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Study of IUD insertions and clinical performance in nulliparous women

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.

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Study of IUD insertions and clinical performance in nulliparous women

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  1. Study of IUD insertions and clinical performance in nulliparous women Dr Andrea Brockmeyer Dr Meera Kishen Abacus Clinics Liverpool, UK

  2. Background • Increased interest in IUDs from nulliparous women • Proven efficacy and safety of standard IUDs • No increased risk of PID in nulliparous women

  3. 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

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

  5. 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

  6. Methodology • Follow-up by postal questionnaire or contact by phone three months and one year after insertion

  7. STI screening • Sexual history • CT/GC testing offered if appropriate • Antibiotics (Azithromycin) offered if high risk of CT

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

  9. Age range

  10. Reasons for IUD/IUS fitting • EC and long-term use 30 (25.4%) • Interval fitting 88 (74.6%)

  11. STI testing • CT test at fitting 48 • CT test in current relationship 65 • CT test declined 5 • Antibiotics given 15 • No positive CT tests reported

  12. 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%)

  13. Clinicians impression of fitting • Easier than expected 46 (41%) • As expected 56 (50%) • Worse than expected 9 (8%)

  14. Client’s impression of fitting

  15. Client’s impression of fitting • Less painful than expected 37 (33%) • As expected 51 (45%) • More painful than expected 22 (19%)

  16. Three-month follow-up (interim results) • No of women contacted 112 • Questionnaire received 72 (64.2%)

  17. Problems • No, not at all 23 (32%) • Yes 49 (68%) • Symptoms but not a problem 10

  18. 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%)

  19. 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

  20. Pelvic infection • Pelvic infection 1 (1.3%)

  21. 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

  22. Satisfaction with IUD/IUS

  23. 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

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