] has made it free to most clients," says Donna Gray, CNM, NP, director of family planning at the Wyoming County Public Health Department, a public health facility in Warsaw, NY. "ARCH mails me an IUD with the client’s name." (See the resources below for contact information for the foundation, as well as for device manufacturers.) 

Get over the myths

While the new generation of IUDs offers safe, effective contraception, information on these devices has been slow to disseminate, say clinicians.

"Patients don’t seem to be able to overcome the barriers, ancient though they are, about the negative things they have been told about IUDs," observes Nicksich. "Education does not always seem to overcome this."

The experience with IUDs in other countries continues to show that intrauterine contraception is well accepted by many women. In a comparative study of five European countries (Italy, Spain, Poland, Germany, and Denmark), the IUD accounted for 9–24% of all contraceptive use.3

For intrauterine contraception to play the role it could play, never-pregnant women should not be excluded from using IUDs, state authors of A Pocket Guide to Managing Contraception.2 Recent research backs this approach: In a study comparing nulliparous women using oral contraceptives and the IUS, the safety and acceptability of the IUS was observed to be as good as with OCs, with a high continuation rate.4

"Many clinicians feel that IUDs are not appropriate for nulliparous women; however, the current findings indicate that the highly effective, levonorgestrel-releasing IUD is a safe, appropriate contraceptive choice for motivated, well-counseled, nulliparous women who prefer the convenience or menstrual-suppression effect of this device," states Andrew Kaunitz, MD, professor and assistant chair in the obstetrics and gynecology department at the University of Florida Health Science Center/Jacksonville.

References

1. Glassberg H. Safer alternatives dispel fear prompted by Dalkon Shield; looking for alternatives to pill. The Wall Street Journal, Aug. 3, 2004:D1.

2. Hatcher RA, Zieman M, Cwiak C, et al. A Pocket Guide to Managing Contraception. Tiger, GA: Bridging the Gap Foundation; 2004.

3. Spinelli A, Talamanca IF, Lauria L. Patterns of contraceptive use in 5 European countries. Am J Public Health 2000; 90:1,403-1,408.

4. Suhonen S, Haukkamaa M, Jakobsson T, et al. Clinical performance of a levonorgestrel-releasing intrauterine system and oral contraceptives in young nulliparous women: A comparative study. Contraception 2004; 69:407-412.

Resources

For more information on ParaGard, contact:

For more information on Mirena, contact:

  • Berlex Laboratories, 340 Changebridge Road, P.O. Box 1000, Montville, NJ 07045-1000. Telephone: (866) 647-3646 or (973) 487-2000. Web: www.mirena.com or www.berlex.com.

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.