Higher discontinuation rate with a standard-sized compared to a small-sized ‘gold standard’ copper intrauterine device: a case-control review

Abstract

BackgroundT-shaped intrauterine devices (IUDs) with a copper surface area of 380 mm2 and copper bands on the transverse arms are the most effective types of copper-containing IUDs. A small-sized ‘gold standard’ IUD is available but there has been little research to compare the effects of this small-sized IUD to its standard-sized counterpart.AimTo determine discontinuation rates and reasons for discontinuation at 1 year of the small-sized Mini TT380 Slimline IUD compared with the standard-sized TT380 Slimline.MethodsThe clinical records of women fitted with Mini TT380 Slimline (‘mini’) IUDs were compared with those of women fitted with standard-sized TT380 Slimline (‘standard’) IUDs over a 3-year period (2013–2016).ResultsClinical records were available for 67 women fitted with a mini IUD (mean age 23 years, 64% nulliparous) and 63 women fitted with a standard IUD (mean age 25 years, 39% nulliparous). At 1 year, twice as many standard IUD users (32%, n=20) had discontinued their IUD use compared with mini IUD users (15%, n=10). Complaints of pain and bleeding were more than double (70%, n=14) in those women who discontinued standard IUD use compared with those who discontinued using the mini IUD (30%, n=3). These differences were statistically significant and were unrelated to parity.ConclusionsMore women using a standard-sized ‘gold standard’ IUD rather than its smaller counterpart complained of pain and bleeding, leading to higher discontinuation at 1 year. More research on the association between size and discontinuation of these IUDs is needed.

Discontinuation rates of intrauterine contraception due to unfavourable bleeding: a systematic review

“…Twelve studies (18 publications) report data for LNG-IUDs, either from single-arm studies, studies comparing the timing of placement of the device (three studies) or a study comparing two LNG dose levels [ 11 – 20 , 25 – 32 ]. Ten studies (10 publications) report data for Cu-IUDs, including two comparing two different devices [ 33 – 42 ]. A further eight publications describe the results of eight studies comparing an LNG-IUD with a Cu-IUD [ 43 – 50 ].…”

“…Rates of discontinuation overall or for bleeding were reported in 18 publications (14 studies) for women using LNG-IUDs [ 11 – 15 , 17 – 19 , 25 – 27 , 29 – 31 , 54 , 56 – 58 ], 10 publications (10 studies) for women using Cu-IUDs [ 33 – 42 ] and 14 publications (14 studies) reporting comparative data for the two types of IUDs [ 22 – 24 , 43 – 50 , 52 , 53 , 55 ] (see Table 2 ).…”

“…Ten publications (10 studies) reported rates of discontinuation/removal of Cu-IUDs for any reason [ 33 – 42 ], with rates from individual studies ranging from approximately 10% at 6 months in two studies [ 34 , 40 ] to approximately 16–32% at 1 year in five studies [ 33 , 35 , 38 , 41 , 42 ] and 40% at 2 years and 3 years in two studies [ 35 , 41 ]. Lower rates were reported for the VeraCept175 and Mini TT380 Slimline in two comparative studies, with 12-month rates being 16% [ 41 ] and 15% [ 42 ], respectively, for these Cu-IUDs compared with 32% for CuT380A. Rates of discontinuation due to bleeding were reported in eight studies [ 33 , 35 – 39 , 41 , 42 ].…”

Long‐acting contraception in adolescents and young women with type 1 and type 2 diabetes

“…[39][40][41][42][43][44][45] The most common side effects of the T-shaped Cu-IUD are heavy menstrual bleeding and dysmenorrhea, which have been reported in 5% of users and may lead to discontinuation of use. 46 These symptoms have been postulated to be secondary to the inflammatory reaction of the uterus. Serious adverse effects are infrequent and include infection, uterine perforation, and pregnancy complications.…”

“…The most common side effects of the T‐shaped Cu‐IUD are heavy menstrual bleeding and dysmenorrhea, which have been reported in 5% of users and may lead to discontinuation of use 46 . These symptoms have been postulated to be secondary to the inflammatory reaction of the uterus.…”