Dramatic upswing reported in use of intrauterine devices

National data mirror findings: Over 2 million U.S. women now use IUDs

For the past decade, subscribers to Contraceptive Technology Update have been asked questions about their prescribing practices. The question "In the past year, how many IUDs have you personally inserted?" was first included in the 2001 survey in light of the 2000 introduction of the Mirena levonorgestrel IUD (Bayer HealthCare Pharmaceuticals, Wayne, NJ.) In that survey, just 3.4% of 2001 respondents said they inserted 25 or more IUDs, and 9.7% said they inserted 11-25 IUDs.

Look at results from the 2010 survey. A total of 30% of survey respondents said they inserted 25 or more IUDs in the last year, and 12% said they inserted 11-25 IUDs.

The latest installment of the National Survey of Family Growth (NSFG) tracks a similar rise in use. In 1995, just one percent was using the IUD, according to the NSFG. In the latest 2006-2008 NSFG statistics, 5.5% of contraceptors — 2.1 million women — were currently using IUDs.¹

Planned Parenthood of Illinois in Chicago also has seen a dramatic increase in the use of IUDs, primarily due to provider comfort with the method and staff educating about the benefits of long-acting reversible contraception, says Kai Tao, ND, MPH, CNM, vice president of clinical operations and associate medical director.

Clinicians at Thomas Jefferson Health District in Charlottesville, VA, are seeing more IUD users, especially Mirena users, says Leslie Steeves, CNM, a certified nurse midwife at the facility. Steeves estimates she inserted approximately 40% more Mirena devices this year than in 2009.

Providers at Richmond City Health District in Richmond, VA, are inserting more IUDs as a result of a grant from the Community Foundation of Richmond and Central Virginia and the Jenkins Foundation, both of Richmond, that awarded money for long-term contraceptive use, says Sulola Adekoya, MD, lead physician at the facility.

While the uptick in use is good, the United States has ground to gain when it comes to use of intrauterine contraception, says Andrew Kaunitz, MD, professor and associate chair in the obstetrics and gynecology department at the University of Florida College of Medicine — Jacksonville. Among women in Denmark and Germany who use contraception, 24% and 17%, respectively, use an IUD.² In France, 17.3% of married women ages 15-49 rely on the device.³

"In parts of Europe, particularly Northern Europe, the prevalence of IUD use is substantially higher than in the U.S. and the rate of unintended pregnancy and induced abortions is lower than in U.S. women," observes Kaunitz. "Our patients will certainly benefit if they become more 'European' in their contraceptive choices by more frequently choosing IUDs."

LARC in focus

Intrauterine device use is being examined as part of the Contraceptive Choice project in St. Louis. The project is designed to promote reversible long-term methods of contraception such as subdermal implants and intrauterine devices and to assess satisfaction and discontinuation rates with various contraceptive methods.

In preliminary results from the project, almost 70% of the participants chose long-acting methods; 56% chose IUDs and 11% chose implants.4 A 2010 analysis of data indicates once financial barriers were removed and long-acting reversible methods of contraception were introduced to all potential participants as a first-line contraceptive option, two-thirds of women in the project chose long-acting reversible methods of contraception.⁴

Who can use the IUD?

Two intrauterine contraceptives are available in the U.S.: the ParaGard Copper T 380A IUD (Duramed Pharmaceuticals, Pomona, NY) and the Mirena levonorgestrel intrauterine system (LNG-IUS).

According to A Pocket Guide to Managing Contraception, women may use intrauterine contraception if

• they are nulliparous or multiparous,
• are young or older until menopause,
• have had a sexually transmitted infection in the past,
• have had an ectopic pregnancy in the past,
• are not in a monogamous relationship, or
• have fibroids that do not distort the uterine cavity.⁵

In addition, intrauterine contraception may be inserted immediately postpartum in the delivery room. The Copper-T IUD may be used for emergency contraception, while the LNG-IUS may be used to help manage endometriosis, adenomyosis, fibroids, and dysfunctional uterine bleeding.⁵

Counsel women thoroughly about the advantages and disadvantages of both forms of intrauterine contraception. In talking about its effectiveness, help women to think of intrauterine contraception as "reversible sterilization." Women need to know that either intrauterine contraceptive may be removed at any time.⁵

References

1. Mosher WD, Jones J. Use of contraception in the United States: 1982-2008. Vital Health Stat 2010;29(23):1-44.
2. Spinelli A, Talamanca IF, Lauria L. Pattern of contraceptive use in 5 European countries. Am J Public Health 2000; 90:1403–1408.
3. Population Reference Bureau. Contraceptive Use Among Married Women 15-49, IUD (%). Accessed at http://www.prb.org/Datafinder/Topic/Bar.aspx.
4. Secura GM, Allsworth JE, Madden T, et al. The Contraceptive CHOICE Project: reducing barriers to long-acting reversible contraception. Am J Obstet Gynecol 2010; 203(2):115.e1-7.
5. Zieman M, Hatcher RA, Cwiak C, et al. A Pocket Guide for Managing Contraception. Tiger, GA: Bridging the Gap Foundation. 2010.