Study of IUD insertions and clinical performance in nulliparous women

Dr Andrea Brockmeyer

Dr Meera Kishen

Abacus Clinics

Liverpool, UK

Background

Increased interest in IUDs from nulliparous women

Proven efficacy and safety of standard IUDs

No increased risk of PID in nulliparous women

Background

No studies about

acceptability removal rates for pain and bleeding rate of spontaneous expulsions

in the standard IUDs and the IUS in nulliparous

women in the UK

Objectives

To assess experience of IUD/IUS fitting and use by nulliparous women (< 24 weeks)

Methodology

Prospective pilot study Recruitment of 100 nulliparous women

at Central Abacus Routine IUD/IUS insertions or IUD

insertions for EC but long-term use Questionnaire at time of IUD/IUS

insertion

Methodology

Follow-up by postal questionnaire or

contact by phone three months and one year after insertion

STI screening

Sexual history CT/GC testing offered if appropriate Antibiotics (Azithromycin) offered if high

risk of CT

Recruitment

Recruitment from May-October 2005 Total recruited 118 IUD/IUS fitted 113 Available for follow-up 112 Failed insertions 2 Other problems 4

Age range

0

10

20

30

40

50

16-19 20-24 25-29 30-34 35-39 > 40

No

of

wo

men

Age in years

Reasons for IUD/IUS fitting

EC and long-term use 30 (25.4%) Interval fitting 88 (74.6%)

STI testingSTI testing

CT test at fittingCT test at fitting 4848 CT test in current relationshipCT test in current relationship 6565 CT test declinedCT test declined 5 5

Antibiotics givenAntibiotics given 1515

No positive CT tests reportedNo positive CT tests reported

Fitting procedure

Local anaesthesia 27 (24%) Difficulty sounding 17 (15%) Use of dilators 10 (9%) Problems 10 (9%)

Failed IUD insertion 2 (1.8%)

Client felt faint 7 (6%)

Clinicians impression of fitting

Easier than expected 46 (41%) As expected 56 (50%) Worse than expected 9 (8%)

Client’s impression of fitting

0

5

10

15

20

25

30

1 2 3 4 5 6 7 8 9 10

Client’s impression of fitting

Less painful than expected 37 (33%) As expected 51 (45%) More painful than expected 22 (19%)

Three-month follow-up (interim results)

No of women contacted 112 Questionnaire received 72

(64.2%)

Problems

No, not at all 23 (32%) Yes 49 (68%) Symptoms but not a problem

10

Abnormal bleeding

Abnormal bleeding 46 (63.8%) Periods heavier 39 (54.1%)

-Unable to cope 4 (5.5%) Intermenstrual bleeding 21 (29.1%) Postcoital bleeding 5 (6.9%) Other 8 (11.1%)

Pain

Pain 45 (62.5%) Periods more painful 35 (48.6%) Dyspareunia 10 (13.8%) Other 13 (18.0%)

- pain between periods 11

- constant pain 2

Pelvic infection

Pelvic infection 1 (1.3%)

Have you still got your IUD/IUS in?

Yes 65 (58%) No 7 (6%)

(+3 removed in 3/12) Expulsion 3 Removal 5 - Bleeding 2 - Pain 3

Satisfaction with IUD/IUS

0

2

4

6

8

10

12

14

16

18

0 1 2 3 4 5 6 7 8 9 10

Conclusion

In general, IUD/IUS fittings well tolerated

Majority of women satisfied with device NICE Guidance: All women should be

given full choice of methods incl. IUD/IUS

Numbers too small to compare devices