Buenas prácticas en el manejo de dispositivos intrauterinos: consejos y sugerencias para facilitar su inserción

Abstract

The role that long-acting reversible contraceptives, such as intrauterine devices (IUDs) can play in reducing the rate of unwanted pregnancies makes overcoming barriers to their use gain in importance. This paper reviews some of the most common barriers to the wide use of IUDs –including levonorgestrel-releasing intrauterine systems (LNG-IUSs)-, offering useful information and suggestions on key aspects before, during and after placement of these devices. To this end, the most up-to-date scientific evidence has been reviewed and where evidence is insufficient, the authors draw on their experience. Among the aspects to be considered before IUD placement, we examine how to determine a woman's eligibility, how to provide proper information, the need to know which IUD is best suited to her characteristics and needs and when is the best time for placement. Studies on pharmacological and non-pharmacological interventions that have been shown to have an effect on pain relief during IUD placement are discussed. Factors that can predict pain are also discussed, as well as how to help minimize it by improving women's experience during insertion. The risk for complications such as uterine perforation is low. Despite this, healthcare practitioners should be trained on how to manage them and should properly inform users on warning signs and symptoms. IUD placement can be especially difficult in women who present with stenosis after conization or who have undergone a Caesarean section, which we also analyze. Lastly, we examine management of vasovagal syncope and post-placement side-effects, such as pain or lost threads and provide guidelines for follow-up visits.