Difficulty of Intrauterine Contraceptive Insertion in Relation to Menstrual Cycle Day of Insertion [3H]

Abstract

INTRODUCTION: The November 2017 American College of Obstetricians and Gynecologists (ACOG) Practice Bulletin No. 186 states that an intrauterine contraceptive (IUC) can be inserted “at any time during the menstrual cycle as long as pregnancy may be reasonably excluded”. However, many providers insert IUCs during menstruation to ensure that a woman is not pregnant and because of a belief that this timing leads to easier insertions. A delay in insertion may be an obstacle to access. This study aims to evaluate if menstruation decreases the rate of difficult insertions. METHODS: We conducted a retrospective chart review of 250 women with IUC insertions in our Gynecology outpatient clinic within 5 days of the start of last menstrual period (LMP) compared to women with insertion outside of menses. Difficult insertions were defined as an initial failed attempt at placement, need for additional dilation, need for pharmacologic cervical preparation, need for second provider, or need for ultrasound guidance. RESULTS: IUCs were inserted within 5 days of LMP in 18.8% of patients (n = 47). The overall difficult insertion rate was 10.0% (n = 25) with 4 failed placements (1.6%). For insertions within 5 days of LMP, 17.0% were difficult compared to 8.4% for insertions not within 5 days of LMP. CONCLUSION: Our results indicate that IUC insertion within 5 days of LMP is not associated with a higher rate of difficult placements. Changing practice patterns to encourage interval IUC insertion would decrease the barrier of timing for women seeking a long-acting form of contraception.