Use of intrauterine devices in nulliparous women

Lohr, Patricia A.; Lyus, Richard; Prager, Sarah

doi:10.1016/j.contraception.2016.08.011

Cited by 48 publications

(34 citation statements)

References 75 publications

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“…This proportion of IUD users differs greatly from Canadian population measurements, which estimated in 2006 that 4.3% of reproductive-age women at risk for unintended pregnancy use IUDs [18]. While this large disparity can be partially attributed to removing the cost barrier for some IUDs, the increasing trend over time within our study coincided with the increasing number of clinical guidelines recommending IUDs as a first choice contraceptive method for all women, including young nulliparae [1,10,[23][24][25][26][27][28][29]. In North America, both the ACOG and SFP released guidelines in 2009 and 2010, respectively, emphasizing the general lack of contraindications for IUD use for all women [30,31].…”

Section: Discussionmentioning

confidence: 88%

“…Research from the United States, New Zealand and China has found that the likelihood of a woman choosing an IUD as her contraceptive method increases with age and parity, especially postabortion [19][20][21][22]. Overall, young (under 20 years old), nulliparous women do not frequently choose IUD [18,21] despite many guidelines suggesting that IUD is a preferred option for this demographic [1,10,[23][24][25][26].…”

Section: Introductionmentioning

confidence: 99%

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Trends and determinants of postabortion contraception use in a Canadian retrospective cohort

Burk

Norman

2019

Contraception

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We aim to describe demographic trends associated with postabortion contraceptive choice, characteristics of intrauterine device (IUD) users and relation to subsequent abortion. Study design: Our retrospective chart review study included all patients obtaining an abortion from 2003 to 2010 at the primary service provider in the Interior Health Region of British Columbia, tracking each patient for 5 years to detect subsequent abortion. We used descriptive statistics to analyze demographic trends and logistic regression to examine determinants of choosing an IUD and likelihood of subsequent abortion per contraceptive method. Results: Our study cohort included 5206 patients, 1247 (24.0%) of whom chose an IUD. Patients increased IUD use from 10.14% to 45.74% of the cohort over the study period. Mean age of those choosing an IUD significantly decreased over the study period [30.9±7.3 years in 2003 to 26.2±6.5 years in 2010 (pb.001)]. In multivariable analysis, factors associated with choosing an IUD postabortion were prior delivery [aOR=2.77 (95% CI 2.40-3.20)] and being older than 20 years [20-29 years: AOR=1.87 (1.51-2.32); or 30+ years: AOR=1.96 (1.54-2.50)]. Patients choosing an IUD were less likely to have a subsequent abortion compared to those selecting oral contraceptives [aOR=1.96 (95% CI 1.54-2.52)] or depomedroxyprogesterone acetate [aOR=1.84 (95% CI 1.36-2.49)]. Conclusions: We found an increasing trend of choosing an IUD after an abortion in our population, especially among youth. Patients who chose an IUD postabortion were less likely to have a subsequent abortion over the next 5 years. Implications: An important strategy for reducing subsequent abortion is to ensure that those seeking abortion have accurate information on the comparative effectiveness of postabortion contraception methods. Educational efforts, alongside removal of cost and other barriers, will contribute to the prevention of subsequent abortion and improve equitable access to IUDs among the population.

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Section: Discussionmentioning

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Trends and determinants of postabortion contraception use in a Canadian retrospective cohort

Burk

Norman

2019

Contraception

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“…Particular concerns such as the risk of pelvic inflammatory disease (PID), infertility, safety, and difficulty of insertion may still present as biases in the provision of this group of women. However, recent studies have shown that intrauterine devices are safe and effective for the majority of women, including those who are young and nulliparous and should be routinely included in the contraception options offered to them 21 .…”

Section: Discussionmentioning

confidence: 99%

Reactional changes in short-term levonorgestrel-releasing intrauterine system (lng-ius) use

Giraldo

Souza

Henrique

et al. 2019

Rev. Assoc. Med. Bras.

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SUMMARY OBJECTIVE: To evaluate endocervical and vaginal environment changes in women using a levonorgestrel-releasing intrauterine system (LNG-IUS). METHODS: A quasi-experimental study included sixty women who had an LNG-IUS inserted in the Family Planning Clinic of UNICAMP between April and November of 2016. Women in reproductive age, non-pregnant, without the use of antibiotics and contraceptives seeking for LNG-IUS insertion were selected for this study. All women were evaluated with regard to vaginal and endocervical pH, vaginal and endocervical Gram-stained bacterioscopy, and Pap-smear before and two months after LNG-IUS insertion. Clinical aspects such as cervical mucus, vaginal discharge, and cervical ectopy were also observed. RESULTS: After LNG-IUS insertion, there was an increase in the following parameters: endocervical pH>4.5 (p=0.02), endocervical neutrophil amount (p<0.0001), vaginal cytolysis (p=0.04). There was a decrease in vaginal discharge (p=0.01). No statistically significant changes were found in vaginal pH, neutrophils amount in the vaginal mucosa, vaginal discharge appearance, vaginal candidiasis, bacterial vaginosis, vaginal coccobacillary microbiota, cervical mucus appearance, or cervical ectopy size. CONCLUSIONS: Short-term LNG-IUS use did not increase vulvovaginal candidiasis or bacterial vaginosis, and led to diminished vaginal discharge. Notwithstanding, this device promoted reactional changes in the vaginal and endocervical environment, without modification on cervical ectopy size.

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“…Two rare adverse effects are perforation of the uterus, related to the insertion procedure, and expulsion of the device. Commonly, the copper-bearing IUD induces a small increase in duration of menstruation and blood loss, while the LNG-IUD often reduces the flow and sometimes induces amenorrhea, and may therefore be useful in patients with anaemia [108][109][110][111][112][113][114].…”

Section: Intrauterine Devices (Iud)mentioning

confidence: 99%

Contraception in chronic kidney disease: a best practice position statement by the Kidney and Pregnancy Group of the Italian Society of Nephrology

et al. 2020

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Even though fertility is reduced, conception and delivery are possible in all stages of CKD. While successful planned pregnancies are increasing, an unwanted pregnancy may have long-lasting deleterious effects, hence the importance of birth control, an issue often disregarded in clinical practice. The evidence summarized in this position statement is mainly derived from the overall population, or other patient categories, in the lack of guidelines specifically addressed to CKD. Oestroprogestagents can be used in early, non-proteinuric CKD, excluding SLE and immunologic disorders, at high risk of thromboembolism and hypertension. Conversely, progestin only is generally safe and its main side effect is intramestrual spotting. Non-medicated intrauterine devices are a good alternative; their use needs to be carefully evaluated in patients at a high risk of pelvic infection, even though the degree of risk remains controversial. Barrier methods, relatively efficacious when correctly used, have few risks, and condoms are the only contraceptives that protect against sexually transmitted diseases. Surgical sterilization is rarely used also because of the risks surgery involves; it is not definitely contraindicated, and may be considered in selected cases. Emergency contraception with high-dose progestins or intrauterine devices is not contraindicated but should be avoided whenever possible, even if far preferable to abortion. Surgical abortion is invasive, but experience with medical abortion in CKD is still limited, especially in the late stages of the disease. In summary, personalized contraception is feasible, safe and should be offered to all CKD women of childbearing age who do not want to get pregnant.

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Use of intrauterine devices in nulliparous women

Cited by 48 publications

References 75 publications

Trends and determinants of postabortion contraception use in a Canadian retrospective cohort

Trends and determinants of postabortion contraception use in a Canadian retrospective cohort

Reactional changes in short-term levonorgestrel-releasing intrauterine system (lng-ius) use

Contraception in chronic kidney disease: a best practice position statement by the Kidney and Pregnancy Group of the Italian Society of Nephrology

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