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