Long-Acting Reversible Contraception Continuation After Management of a Malpositioned Intrauterine Device [ID: 1376021

Abstract

INTRODUCTION: Studies have investigated risk factors for intrauterine device (IUD) malposition, but there is a paucity of data regarding patients’ contraceptive decisions after experiencing a malpositioned IUD. Therefore, we sought to investigate continued long-acting reversible contraception (LARC) usage after management of a malpositioned IUD. METHODS: After IRB approval, a retrospective cohort study was conducted, which included 541 patients who underwent IUD insertion at one institution with subsequent pelvic imaging. One hundred six had a malpositioned IUD and were age-matched to controls. Chart and imaging reports were abstracted. Long-acting reversible contraception retention was documented through 24 months from index imaging. RESULTS: Most patients had a levonorgestrel IUD (90.9%) for the indication of contraception alone (54.1%). The imaging indication of abnormal uterine bleeding (AUB) was most likely to be associated with malposition (odds ratio [OR] 1.67 [1.03–2.71], P=.038), as well as a copper IUD type (OR 5.31 [2.14–13.18], P<.001). Most patients with a malpositioned IUD did not have an IUD replaced after removal (57.8%). Of those who abandoned IUD therapy, only six chose to initiate an alternative LARC. Malposition was not an independent risk factor for LARC abandonment between the two groups over the 24 months of follow-up. Risk factors for abandonment over the follow-up period included AUB, copper IUD use, younger age, and shorter duration of use before undergoing imaging. CONCLUSION: Most patients with a malpositioned IUD did not have IUD replacement and abandoned all LARC therapy. These are important preliminary findings regarding LARC abandonment associated with IUD malposition that will help shape further studies as well as clinical counseling.