Intrauterine device continuation rates and reasons for discontinuation in a Central European clinic with a high standard of care and ultrasound follow-up: a retrospective cohort study

Abstract

Objectives: The aims of the study were to conduct an analysis of intrauterine device (IUD)-related outcomes, including continuation rates, reasons for discontinuation, rates of dislocation and risk factors for dislocation, in a clinical setting with regular ultrasound monitoring of the IUD position.

Methods: A retrospective chart review was carried out of all IUD insertions over a period of 5 years.

Results: A total of 755 IUDs were inserted over the study period. The overall observation time was 1572 woman-years. The removal rate was highest in the first year after insertion and did not differ between devices: the 52 mg levonorgestrel-releasing intrauterine system (LNG-IUS; 18%) and third generation copper-T (Cu-T) IUDs (20%). Most removals were related to dislocation; fewer dislocations were seen with the LNG-IUS compared with the Cu-T IUDs (p< .001). More removals of the LNG-IUS were carried out because of amenorrhoea, pain and hormone-related adverse events (20% of all removals). The discontinuation rate was higher in young women (age <25 years; p< .03), demonstrating the limitations of long-acting reversible contraception in this age group. The dislocation rate for devices replaced after dislocation was 31% in women receiving a Cu-T IUD and 38% in women receiving an LNG-IUS.

Conclusions: The first year after IUD insertion is crucial with regard to discontinuation. Most removals were attributed to dislocation and affected mainly younger women. Dislocations occurred more rarely in LNG-IUS users and the rate decreased over time. We recommend follow-up within the first 6-12 months, especially in young women. Structured counselling and consideration of risk factors for dislocation may reduce removal rates for adverse events and dislocations.

摘要

目的：本研究旨在对宫内节育器 (IUD) 相关结局进行分析, 包括在定期超声监测 IUD 位置的临床环境下的续用率、停用原因、移位率和移位的风险因素。

方法：回顾性分析5年间所有放置宫内节育器的病例。

结果：研究期间共放置宫内节育器755例。总观察时间为 1572 妇女年。放置后第一年的取出率最高, 两种宫内节育器无差异：左炔诺孕酮宫内缓释系统 (LNG-IUS；52 mg；18%) 和第三代铜-T (Cu-T) 宫内节育器 (20%)。大多数取出与移位有关；与 Cu-T IUD 相比, LNG-IUS 的移位比例较少 (p <0 .001), 而由于闭经、疼痛和激素相关不良反应（占所有取出的 20%）, 取出 LNG-IUS比例较高。年轻女性（年龄 < 25 岁；p <0 .03）的停用率较高, 表明该年龄组长效可逆避孕的局限性。放置 Cu-T 宫内节育器的妇女在放置节育器后, 节育器移位率为 31%, 放置 LNG-IUS 的妇女移位率为 38%。

结论：放置宫内节育器后第一年对于是否停用是至关重要的。大部分取出归因于移位, 主要影响年轻女性。移位在 LNG-IUS 应用者中更少见, 并且发生率随时间推移而降低。我们建议在放置的6-12 个月内进行随访, 尤其是年轻女性。结构化咨询和考虑移位风险因素可能会降低因不良反应及移位的取出率。

Keywords:

• Contraception
• copper-T IUD
• discontinuation
• dislocation
• intrauterine device
• levonorgestrel-releasing intrauterine system
• long-acting reversible contraception

Disclosure statement

MB, KB, JH, LW and BL report no conflicts of interest. GSM-F has received funding for studies and/or has been a lecturer/adviser for MSD, Bayer and Exeltis. There was no funding for the retrospective analyses of data in the patient charts.