Intrauterine Device Users Research Articles

Evaluation of Predictive Value of Uterine Artery Doppler Indices versus Histopathology Sampling in Detection of Abnormal Uterine Bleeding in Intrauterine Contraceptive Device Users

Background: Contraceptive intrauterine device (IUD) is a successful method of contraception that has been used for more than 30 years. However, it is associated with excessive uterine bleeding, that might cause iron deficiency anaemia, making CIUD use inconvenient for many women especially those with severe menstruation. Objective: The objective of our study was to evaluate the correlation between abnormal uterine bleeding in IUD with endometrial sampling. Methods: Study included 120 women from the obstetrics and gynaecology departments of Zagazig University Hospitals, divided into three groups: Group I included 40 women who used intrauterine coipper (TCu-380A) and complained of menorrhagia or menometrorrhagia. Group II included 40 womenusing CIUD and not complaining of abnormal uterine bleeding. Group III included 40 women complaining of vaginal discharge or requesting CIUD insertion, and not complaining of abnormal uterine bleeding as a control group. Results: PI and RI were significantly lower in IUD-induced irregular bleeding than in IUD-induced women who did not complain of abnormal vaginal bleeding. Conclusion: Endometrial biopsy has no role in predicting the abnormal uterine bleeding cause. Transvaginal ultrasonography findings can be efficiently used to classify women at risk of experiencing excessive uterine bleeding following CIUD insertion and to make a preliminary diagnosis, thus, notify the pathologists.

Clinical Evaluation of Li Brush Endometrial Samplers for Diagnosing Endometrial Lesions in Women With Intrauterine Devices.

Background: For women with intrauterine devices (IUDs), it is difficult to sample the endometrium when abnormal uterine bleeding occurs or when regular screening of endometrial cancer is proposed. The purpose of this study is to evaluate the validity of endometrial sampling using Li Brush in IUD users.Methods: This study was a prospective cohort study and conducted in two parts. Part I was to assess the impact of Li Brush on the position of IUDs. Transvaginal ultrasound was used to locate IUDs before and after sampling. Part II was to explore the diagnostic accuracy of Li Brush in detecting endometrial lesions. IUD users with irregular uterine bleeding were recruited in the IUD group and IUD non-users who arranged for dilatation and curettage (D&C) were recruited in the control group. The endometrium was sampled by Li Brush for cells and by D&C for tissues in both groups. The satisfactoriness of sampling and validity of Li Brush were evaluated.Results: Seventeen cases in part I confirmed no significant difference in the position of IUDs before and after sampling (p = 0.20). 112 IUD users and 139 IUD non-users were recruited in part II. Li Brush achieved 94.64 and 92.09% satisfactory sampling rates in the IUD group and control group, respectively, without statistically significant difference between the two groups (p = 0.42). The Sensitivity and specificity of Li Brush for detection of endometrial lesions in IUD group were 95.35 and 87.76% respectively.Conclusions: Li Brush used for endometrial biopsy did not affect the position of IUDs and had high yield of satisfactory samples and good validity for endometrial diagnoses. It was feasible to screen endometrial lesions by Li Brush for women with IUDs.

Pregravid contraceptive use and fecundability: prospective cohort study

ObjectiveTo evaluate the association between pregravid use of a variety of contraceptive methods and subsequent fecundability.DesignProspective cohort study.SettingDenmark and North America, 2007-19.Participants17 954 women who had tried to conceive for...

Differences in knowledge and attitudes toward the intrauterine device: Do age and race matter?

The intrauterine device (IUD) is highly effective birth control, but US IUD usage lags. Barriers to usage, including patient attitudes and lack of knowledge, are not well-characterized. This study sought to investigate how attitudes and knowledge about IUD vary by age and race. A survey was distributed to all women in the outpatient obstetrics and gynecology office of a large, urban, academic medical center in Philadelphia. Exclusion criteria included inability to read English or age less than 14 years. Surveys queried participant demographics, knowledge about and opinions of IUD. The authors performed exploratory bi-variable analysis using t tests and chi-square testing to determine which outcomes differed by age and race. For those differing significantly, the authors performed regression analysis to assess for confounding by other factors. Of 1366 women approached, 521 completed the survey (38% response rate). After controlling for confounding, only responses to the statement 'Hormonal birth control is safe and effective' differed significantly by age. Knowledge about IUD did not differ significantly by race, but black women were significantly more likely to perceive that they had insufficient knowledge about IUD compared to white women (odds ratio [OR]: 1.91; 95% confidence interval [CI]: 1.06-3.46). Black women had a more negative opinion of IUD safety (OR: 5.0; 95% CI: 2.35-10.66) and reliability (OR: 5.5; 95% CI: 2.20-14.13) than white women. Attitudes and knowledge about IUD do not differ significantly by age. While knowledge about IUD is similar between races, black women may have more negative opinions of IUD.

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.

Management of bothersome bleeding associated with progestin-based long-acting reversible contraception: a review.

To describe common bleeding patterns and treatment strategies to minimize bothersome bleeding in users of progestin-based long-acting reversible contraception (LARC). Most levonorgestrel intrauterine device users will establish a favorable bleeding pattern within a year; NSAIDs are the most effective bridge to help with bothersome bleeding during that time period. Early follicular phase insertion and fundal placement are associated with more favorable early bleeding profiles. Recent studies exploring tranexamic acid, mifepristone, and tamoxifen's adjunct role show modest or no benefit. The progestin implant is associated with more persistent unpredictable bleeding disproportionately affecting women with higher etonogestrel serum levels; recent studies indicate that oral contraceptives, ulipristal acetate, and tamoxifen may all provide temporary relief. Women's healthcare providers can offer patients adjunct medical therapies to minimize bothersome bleeding associated with progestin LARC use, which may result in increased satisfaction and continuation rates of these effective forms of contraception.

Sexual Life Pattern and Self-Care Practices Among Copper Intra Uterine Device (IUD) User At Assiut City

Abstract Background: Contraceptives as IUD method can enhance women’s and public health, but may be terminated due to occurance of some problems as sexual problems and genital infection Aim: To assess self-care practices and sexual life pattern among copper IUD user at Assiut city. Methods: Descriptive research design was used, sample size convience sample involved 500 women IUD’s users, study was conducted at family planning outpatient clinic, Woman’s Health Hospital, and Qlta Maternal and Child Health Care center and Mabra Hospital, Eleman hosital Assiut, Egypt. Data was collected by using interview questionnaire. Results: Study shows that 67.6% of studied women have a satisfactory practices. Regarding sexual life pattern about 26% of women complain from differences in libido after using IUD, 24.4%, 21.2%, 23.6%, 20.0%, 26.8%, and 25.8 % of women have a difference in sexual desire, difficulty in vaginal wetting during cotius, difficultly reach orgasm, woman's don’t satisfied at the end of sexual relationship, husband don’t satisfied at the end of sexual relationship, and dysparenia respectivelly. Conclusion: IUD’s users had insufficient self care practices and there have some form of sexual pattern affected by using IUD as a contraceptive method. Recommendations: Educational program about self care practices and sexual pattern for IUD users should be provided. Counselling from health care provider about self care practice

Sexual Life Pattern and Self-Care Practices Among Copper Intra Uterine Device (IUD) User At Assiut City

Sexual Life Pattern and Self-Care Practices Among Copper Intra Uterine Device (IUD) User At Assiut City

Reasons Why Young Women in the United States Choose Their Contraceptive Method.

Background: Understanding reasons for birth control method choice may inform interventions that help young women choose the best method for them. The purpose of this study was to examine why young women in the general population select their method of contraception. Methods: An online survey was advertised through social media in 2017. After consenting, participants were gated through questions that ensured they were female, within the age range (16-25 years old), lived in the 50 U.S. states, and using intrauterine devices (IUDs), hormonal birth control, or barrier methods specified in the survey. Surveys with incompatible responses were excluded. Satisfaction, plans to discontinue, and primary reason for using current contraceptive method were examined and compared by contraception types using chi-square analyses. Multivariable binary logistic regression was used to examine satisfaction between contraceptive methods and races/ethnicities. Results: A total of 2632 responses were included. A high frequency of women using less effective methods (48.6% of nonhormonal birth control) chose them primarily to prevent pregnancy (20.6% of Copper T IUD, 23.0% of hormonal IUD, and 30.9% of Mirena IUD users), while other more effective birth control methods were often chosen primarily for other reasons. Recommendations from family or friends (14.6%) were used by some to make their contraception decision. Black respondents were less likely and Hispanic respondents were more likely to be satisfied with their birth control compared to white women. Conclusion: Providers should consider that their young patients may want to better understand benefits and side effects of their birth control outside of pregnancy prevention. Furthermore, young women may utilize their friends and family to make their contraceptive choice, which should be taken into consideration when counseling patients.

Assessing Sexual Function of Women after 12 Months of IUD Usage

The Intrauterine Device (IUD) is a well-accepted method of contraception. Most women are currently using it because of its effectiveness, longevity, and affordability. Moreover, users need no strict routine instructions for IUD. However, many women in the absence of any pre-existing conditions that may impair sexual functions discontinue the method due to poor sexual satisfaction. This paper aims to assess and measure the effects of IUDs on sexual function in women with no underlying condition over a period of 12 months. This study employed a longitudinal approach. To be eligible to participate, the study enrolled 260 women who have chosen to use IUDs willingly on their own at these selected centers during this period and are aged 20 years and above. It collected data at baseline and at 12 months of use. Measurements at these two timelines were done using the Female Sexual Function Index (FSFI). The prevalence of female sexual dysfunction among participants after 12 months was 47.7% (124). In the analysis of Mean scores, FSFI at baseline and at 12 months was 31.31 and 24.76 respectively (p<0.05). Significantly reduced scores (p=0.001), for all the six domains (desire, arousal, lubrication, orgasm, satisfaction, and pain) of sexual function were noted. Desire and pain were the most affected areas of sexual function with very low scores. Without any underlying and related triggers of sexual health, the study discovered that IUDs have the potentials to cause female sexual dysfunction in almost half of its users.

Free-of-charge long-acting reversible contraception: two-year discontinuation, its risk factors, and reasons

Since 2013, the residents of the city of Vantaa, Finland, have been offered their first long-acting reversible contraceptive method (levonorgestrel-releasing intrauterine system, implant, and copper intrauterine device) free of charge. The primary aim of this study was to assess the 2-year cumulative discontinuation rates of long-acting reversible contraceptive methods when provided free of charge for first-time users in a real-world setting. Additional aims were to describe factors associated with discontinuation and to evaluate the reasons for discontinuation. This is a retrospective register-based cohort study of 2026 nonsterilized women aged 15 to 44 years, who initiated a free-of-charge long-acting contraceptive method in 2013-2014 in the city of Vantaa. Removals within 2 years after method initiation and reasons for discontinuation were obtained from electronic health records and from national registers. We calculated the 2-year cumulative incidence rates of discontinuation with 95% confidence intervals for each method. Furthermore, we assessed crude and adjusted incidence rate ratios of discontinuation with 95% confidence interval by Poisson regression models comparing implants and copper intrauterine device with levonorgestrel-releasing intrauterine systems. During the 2 -year follow-up, 514 women discontinued, yielding a cumulative discontinuation rate of 28.3 per 100 women-years (95% confidence interval, 26.2-30.4). Among the 1199 women who initiated the levonorgestrel-releasing intrauterine system, the cumulative discontinuation rate was 24.2 per 100 women-years (95% confidence interval, 21.7-26.9); among the 642 implant users, 33.3 per 100 women-years (95% confidence interval, 29.5-37.4); and among the 185 copper intrauterine device users, 37.8 per 100 women-years (95% confidence interval, 31.0-45.7). Compared with women aged 30 to 44 years, women aged 15 to 19 years (adjusted incidence rate ratio, 1.58; 95% confidence interval, 1.17-2.14) and 20 to 29 years (adjusted incidence rate ratio, 1.35; 95% confidence interval, 1.11-1.63) were more likely to discontinue. We observed a higher discontinuation rate in women who had given birth within the previous year (adjusted incidence rate ratio, 1.36; 95% confidence interval, 1.13-1.65), spoke a native language other than Finnish or Swedish (adjusted incidence rate ratio, 1.31; 95% confidence interval, 1.06-1.63), and had a history of a sexually transmitted infection (adjusted incidence rate ratio, 1.62; 95% confidence interval, 1.07-2.46). No association was found in marital status, overall parity, history of induced abortion, socioeconomic status, education level, or smoking status. The most common reason for discontinuation was bleeding disturbances, reported by 21% of women who discontinued the levonorgestrel-releasing intrauterine system, by 71% who discontinued the implant, and by 41% who discontinued the copper intrauterine device. One in 4 women who discontinued the copper intrauterine device reported heavy menstrual bleeding, whereas only 1% who discontinued the levonorgestrel-releasing intrauterine system and none who discontinued implants reported this reason. Abdominal pain was the reported reason for discontinuation in 20% of both intrauterine device users and in only 2% who discontinued implants. At 2 years, the use of implants and copper intrauterine devices was more likely to be discontinued than that of the levonorgestrel-releasing intrauterine system. Women younger than 30 years and those who gave birth in the preceding year, spoke a native language other than Finnish or Swedish, or had a history of sexually transmitted infections were more likely to discontinue. The levonorgestrel-releasing intrauterine system was least likely to be removed owing to bleeding disturbances.

Elevated Risk of Bacterial Vaginosis Among Users of the Copper Intrauterine Device: A Prospective Longitudinal Cohort Study.

Limited evidence suggests that the nonhormonal contraceptive copper intrauterine device (Cu-IUD) may increase bacterial vaginosis (BV) risk, possibly due to increased volume and duration of menses, a common side effect of Cu-IUD use. Although increases in bleeding typically resolve within 6-12 months following initiation, evaluations of the association between Cu-IUD and BV have not included more than 6 months of follow-up. This secondary analysis of a human immunodeficiency virus type 1 prevention trial included 2585 African women ages 18-45 followed for up to 33 months. Women reported contraceptive use each month. BV was evaluated by Nugent score in 6-monthly intervals and, if clinically indicated, by Amsel criteria. Andersen-Gill proportional hazards models were used to (1) evaluate BV risk among Cu-IUD users relative to women using no/another nonhormonal contraceptive and (2) test changes in BV frequency before, while using, and following Cu-IUD discontinuation. BV frequency was highest among Cu-IUD users at 153.6 episodes per 100 person-years (95% confidence interval [CI]: 145.2, 162.4). In adjusted models, Cu-IUD users experienced 1.28-fold (95% CI: 1.12, 1.46) higher BV risk relative to women using no/another nonhormonal contraception. Compared to the 6 months prior to initiation, BV risk was 1.52-fold (95% CI: 1.16, 2.00) higher in the first 6 months of Cu-IUD use and remained elevated over 18 months of use (P < .05). Among women who discontinued Cu-IUD, BV frequency was similar to pre-initiation rates within 1 year. Cu-IUD users experienced elevated BV risk that persisted throughout use. Women and their providers may wish to consider BV risk when discussing contraceptive options.

Association between contraceptive method chosen after induced abortion and incidence of repeat abortion in Northern Portugal

Objectives In Portugal, a country with strong Catholic roots, elective termination of pregnancy at women’s request is still stigmatised, especially if it is a repeat abortion. The objectives of this study were to determine the incidence of repeat abortion, taking into account the contraceptive method chosen after the index abortion event, and characterise the risk factors for repeat abortion. Methods This was a retrospective cohort study of 988 women who requested termination of pregnancy during 2015 in a Portuguese tertiary care public hospital. Contraception was given free of charge after the index event. The occurrence of a repeat induced abortion was evaluated during a 24 month follow-up period. Results Forty-nine (5.0%) of the 988 women had a repeat abortion. Users of long-acting reversible contraception (LARC) had fewer repeat abortions compared with users of non-LARC methods. Overall repeat abortion was 0.8% in subcutaneous contraceptive implant users, 1.5% in intrauterine contraceptive device (IUCD) users, 2.8% in vaginal ring users and 5.8% in oral contraceptives users (p < 0.05). Cox hazards ratio (HR) analysis showed that method choice after abortion correlated significantly with the probability of repeat abortion (p < 0.05). Using women choosing oral contraception as the reference group, the HRs (95% CIs) for repeat abortion were as follows: IUCD 0.282 (0.084, 0.942), contraceptive implant 0.142 (0.019, 1.050), vaginal ring 0.508 (0.175, 1.477). Conclusion Even though highly effective contraceptive methods are freely accessible in Portugal, other challenges must be managed to improve outcomes, such as a timely, patient-centred counselling approach.

Bleeding Patterns among Adolescents Using the Levonorgestrel Intrauterine Device: A Single Institution Review.

To describe the bleeding patterns associated with the use of the levonorgestrel intrauterine device (IUD) in adolescents. A retrospective chart review of postmenarchal adolescent patients ages 8-19years who had the levonorgestrel IUD inserted at Phoenix Children's Hospital from 2012 to2018. Insertion of the 52-mg and 13.5-mg levonorgestrel IUD. The rate of amenorrhea and other bleeding patterns after insertion of the levonorgestrel IUD and the factors that might predict those bleeding patterns. A total of 260 charts were identified with 221/260 (85.0%) patients choosing the 52-mg IUD and 39/260 (15.0%) patients choosing the 13.5-mg IUD to be inserted. Follow-up data were available for 166 patients. The overall rate of amenorrhea among IUD users was 39.8% (n=66) with no difference between 52-mg and 13.5-mg IUD users (P=.656). Regularity and flow of menstrual cycle, history of bleeding disorder, history of developmental delay, and current treatment with testosterone for gender dysphoria before IUD insertion did not appear to have a significant effect on the rate of amenorrhea or bleeding patterns post-IUD insertion. The levonorgestrel IUD can be successfully used to control abnormal uterine bleeding and suppress menses in adolescents. Menstrual cycle characteristics pre-IUD insertion did not result in predictable post-IUD bleeding patterns.

Progesterone vaginal ring as a new contraceptive option for lactating mothers: Evidence from a multicenter non-randomized comparative clinical trial in India

ObjectivesEvaluate and compare contraceptive efficacy, safety, continuation rates and duration of lactational amenorrhea (LA) in married lactating women (20–35 years) using the progesterone vaginal ring (PVR) or Copper-T380A intrauterine device (IUD) during the first postpartum year. Study designWe conducted a one-year multicenter, non-randomized, non-inferiority, open-label, comparative trial at 20 centers in India and compared efficacy, safety, continuation and LA plus feeding patterns and growth/well-being of participants’ infants. Women used four 3-month PVRs consecutively (lost PVRs were not replaced) and were to breastfeed at least four times/day. We used Pearl Index (PI) and Kaplan Meier (K-M) rates to analyze pregnancy and K-M for continuation. ResultsWe enrolled 789 women (459 PVR, 330 IUD). Neither PI nor K-M one-year pregnancy rates differed significantly between groups (PI: PVR-0.62; IUD-0.35); (K-M: PVR-0.7; IUD-0.4, p = 0.58). Continuation rates at 12 months were 78.5% (IUD) vs. 56.9% (PVR) (p < 0.001). Ring expulsions and menorrhagia were the most common discontinuation among PVR/IUD users respectively. The median duration of LA among PVR vs. IUD users was 405 vs. 120 days (p < 0.001). Both groups reported similar adverse events (PVR: 24.2%; IUD: 23.0%); there were no serious adverse events among PVR users. Infants from both groups fed 12–7 times/day and grew at expected rates. ConclusionsEfficacy and safety outcomes were comparable among women in both groups. Continuation rates for PVR, a woman-controlled method, were shorter than IUD rates while PVR users maintained LA significantly longer than IUD users. Infant breastfeeding and growth patterns/well-being were favorable in both groups. ImplicationsPVR, a user-controlled device, offers an additional contraceptive choice for lactating women for one-year postpartum use and can help to address the unmet need for contraception among postpartum women while encouraging breastfeeding to enhance infant growth and well-being.

Menstrual Cup Use and Intrauterine Device Expulsion in a Copper Intrauterine Device Contraceptive Efficacy Trial [OP01-1B

INTRODUCTION: Menstrual cup use for menstrual hygiene is increasingly popular. We evaluated relationship of menstrual cup use and intrauterine device (IUD) expulsion in a prospective trial of two copper IUDs. METHODS: An ongoing 3-year contraceptive efficacy trial randomized women to one of two copper IUDs, with successful placement in 1,092 women. Institutional Review Board approval was obtained, and all subjects provided informed consent. Follow-up visits in the first year occurred at 6 weeks, and then 3, 6, and 12 months after insertion. At nine months after initiating enrollment, we modified the protocol to advise subjects against concurrent menstrual cup use with the IUD. We evaluated the association of menstrual cup use and expulsion risk over the first 24 months of study conduct. RESULTS: Overall, 266 (24.4%) women reported menstrual cup use. At 24 months after initiating enrollment, 46 (17.3%) cup users and 43 (5.2%) non-users experienced expulsion (odds ratio 3.81 [95% CI 2.45-5.92]). Fourteen (30.4%) menstrual cup users with expulsion reported the event occurred during menstrual cup removal. At Year 1 of the study, expulsion rates among menstrual cup users and non-users were 14.3% and 4.7%, respectively (P&lt;.001). By the end of Year 2, these rates were 23.2% and 6.5% (P&lt;.001). CONCLUSION: We found higher than expected IUD expulsion rates in menstrual cup users amongst participants in a prospective trial of two copper IUDs. Copper IUD users should be cautioned that concurrent menstrual cup use increases the risk of IUD expulsion and expulsion risk continues with ongoing menstrual cup use.

Pelvic inflammatory disease among users and non-users of an intrauterine device

The correlation between pelvic inflammatory disease (PID) and a present intrauterine device (IUD) has been debated. We aimed to evaluate the differences between IUD users and non-users among women hospitalised with a diagnosis of PID. Our hypothesis was that the role of a present IUD among PID patients is minimal, if any. We performed a retrospective cohort study during 2010–2018 in a tertiary university hospital. Overall, 474 hospitalised patients were diagnosed with PID. Of these, 121 patients were IUD users. The patients without an IUD were younger and had lower gravidity and parity. Among the patients without an IUD, higher rates of prior history of PID and fever at presentation were noticed. In 23.9% (29/121) of women, the IUD was inserted less than four weeks prior to the PID diagnosis. The patients with an IUD insertion-associated PID, had lower rates of tubo-ovarian abscess (2 (6.9%) versus 24 (26.0%), OR [95% CI] 0.18 (0.04–0.84), p = .02) at presentation, as well as a shorter length of stay (LOS) (median 4 versus 5 days, p = .05). In a patient in whom the IUD was retained, hospitalisation period was shorter (median LOS 4 days versus 5 days, p = .007). PID inpatients who carry an IUD represent a specific subset of patients with a milder disease. Impact statement What is already known on this subject? The correlation between pelvic inflammatory disease (PID) and a present intrauterine device (IUD) is debateable. What the results of this study add? PID inpatients who carry an IUD represent a specific subset of patients with milder disease. What the implications are of these findings for clinical practice and/or further research? Our results show that in IUD users with PID, the practice of IUD removal as part of their PID treatment is of little benefit.

“$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.

Copper IUD increases virulence of non-albicans Candida species isolated from women with vulvovaginal candidiasis

Objectives: The aim of the study was to investigate the effect of copper-bearing intrauterine device (IUD) use on the virulence of Candida species causing vulvovaginal candidiasis (VVC). The in vitro ability of Candida species to produce proteinase and phospholipase enzymes was studied, together with their antifungal susceptibility.Methods: Vaginal swabs from women with VVC were cultured and Candida species were identified. Participants comprised 132 women with culture-confirmed VVC, of whom 65 were using a copper-bearing IUD and 67 were not. Candida isolates were tested for their ability to produce proteinase and phospholipase as well as for their susceptibility to fluconazole and nystatin.Results: Proteinase production was higher in non-albicans Candida (NAC) isolates of IUD users compared with non-users (p = 0.017). IUD use was significantly associated with antifungal resistance of NAC isolates to fluconazole (p = 0.013) and nystatin (p = 0.018). By contrast, IUD use seemed to significantly reduce the production of proteinase by C. albicans (p = 0.041), with no effect on its antifungal susceptibility. There was a significant negative correlation between proteinase production in both C. albicans and NAC as well as sensitivity to fluconazole (r= −0.383, p < 0.05 and r= −0.497, p < 0.05, respectively).Conclusion: IUD use enhanced the virulence (proteinase production and antifungal resistance) of NAC but not C. albicans, indicating a variation in virulence between Candida species in response to IUD use. C. albicans responded better to fluconazole, whereas NAC isolates were more sensitive to nystatin.

Relative Risk of Cervical Neoplasms Among Copper and Levonorgestrel-Releasing Intrauterine System Users.

To evaluate the relative risk of cervical neoplasms among copper intrauterine device (Cu IUD) and levonorgestrel-releasing intrauterine system (LNG-IUS) users. We performed a retrospective cohort analysis of 10,674 patients who received IUDs at Columbia University Medical Center. Our data were transformed to a common data model and are part of the Observational Health Data Sciences and Informatics network. The cohort patients and outcomes were identified by a combination of procedure codes, condition codes, and medication exposures in billing and claims data. We adjusted for confounding with propensity score stratification and propensity score 1:1 matching. Before propensity score adjustment, the Cu IUD cohort included 8,274 patients and the LNG-IUS cohort included 2,400 patients. The median age for both cohorts was 29 years at IUD placement. More than 95% of the LNG-IUS cohort used a device with 52 mg LNG. Before propensity score adjustment, we identified 114 cervical neoplasm outcomes. Seventy-seven (0.9%) cervical neoplasms were in the Cu IUD cohort and 37 (1.5%) were in the LNG-IUS cohort. The propensity score matching analysis identified 7,114 Cu IUD and 2,174 LNG-IUS users, with covariate balance achieved over 16,827 covariates. The diagnosis of high-grade cervical neoplasia was 0.7% in the Cu IUD cohort and 1.8% in the LNG-IUS cohort (2.4 [95% CI 1.5-4.0] cases/1,000 person-years and 5.2 [95% CI 3.7-7.1] cases/1,000 person-years, respectively). The relative risk of high-grade cervical neoplasms among Cu IUD users was 0.38 (95% CI 0.16-0.78, P<.02) compared with LNG-IUS users. By inspection, the Kaplan-Meier curves for each cohort diverged over time. Copper IUD users have a lower risk of high-grade cervical neoplasms compared with LNG-IUS users. The relative risk of cervical neoplasms of LNG-IUS users compared with the general population is unknown.