Non-hormonal and hormonal intrauterine contraception: survey of patients’ perceptions in four Latin American countries

ABSTRACT

Objectives: This study sought to understand women’s perceived barriers to the use of hormonal and non-hormonal intrauterine contraception in Latin America. Methods: We developed an online survey for women in Argentina, Brazil, Colombia and Mexico who were seeking contraception. The questions aimed at evaluating patient awareness of negative stories and statements, as well as perceived barriers to the copper intrauterine device (IUD) and the levonorgestrel-releasing intrauterine system (LNG-IUS). Results: The survey was mailed to 2300 women. A total of 1953 responses were received from Argentina (n = 465), Brazil (n = 380), Colombia (n = 613) and Mexico (n = 495). More women reported having heard negative stories about the copper IUD than about the LNG-IUS. More women believed that the copper IUD, rather than the LNG-IUS, was suitable only for those who had already had children. More women believed that weight gain (14.3% vs. 38.2%; p < 0.001), mood swings (14.1% vs. 38.7%; p < 0.001) and infertility (16.3% vs. 19.9%; p = 0.016) were possible side effects of the LNG-IUS. By contrast, more women believed that abortion (36% vs. 22.7%; p < 0.001), pelvic infections (42.1% vs. 15.7%; p < 0.001) and ectopic pregnancy (43.5% vs 23.5%; p < 0.001) were side effects more associated with the copper IUD. More believed the copper IUD was associated with less pain during placement and removal compared with the LNG-IUS (42.8% vs. 31.2%; p < 0.001). The perception of increased risk of contracting a sexual transmitted disease did not differ between the methods (IUD vs. LNG-IUS, 21.7% vs. 20.3%; p = 0.388). Conclusions: Respondents to a web-based survey in four Latin American countries have misperceptions regarding the adverse effects and risks of intrauterine contraception, which may hamper the use of these safe and efficient contraceptive methods. Education about the true risks and benefits involved is fundamental to improving patient acceptance and compliance as well as reducing unplanned pregnancies and unsafe abortions.

Chinese abstract

目的：该研究试图了解拉丁美洲妇女对使用含激素和无激素宫内避孕方法的认知障碍。方法：我们研发了一套在线调查系统，针对阿根廷、巴西、哥伦比亚和墨西哥寻求避孕的妇女。这些问题目的在于评估患者对负面报道和声明的认知，以及对含铜宫内节育器(IUD)和左炔诺孕酮宫内缓释系统(LNG-IUS)的认知障碍。结果：该调查邮寄给2300名妇女。总共回收1953份，分别来自阿根廷(n=465)、巴西(n=380)、哥伦比亚(n=613) 和墨西哥(n=495)。与LNG-IUS相比，更多妇女曾听说过关于含铜IUD的不良报道。更多妇女相信含铜IUD只适合那些已经生育过的妇女，而不是LNG-IUS 。更多妇女相信体重增加(14.3% vs. 38.2%; p<0.001)、情绪波动(14.1% vs. 38.7%; p<0.001)和不孕(16.3% vs. 19.9%; p=0.016)是LNG-IUS 可能的不良反应。与之相比，更多妇女相信流产(36% vs. 22.7%; p<0.001)、盆腔炎(42.1% vs. 15.7%; p<0.001)和异位妊娠(43.5% vs. 23.5%; p<0.001)是与含铜IUD更相关的不良反应。更多妇女相信与LNG-IUS相比含铜IUD在放置和取出过程中疼痛更轻(42.8% vs. 31.2%; p<0.001)。两种方法对感染性传播疾病风险增加的认知无差异(IUD vs. LNG-IUS, 21.7% vs. 20.3%; p=0.388)。结论：四个拉丁美洲国家受访者基于网络的调查显示对于宫内避孕的不良反应和风险存在认知错误，这有可能妨碍这些安全并有效的避孕方法的使用。真正的风险和获益的教育是必要的，以提高患者的接受度和依从性，并减少意外怀孕和不安全流产。

Keywords:

• Intrauterine contraception
• intrauterine device
• knowledge

Disclosure statement

Some authors are members of the HELP group, a panel of independent physicians with expert interest in heavy menstrual bleeding, the formation of which was facilitated by Bayer HealthCare. This publication and its content are the sole responsibility of the authors. Some authors have acted as consultants to Bayer HealthCare and received consultancy honoraria.