Intrauterine Device Discontinuation Research Articles

Bleeding profile and safety of a levonorgestrel 13.5 mg intrauterine device versus Nova T copper 380 mm2 intrauterine device: Results of a 3-year, single-center, randomized phase 4 study

ObjectiveTo assess the bleeding profiles of the levonorgestrel 13.5 mg intrauterine device (LNG13.5-IUD) and Nova T copper 380 mm2 IUD (Cu380-IUD). Study designSingle-center, evaluator-masked, randomized study conducted in women aged 18–45 years starting these methods. Primary outcomes were number of bleeding days, self-reported bleeding intensity, Pictorial Blood Assessment Chart (PBAC) score, and blood biochemical values at baseline, months 3, 6, 12, 24, and 36 per 90-day reference periods except for PBAC (months). Secondary objectives were presence/duration/intensity of dysmenorrhea and tolerability. ResultsWe included 106 women aged 32.5 ± 6.7 years: 55 with LNG13.5-IUD and 51 with Cu380-IUD. Data for LNG13.5-IUD versus Cu380-IUD at baseline and month 36 (both respectively) were as follows: (1) median (25th; 75th percentile) number of bleeding days: 12 (9.0; 15.0) versus 12 (9.0; 15.0), p = 0.82, and 4 (0; 13.7) versus 15 (14.2; 20.0), p < 0.001; (2) mean bleeding intensity: 1.7 for both, p = 0.66, and 0.7 and 2.2, p < 0.001. Forty percent versus 0% presented with amenorrhea at month 36; (3) mean PBAC score (95% Confidence interval (CI): 50.7 (16.6; 84.7) versus 130.4 (95.7; 165.0) at month 1, and 7.9 (−26.7; 42.6) versus 126 (90.7; 161.2), p < 0.001; (4) median (25th; 75th percentile) ferritin levels (Ug/L) 33 (19; 53) versus 30 (19; 45), p = 0.70, and 59 (42; 84) versus 21 (8; 39). We did not observe changes or differences between groups in hemoglobin and hematocrit. The duration and intensity of dysmenorrhea were significantly lower with LNG13.5-IUD versus Cu380-IUD. Adverse events were those expected. ConclusionsLNG13.5-IUD is associated with a significant reduction in blood loss and dysmenorrhea compared with Cu380-IUD. ImplicationsWomen eligible for a levonorgestrel 13.5 mg intrauterine device (IUD) or a copper 380 mm2 IUD should be informed of the differences in bleeding profiles—one of the main causes for IUD discontinuation—so they can compare this information against their bleeding expectations.

Identifying The Factors Associated with Time to Discontinuation of Intrauterine Device Among Women of Reproductive Age at Arba Minch Town and Zuria Woreda, Gamo Zone, Southern Ethiopia

Background: Intrauterine device (IUD) is the world’s most widely used reversible birth control method. This study was aimed to assess factors that influence the time to discontinuation of Intrauterine device among women who ever used IUD in Arba Minch Town and Zuria Woreda, Southern part of Ethiopia. Methods: A retrospective cohort study design was carried and stratified random sampling technique was used to determine sample of size 230 from a total population of 25,658 Women. The Kaplan-Meier estimation method was used to compare the survival experience of Intrauterine device discontinuation with respect to different covariates. Three parametric accelerated failure time models were compared by using AIC and BIC. Result: Accelerated failure time model with Weibull distribution was found to be appropriate model to fit the data set. The results indicated that the baseline age of the women’s, place of insertion, HIV test, income and educational level of women were significantly associated with time to discontinuation of IUD. Hence, illiterate women with low income and refused to test for HIV had higher hazard rate for time to discontinuation of IUD. Conclusion: From these analyses we conclude that the covariates such as age, place of insertion, Human Immunodeficiency Virus test, income and education are associated with time to discontinuation of Intrauterine device in classical approach. So, we recommended that all stakeholders should be considered when planning and implementing against women’s who utilize Intrauterine device to increase survival time of utilization.

Switching and discontinuation of participant-masked randomization to a copper or levonorgestrel intrauterine device when presenting for emergency contraception

ObjectivesExamine intrauterine device (IUD) switching or discontinuation up to 6 months after participant-masked randomization to different IUDs. Study designParticipants were randomized 1:1 to the copper T380A or levonorgestrel 52 mg IUD for emergency contraception and informed they could switch IUD type without cost at any time. ResultsOf the 327 subjects allocated to the levonorgestrel IUD, 7 (2.1%) switched their IUD type by 6 months versus 18 (5.5%) of the 328 copper IUD users (RR: 0.4 [95% CI: 0.2, 0.9], p = 0.03). Six-month IUD discontinuation occurred in 34 (10.4%) levonorgestrel and 35 (10.7%) copper IUD users. ConclusionIndividuals randomly assigned to IUD type at presentation for emergency contraception continue their assigned IUDs at high rates over 6 months. ImplicationsWhile many recruited individuals declined enrollment, those who accepted randomization had high continuation rates; the high continuation and low cross-over supports using IUD randomization as a tool for future investigation. Participants’ similar rates of and reasons for switching and discontinuation by IUD type over the study period may impact clinical counseling.

Systematic review of copper intrauterine contraception continuation in young nulliparous women based on intrauterine device type

ObjectivesNo copper intrauterine device (IUD) type is known to better suit young nulliparous women who tend to experience higher rates of IUD discontinuation compared with their older parous counterparts. A...

Use of the Levonorgestrel Intrauterine System to Treat Heavy Menstrual Bleeding in Adolescents and Young Adults with Inherited Bleeding Disorders and Ehlers-Danlos Syndrome.

To report on the rate of amenorrhea among adolescents and young adults with a bleeding diathesis after insertion of the 52-mg levonorgestrel intrauterine system (LNG-IUS) DESIGN: Retrospective chart review SETTING: Tertiary care, multidisciplinary Gynecology-Hematology clinic or Adolescent Gynecology clinic PARTICIPANTS: The cohort included 35 females aged 12-25 years presenting from January 2010 to January 2020 with heavy menstrual bleeding, 23 with an inherited blood disorder, and 12 with Ehlers-Danlos syndrome INTERVENTIONS: The 52-mg LNG-IUS MAIN OUTCOME MEASURES: Primary outcome was bleeding profile after LNG-IUS insertion. Secondary outcomes included rates of amenorrhea, intrauterine device (IUD) expulsion, IUD discontinuation, and unplanned pregnancy. Mean age at menarche was 11.6 years, with mean age at insertion of 16.9 (range 11-23). Most participants were white (n=26, 74.3%). Von Willebrand disease was present in 16 patients (45.7%) and Ehlers-Danlos syndrome in 12 (34.3%). Most (91.4%) had tried at least 1 hormonal regimen prior to LNG-IUS. Most participants (81.8%) reported improvement in bleeding, with 60.6% reporting spotting or amenorrhea. LNG-IUS expulsion occurred in 3 participants (9.1%) within the first 21 days, despite hemostatic agents at time of insertion. Mean continuation was 5.08 years (95% CI, 4.24-5.92), with 79% likelihood that participants kept their IUD in place for at least 2.5 years, and some up to 6 years. The 52-mg LNG-IUS is an effective treatment option for adolescents and young adults with heavy menstrual bleeding and a bleeding diathesis, with high rates of amenorrhea. Rates of IUD expulsion appeared higher during the first 30 days, but long-term continuation remained high.

Determinants of Intrauterine Contraceptive Device Discontinuation Among Women Using Family Planning, in Southwest Ethiopia: Unmatched Case-Control Study.

BackgroundAlthough the intrauterine contraceptive device is an effective, reliable, safe, and recommended contraceptive method, it is still underutilized and has a high discontinuation rate in Ethiopia. The study aims to assess determinants of the discontinuation of IUCDs among women using family planning in Ilu Aba Bor Zone.MethodsA facility-based unmatched case–control study was conducted from September to October, 2021 among 168 (56 cases and 112 controls) IUCD-user women in public health facilities in south-west Ethiopia. Pretested, structured and interviewer administered questionnaires were used for data collection. The data were coded, cleaned and entered to Epi-data version 3.1 and exported to SPSS version 23 for advanced analysis. A binary logistic regression was used to estimate the degree of association between the outcome variable and independent variables. Finally, variables with a p-value less than 0.05 at 95% confidence interval were declared as statistically significant with outcome variable.ResultsA total of 168 (163) respondents participated in the study, with a response rate of 97%. The mean (+SD) age of the respondents was 31.36 ± 5.916. Regarding the educational status of respondents about 36 (64.3%) of cases and 90 (84.1%) of controls have formal education, and about 42 (75%) of cases’ husbands and 97 (90.65%) of controls’ husbands have formal education, respectively. Experiencing side effects (AOR = 2.36; 95% CI: 1.01, 5.55), lack of follow up (AOR = 4.069; 95% CI: l.30, 12.69), and planning for next pregnancy (AOR 4.14; 95% CI: 1.58, 10.88) were found to be the main determinants of intrauterine device discontinuation.ConclusionThe findings of the study showed that lack of follow-up after insertion of the IUCD, experiencing side effects, and having a plan for the next pregnancy were found to be the main determinants of intrauterine device discontinuation. Hence, arranging recommended regular follow-up and treating side effects are very important to sustain intrauterine device utilization.

Predictors for Discontinuation of Intrauterine Devices That Underwent Ultrasound-Guided Placement in a Long-term Follow-up Cohort.

To investigate long-term outcomes of ultrasound-guided intrauterine device (IUD) insertion. The rate of and reasons for IUD discontinuation were reviewed, including the prevalence of uterine fibroids. A retrospective cohort of patients who underwent transabdominal ultrasound (TAUS)-guided IUD insertion was reviewed. Information collected included age, body mass index, insertion date, indication for IUD use, indication for using TAUS guidance, and presence of uterine fibroids. The date of and reason for discontinuation were recorded. One hundred sixteen patients with successful TAUS-guided IUD placement were identified. Of these, 51 patients (43.97%) no longer had an IUD in place. An overall actual-to-expected use ratio was calculated to be 63.49%. The most common reason for IUD discontinuation was spontaneous expulsion (11.21%). The prevalence of fibroid uteri was 27.6% in our cohort. The actual-to-expected use ratio of those with a fibroid uterus was calculated to be 43.28%, which was significantly lower than that for a nonfibroid uterus (73.80%; P=.002). There were 27 of 104 patients with IUD use of less than 1 year, and fibroids were present 44.4% of the time. Comparatively, of the 77 patients that had IUD continuation of greater than 1 year, only 24.7% had fibroids (P=.022). The yearly continuation rates over 5 years were 74.04%, 55.84%, 41.67%, 35.14%, and 32.0% respectively. Of the 18 patients who received TAUS-guided insertion for a previous IUD expulsion, 33.3% had another spontaneous expulsion. Uterine fibroids and a previous expulsion appear to be the most likely predictors of IUD discontinuation, particularly within 1 year after insertion.

Oral contraceptive use and anterior cruciate ligament injury: comparison of active comparator new user cohort and case-control study designs

BackgroundThis study further investigates a protective association between oral contraceptive (OC) use and anterior cruciate ligament (ACL) injury noted in prior case-control studies.MethodsActive comparator new user cohort analysis of women aged 13–45 years in the United States from the IBM MarketScan Commercial Claims and Encounters database who newly-initiated low-dose OCs (exposed) or underwent intrauterine device (IUD) insertion (comparison group) from 2000 to 2014. Women were followed for ACL injury starting 90 days after OC initiation or IUD insertion until OC or IUD discontinuation or end of continuous enrollment. Adjusted hazard ratios (adjHR) and 95% confidence intervals (CI) were estimated controlling for age. Secondary analysis replicated previously-published case-control studies assessing “ever” versus “never” OC use over 1- and 5-year periods among women who underwent ACL reconstruction compared to age-matched controls.ResultsIn the cohort analysis, 2,370,286 women initiated OCs and 621,798 underwent IUD insertion. There were 3571 (0.15%) ACL injuries during an average 370.6 days of continuous OC use and 1620 (0.26%) during an average 590.5 days of IUD use. No difference in risk of ACL injury was observed between OC initiators and IUD users (adjHR = 0.95; 95%CI 0.89, 1.01). The case-control analysis replicated the slight protective association observed in prior studies over a 5-year period (OR = 0.90; 95%CI 0.85, 0.94).ConclusionsThis cohort study suggests no association between OC use and ACL injury, while the case-control study suggested bias from uncontrolled confounding and selection factors may have influenced previous findings that suggested a protective association between OC use and ACL injury.

Discontinuation of intrauterine device: Are the reasons changing?

Intrauterine devices (IUDs) are among the most widely used contraceptive methods and users discontinue use despite its effectiveness due to different reasons. This study is aimed at determining the reasons for IUD discontinuation. A retrospective survey was conducted at Family Planning Clinic of University College Hospital, Ibadan, Nigeria. Information on socio-demographic characteristics, IUD - duration of use and reason(s) for removal was obtained using a proforma. Data were analyzed using SPSS version 20.0. A total of 1,961 women had IUD removal within the study period. Mean age and duration of use was 37.8 ±8.6 and 6.2±4.6 years, respectively. Their parity ranged from one to six and majority 528(26.9%) were 30-34 years of age. More than one-third 710(36.2%) had secondary level of education and were mainly grandmultipara. Commonest reasons for IUD discontinuation were side-effects 543 (27.6%) and client’s preference 536(27.3%). About a fifth of them had early IUD discontinuation while majority 651(33.2%) used the device for four to ten years. Thus, IUDs are safe and well tolerated with side effects and client’s preference as commonest reasons for its discontinuation. Providers should provide information on the side effects and its management at insertion knowing that the woman’s choice is paramount. Key words: Intrauterine devices (IUDs), discontinuation, duration, reasons.

“$231 … to pull a string!!!” American IUD users’ reasons for IUD self-removal: An analysis of internet forums

ObjectiveThe perspectives and experiences of intrauterine device (IUD) users who consider IUD self-removal are largely unknown. This study describes the reasons for IUD self-removal as documented in internet forums by IUD users discussing self-removal. Study designThis qualitative study used an internet search strategy to document IUD users’ reasons for self-removal in the United States. We employed a content analysis of online data using inductive and deductive qualitative techniques to examine the reasons why IUD users consider self-removal. ResultsSearch results initially identified 235 websites, of which 28 had online health or parenting forums with content related to IUD self-removal. Individual websites contained between 1 and 637 posts by between 1 and 454 individual users. IUD users described a variety of reasons for IUD discontinuation including undesired symptoms or side effects as well as planning for pregnancy. IUD users discussed difficulties accessing provider-removal because of cost or lack of appointment availability. IUD users also discussed how reading about others’ successful self-removal experiences or approval by medical providers made self-removal a feasible or acceptable option. ConclusionsSome IUD users utilize online forums for advice about IUD removal, and attempt IUD self-removal due to side effects or because they desire pregnancy. Lack of access to a provider led some patients to attempt self-removal who may have preferred provider-removal. ImplicationsFor those who prefer self-removal, anticipatory counseling from a clinician regarding self-removal might be useful and reassuring. Improving access to self-removal may help preserve reproductive autonomy for those who face barriers to IUD removal in the clinical setting.

Predictors of Discontinuation of Long-Acting Reversible Contraception Before 30 Months of Use by Adolescents and Young Women

PurposeThe purpose of the article was to describe adolescent and young women's rates of discontinuation of intrauterine devices (IUDs) and contraceptive implants, the extent to which discontinuation is predicted by baseline factors, reasons for discontinuation, and subsequent contraceptive initiation. MethodsWe recruited English-speaking women, aged 13–24 years, from a family planning clinic serving clients <25 years old. Participants completed surveys before and after contraceptive initiation visits. We reviewed medical records and contacted participants who initiated use of an IUD or contraceptive implant and assessed contraceptive discontinuation before 30 months of use. We collected follow-up data on duration of use, reasons for discontinuation, and new method selected. We used multivariable regression models to ascertain factors associated with method discontinuation. ResultsFrom 2011 to 2013, 775 young women completed surveys and initiated IUD or implant use. We determined 30-month discontinuation status of 633 women (81.7%). Among those with known outcome, fewer IUD than implant initiators had discontinued use (36.3% vs. 45.4%, p = .02). Mean duration of use was 733 days (95% confidence interval 702–763 days) for the IUD and 697 days (95% confidence interval 666–728 days) for the implant. Participants who stated at baseline that it was “very important” to avoid pregnancy were about half as likely to discontinue use. The most common reasons for discontinuation were pain (IUD) and bleeding (implant). Most participants initiated alternate contraception after discontinuing their original method. ConclusionsAdolescents and young women who initiate an IUD or implant make decisions for discontinuation based on weighing high contraceptive effectiveness with other reproductive health values and preferences.

Effect of baseline menstrual bleeding pattern on copper intrauterine device continuation

Heavy menstrual bleeding is a leading cause of copper intrauterine device discontinuation. Thus, girls and women with heavy baseline menstrual bleeding may be at increased risk for early copper intrauterine device discontinuation. Our objective was to assess if there was an association between baseline menstrual bleeding pattern prior to intrauterine device insertion and discontinuation rate at 12 months among study participants who chose copper intrauterine device at baseline. We performed a secondary analysis of the Contraceptive CHOICE Project, a prospective observational cohort study of 9256 girls and women offered no-cost contraception for 2-3 years. Included in our study were participants who chose copper intrauterine device for contraception and for whom method continuation data at 12 months were available. Prior to contraception initiation, participants were asked to qualify their menstrual bleeding over the past year as: light, moderate, moderately heavy, or heavy. Light bleeding corresponded to using ≤10 pads/tampons per period. Moderate, moderately heavy, and heavy bleeding corresponded to 11-20 pads/tampons, 21-30 pads/tampons, and >30 pads/tampons per period, respectively. Subjects were then categorized into either a "heavy" baseline group (those reporting moderately heavy or heavy bleeding at baseline), or a "not heavy" group (those reporting light or moderate bleeding). The 12-month continuation rate for each group was then calculated using Kaplan-Meier survival function, and hazard ratio for risk of discontinuation was evaluated using a Cox proportional hazard model to determine if moderately heavy or heavy bleeding at baseline was associated with early discontinuation. Of the 918 girls and women meeting the inclusion criteria for this analysis, 165 were in the heavy baseline bleeding group, while 753 were in the not heavy bleeding group. The 12-month continuation rates for groups were similar: 80.2% (heavy) and 85.0% (not heavy; P= .24). Patients reporting either moderately heavy or heavy baseline bleeding were not at increased risk for early discontinuation of copper intrauterine device (hazard ratio, 1.21; 95% confidence interval, 0.88-1.66). Our sample size provided >90% power to detect a clinically important difference of 15% (assuming 20% discontinuation rate in not heavy bleeding group and a 35% discontinuation rate in the heavy bleeding group). We did not find that girls and women who reported baseline moderately heavy or heavy menstrual bleeding were at increased risk for early discontinuation. Thus, we do not believe that girls and womenwith heavy menstrual bleeding should be discouraged from using this safe and highly effective form of contraception.

Use and discontinuation of intrauterine contraceptive device in the Greater Accra Region of Ghana

BackgroundThe intrauterine contraceptive device is one of the modern long-acting and reversible contraception that is very safe and effective. Yet, less than 2 % of women are using intrauterine devices in Ghana. This study therefore explored the experiences and barriers to intrauterine contraceptive device use and discontinuation in Greater Accra Region, Ghana.MethodsIntrauterine contraceptive device users and providers were purposively selected from eight private family planning clinics in the Greater Accra Region. Semi-structured interview guides were used for in-depth interviews during data collection. The interviews were audio-taped to ascertain accurate accounts of the interviews and recordings replayed for analytical responses. Field assistants transcribed the interviews conducted themselves and read through the transcripts produced twice to increase familiarity with the dataset. A list of code labels was created and a series of categories for the main themes that emerged from the transcripts were developed. The transcribed data was organized, coded and manually thematically analysed in word. Study results were presented in tables and quotes from respondents.ResultsResults showed that key motivations for intrauterine contraceptive device use include effectiveness, benefits, and efficacy of the device, fertility regulation, peace of mind, contraceptive method switching, health provider effects, desire for long-acting contraceptive method, and partner characteristics. Intrauterine contraceptive device discontinuation was due to bleeding irregularities, vaginal infections, desire to increase fertility, physical features of the intrauterine device, and partner disapproval of use. Other reasons in both cases pertained to non-hormonal aspects of the intrauterine device, partner characteristics, and provider encouragement and influence.ConclusionsSeveral factors influence the use and discontinuation of intrauterine device in Ghana. Comprehensive contraceptive counselling on the intrauterine device is essential in promoting uptake and knowledge of the intrauterine device at the health facility level. Various targeted messages are also needed to dispel misconceptions at the community level.

Effect of Knowledge of Self-removability of Intrauterine Contraceptives on Uptake, Continuation, and Satisfaction

ObjectivePreference for control over use is a consideration in choosing a contraceptive method. Counseling women on the possibility of intrauterine device (IUD) self-removal may increase interest in the method. This study tests whether counseling on self-removability as a stated feature of IUDs affects uptake, satisfaction, and continuation. Study DesignWe monitored clinic-level data on IUD uptake at clinics in Michigan, Missouri, New Jersey, and Utah over 6 months. During the first 3 months, counselors provided standard contraceptive counseling. During the second 3 months, they added information about IUD self-removal. Women who initiated IUD use in both periods were recruited and asked to complete baseline and follow up surveys at 3 and 6 months after insertion. Among 361 women who had IUDs inserted during the study, we compared outcomes for women who did and did not receive information about self-removability during contraceptive counseling. We conducted descriptive analyses to test for differences by group and used logistic regression and survival analysis to assess discontinuation. ResultsThere were no differences in IUD uptake, satisfaction, or discontinuation by receipt of self-removal information. Those who did not receive information about self-removal were more likely to report considering discontinuing use of the IUD. One-third of participants who considered discontinuation faced barriers to IUD removal. Knowledge of self-removability before the study was high in both groups, reducing our ability to find group differences. ConclusionsCounseling women on the possibility of self-removal may empower women when they face barriers to removal at facilities. More research is needed to understand whether knowledge of self-removal increases uptake and continuation.

A retrospective evaluation of the intrauterine device in a patient population in Buenos Aires, Argentina

BackgroundThe intrauterine device (IUD) is a long-acting reversible contraceptive method that is safe for a wide range of women, including adolescents and nulliparous women. Globally, it is often underutilised due...

Adolescent Experiences With Intrauterine Devices: A Qualitative Study

PurposeThe purpose of this study was to improve understanding of adolescents' reasons for choosing an intrauterine device (IUD) and to explore experiences that led to continuation or discontinuation of the levonorgestrel intrauterine system (LNG-IUS) and the copper IUD (copper IUD). MethodsWe conducted focus groups (FGs) with adolescents and young women who were current or former IUD users stratified by IUD type and 12-month IUD continuation or discontinuation. All subjects were participants from the Contraceptive CHOICE Project. FG data were supplemented with in-depth interviews (IDIs). Data collection was continued until thematic saturation was reached. Transcripts were independently coded by two researchers, and interrater reliability was calculated using a Kappa coefficient. Analysis followed a standard text-analysis approach. ResultsThirteen FGs and seven IDIs were conducted with 43 young women. Effectiveness, duration of use, convenience, and potential bleeding changes emerged as themes for both choosing and continuing IUDs. Some women chose the LNG-IUS to achieve amenorrhea, whereas copper IUD users wanted a nonhormonal method and continued menses. Copper IUD users cited expulsion and bleeding irregularities as reasons for discontinuation, whereas LNG-IUS users reported bleeding irregularities and continued pain as reasons for removal. IUD users noted an adjustment period of weeks to months in which side effects were present before lessening. ConclusionsEffectiveness, duration of use, convenience, and potential changes in bleeding patterns drove adolescents' choice and continuation of an IUD. Bleeding changes and pain contributed to IUD discontinuation. Discussion of effectiveness, duration and convenience, and anticipatory guidance regarding post-insertion side effects may be important in counseling young women about IUDs.

Determinants of intrauterine contraceptive device discontinuation among Indian women.

To determine intrauterine contraceptive device (IUCD) discontinuation rate and its causes and related factors among women attending the OPD/family planning clinic in Mahila Chikitasalaya, SMS Medical College, Jaipur from January 2012 to December 2012. 387 women who had an intrauterine device (IUD) inserted during the last 1-5years were interviewed during their visits to the OPD/family planning clinic. Sociodemographic characteristics for all women were described using frequency distribution. Life tables were used to describe the proportion of women who discontinued IUD at various time intervals. The main outcome measure was IUD discontinuation. The incidence of IUD discontinuation in the first year following insertion was 16.79%. Approximately 31% of the study sample continued using their devices after 5years. The average duration of IUD use was 36months. Of the 387 women, 56% discontinued IUD use because of a desire to conceive, 27.7% because of side effects, 15.36% because of opposition from the woman's family, and 1.5% because they were sexually inactive. The most common side effects reported as the reasons for discontinuation were bleeding, infection, and pain. Discontinuation was inversely related to the age at insertion, the number of living children, and the sex of children. Previous contraceptive users were significantly less likely to discontinue IUD use. The crude cumulative rate of IUD discontinuation was 16.79% during the first year, suggesting a need to tackle the problem of discontinuation through effective educational strategies and counseling techniques. Desire to have a male child still predominates among Indian families. The average duration of IUD use in majority of the females was about 36months (45%), thereby fulfilling its objective of spacing between children as laid down by the WHO (2years spacing between pregnancies). About 31% of the women continued using IUCD even after 5years. It is crucial to correct misconceptions and identify the lack of correct and complete information both among the providers and the acceptors, to improve the effectiveness of family planning programs.

Levels and determinants of switching following intrauterine device discontinuation in 14 developing countries

ObjectiveTo examine the levels and determinants of switching to any reversible modern contraceptive method following intrauterine device (IUD) discontinuation due to method-related reasons among women in developing countries. Study DesignWe analysed 5-year contraceptive calendar data from 14 Demographic and Health Surveys, conducted in 1993–2008 (n=218,092 women; 17,151 women contributed a total of 18,485 IUD episodes). Life-table methods were used to determine overall and cause-specific probabilities of IUD discontinuation at 12 months of use. For IUD episodes discontinued due to method-related reasons, the probability of switching to another reversible modern method within 3 months was estimated, overall and by place of residence, education level, motivation for use, age category and wealth tertiles. Country-specific rate ratios (RR) were estimated using generalized linear models, and pooled RRs using meta-analyses. ResultsThe median duration of uninterrupted IUD use was 37 months. At 12 months, median probability of discontinuation was 13.2% and median probability of discontinuation due to method-related reasons was 8.9%. Within 3 months of discontinuation due to method-related reasons, half of the women had switched to another reversible modern method, 12% switched to traditional methods, 12% became pregnant, and 25% remained at risk for pregnancy. More educated women were more likely to switch to another reversible modern method than women with primary education or less (pooled RR 1.47; 95% CI 1.10–1.96), as were women in the highest wealth tertile (pooled RR 1.38; 95% CI 1.04–1.83) and women who were limiting births (pooled RR 1.35; 95% CI 1.08–1.68). ConclusionDelays to switching and switching to less reliable methods following IUD discontinuation remain a problem, exposing women to the risk of unwanted pregnancy. Family planning programmes should aim to improve quality of services through strengthening of counselling and follow-up services to support women's continuation of effective methods. ImplicationsThe risk of unintended pregnancy following IUD discontinuation remains high in developing countries. The quality of family planning services may be an important factor in switching to alternative modern contraceptive methods. Service providers should focus on counselling services and follow-up of women to support the continued use of effective methods.

Effects of Age, Parity, and Device Type on Complications and Discontinuation of Intrauterine Devices

To conduct an analysis of intrauterine device (IUD)-related outcomes including expulsion, contraceptive failure, and early discontinuation and to compare these outcomes in regard to age, parity, and IUD type. This was a multicenter retrospective chart review of adolescents and women aged 13-35 years who had an IUD inserted for contraception between June 2008 and June 2011. A total of 2,523 patients' charts were reviewed. Of these, 2,138 patients were included in our analysis. After a mean follow-up of 37±11 months, the overall rates of IUD expulsion and pregnancy were 6% and 1%, respectively, and were not significantly different by age or parity. Intrauterine device discontinuation rates were 19% at 12 months and 41% after a mean follow-up of 37 months. Despite similar rates of IUD discontinuation between age groups at 12 months of use, teenagers and young women aged 13-19 years were more likely to request early discontinuation at the end of the total follow-up period. No significant difference was noted in pelvic inflammatory disease rates (2%) based on age. After adjusting for age and parity, we found that copper IUD users were more likely to experience expulsion and contraception failure compared with levonorgestrel intrauterine system users (hazard ratios 1.62, 95% confidence interval [CI] 1.06-2.50 and hazard ratios 4.89, 95% CI 2.02-11.80, respectively). Similar to adults, IUD use in adolescents and nulliparous women is effective and associated with low rates of serious complications. Health practitioners should therefore consider IUDs for contraception in all females. Teenagers and young women are more likely to request premature discontinuation of their IUDs and may benefit from additional counseling.

Temporal Trends of Copper-Bearing Intrauterine Device Discontinuation

Copper-bearing intrauterine device (IUD) insertion for long-term contraceptive use is high in China, but there has been evidence that first-year discontinuation rate of copper-bearing IUD has also increased rapidly in recent years especially among rural married women. To investigate long-term use of copper-bearing IUD, the authors examined the 7-year temporal trends of copper-bearing IUD discontinuation in a population-based birth-cohort study among 720 rural married women in China, from 2004 to 2012. Women requesting contraception were followed-up twice per year after the insertion of IUD. The gross cumulative life table discontinuation rates were calculated for each of the main reasons for discontinuation as well as for all reasons combined. By the end of 7 years, 384 discontinuations were observed. With a stepped-up trend, the gross cumulative life table rate for discontinuation increased from 10.06 (95% confidence interval = 7.86-12.27) per 100 women by the first year to 52.69 (95% confidence interval = 48.94-56.44) per 100 women by the end of 7 years, which increased rapidly in the first 2 years after copper-bearing IUD insertion, flattened out gradually in the following 2 years, then increased again in the last 3 years. Among reported method failure, expulsion and side effects were the main reasons for discontinuation of the copper-bearing IUD but not pregnancy. Personal reasons, such as renewal by personal will had influenced copper-bearing IUD use since the second year and should not be neglected. Based on this study, the temporal trends of copper-bearing IUD discontinuation was in a stepped-up trend in 7 years after insertion. Both reported method failure (expulsion and side effect) and personal reason had effect on the discontinuation of copper-bearing IUD, but pregnancy was no more the most important reason affecting the use of copper-bearing IUD.