1
|
Versailles JBE, Bahamondes L, Marcelino AC, da Cunha Pereira P, Juliato CRT. Prospective evaluation of ease and difficulties of 872 cases of IUD removals. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024:102616. [PMID: 39069127 DOI: 10.1016/j.jogc.2024.102616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 06/24/2024] [Accepted: 07/17/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVE The objective was to describe the ease and difficulty of removing intrauterine devices (IUDs). METHODS We conducted a prospective study at the University of XXX, Faculty of Medical Sciences, XXXX. We included women who requested IUD removal. We excluded women with partial IUD expulsion in which the IUD was protruded at the external os. We identified difficult IUD removal when the removal was challenging, including the inability to visualize IUD strings extending from the cervical os. RESULTS A total of 869 women participated. Women were aged 29.4 ± 8.0 years (mean ± SD; range 14-51) and the duration of IUD use at the time of removal was 4.3 ± 4.2 years. We found that 702 (80.8%) women had visible strings at the external os and the removals were performed at the first attempt without difficulty in 692 (79.6%) participants. Pain was more intense (>4) in cases of difficult removals. After multivariate logistic analysis, difficult removals were associated with users of IUD > 3 years (3 times higher risk); for each previous cesarean delivery, the risk increased by 1.5 times. CONCLUSION Our study showed that IUD removal is an easy and safe procedure, with only a small proportion of women reporting significant pain with IUD removal.
Collapse
Affiliation(s)
- Jacques B E Versailles
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, Universidade Estadual de Campinas Campinas, SP, Brazil
| | - Luis Bahamondes
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, Universidade Estadual de Campinas Campinas, SP, Brazil
| | - Ana Claudia Marcelino
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, Universidade Estadual de Campinas Campinas, SP, Brazil
| | - Paula da Cunha Pereira
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, Universidade Estadual de Campinas Campinas, SP, Brazil
| | - Cassia R T Juliato
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, Universidade Estadual de Campinas Campinas, SP, Brazil.
| |
Collapse
|
2
|
Petrie KA, McCoy EE, Benson LS. IUD self-removal: A randomized controlled trial of a self-removal guide in clinical and nonclinical settings. Contraception 2024; 135:110421. [PMID: 38518903 DOI: 10.1016/j.contraception.2024.110421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 03/08/2024] [Accepted: 03/11/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVES Intrauterine device (IUD) users often encounter barriers to desired removal. Self-removal, while previously found to be successful only 19% of the time, may mitigate these obstacles. Our primary objective was to evaluate the effectiveness of our previously developed IUD self-removal guide. Our secondary objectives were to evaluate the acceptability of the guide and characterize the self-removal process. STUDY DESIGN: This was a randomized controlled trial comparing IUD self-removal success rates with and without a guide. Participants selected a clinical or nonclinical setting for self-removal. The primary outcome was the rate of successful IUD self-removal. Covariates of interest included demographic characteristics, parity, body mass index, and attempted removal setting. RESULTS Of the 116 participants, 35 (30%) successfully removed their IUDs, 20 (32%) randomized to the guide, and 15 (28%) randomized to no guide (p = 0.7). While our guide was not associated with increased successful self-removal, the majority (97%) of those randomized to it reported it to be helpful. Those who selected a nonclinical setting (80%) were more successful at self-removal (35% vs 9%, p = 0.01). Most participants would recommend IUD self-removal to a friend (68%) and attempt again with a future IUD (80%). CONCLUSIONS The proportion of participants who successfully removed their IUDs was higher than previously shown, with or without the use of our guide. Our inclusion of a nonclinical setting was novel, in which the proportion of successful self-removal was significantly higher. Providers should consider discussion of IUD self-removal, with a reasonable expectation about the likelihood of success, as a means of increasing reproductive autonomy. IMPLICATIONS IUD self-removal was feasible and acceptable.
Collapse
Affiliation(s)
- Kelsey A Petrie
- Division of Complex Family Planning, University of Washington Department of Obstetrics and Gynecology, Seattle, WA, United States.
| | - Erin E McCoy
- Division of Complex Family Planning, University of Washington Department of Obstetrics and Gynecology, Seattle, WA, United States
| | - Lyndsey S Benson
- Division of Complex Family Planning, University of Washington Department of Obstetrics and Gynecology, Seattle, WA, United States
| |
Collapse
|
3
|
Taghinejadi N, van der Westhuizen HM, Ayomoh FI, Ahmed W, Greenhalgh T, Boylan AM. Pain experiences during intrauterine device procedures: a thematic analysis of tweets. BMJ SEXUAL & REPRODUCTIVE HEALTH 2024:bmjsrh-2023-202011. [PMID: 38862196 DOI: 10.1136/bmjsrh-2023-202011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 04/16/2024] [Indexed: 06/13/2024]
Abstract
INTRODUCTION In June 2021, high-profile testimonials in the media about pain during intrauterine device (IUD) procedures in the UK prompted significant discussion across platforms including Twitter (subsequently renamed X). We examined a sample of Twitter postings (tweets) to gain insight into public perspectives and experiences. METHODS We harvested tweets posted or retweeted on 21-22 June 2021 which contained the search terms coil, intrauterine system, IUD or intrauterine. We analysed the dataset thematically and selected illustrative tweets with the authors' consent for publication. RESULTS Following deduplication and screening, we included 1431 tweets in our analysis. We identified testimonials with descriptions of varied pain experiences. Twitter users reported that clinicians had not warned them that pain could be severe or explained the options for pain relief. Some raised concerns about pain being minimised or dismissed and linked this to the management of women's pain in medicine more broadly. Twitter users described connecting to an online community with shared experiences as validating and used this as a springboard for collective action. CONCLUSIONS While we acknowledge the limitations of our sample, this study highlights important perspectives and accounts relating to pain during IUD procedures. Our findings attest to the need for strategies to improve the patient experience for those opting for IUD as a clinical priority. Further research should explore IUD users' experiences, expectations and wishes around pain management.
Collapse
Affiliation(s)
- Neda Taghinejadi
- University of Oxford Nuffield Department of Primary Care Health Sciences, Oxford, UK
- Oxfordshire Sexual Health Service, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | | | - Wasim Ahmed
- Newcastle University Business School, Newcastle upon Tyne, UK
| | - Trisha Greenhalgh
- University of Oxford Nuffield Department of Primary Care Health Sciences, Oxford, UK
| | - Anne-Marie Boylan
- University of Oxford Nuffield Department of Primary Care Health Sciences, Oxford, UK
| |
Collapse
|
4
|
Cartwright AF, Velarde M, Beksinska M, Smit J, Kasaro M, Tang JH, Milford C, Maphumulo V, Chinyama M, Chabu E, Mudenda M, Wong C, Fawzy M, Callahan R. Perspectives on sexual and reproductive health self-care among women, healthcare providers, and other key informants: a mixed-methods study in South Africa and Zambia. Reprod Health 2023; 20:65. [PMID: 37118835 PMCID: PMC10144905 DOI: 10.1186/s12978-023-01596-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 03/08/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND "Self-care" for sexual and reproductive health (SRH) includes contraceptive methods and other supplies that people can use with or without the support of a healthcare provider. Self-administered tests, self-injection of injectable contraception, or self-removal of intrauterine devices (IUDs) can increase people's access to and autonomy over their own SRH. Objectives of this study were to assess women's current interest in and use of SRH self-care and explore key informants' (KI) opinions of self-care, especially during the COVID-19 pandemic. METHODS Data for this study came from female participants in the longitudinal Contraceptive Use Beyond ECHO (CUBE) study, and KIs, including healthcare providers, in South Africa and Zambia between September 2020 and June 2021. For this analysis, we used data from a participant phone survey (n = 537), and from in-depth interviews (IDIs) completed with a sub-sample of women (n = 39) and KIs (n = 36). Survey data were analyzed with descriptive statistics, and IDI data were analyzed using applied thematic analysis. RESULTS Female survey participants in South Africa were more interested in learning about emergency contraceptive pills, subcutaneous injectable contraception, and CycleBeads, while Zambian participants wanted more information and access to condoms. However, in IDIs in both countries, women described minimal experience with self-care beyond condom use. In the Zambian KI IDIs, COVID-19 led to increased self-care counseling on subcutaneous injectable contraception and HIV self-testing. KIs who do not counsel on self-care were concerned that women may harm themselves or blame the provider for difficulties. Two KIs thought that women could possibly self-remove IUDs, but most expressed concerns. Reported barriers to self-care included COVID movement restrictions, transport costs, lack of accessible pharmacies, women's low awareness, and possible stigma. CONCLUSIONS Women surveyed reported interest in learning more about SRH self-care methods and resources, but in IDIs did not report extensive previous use besides condoms. KIs described some concerns about women's ability to use self-care methods. Counseling on and provision of self-care methods and supplies may have increased during the COVID-19 pandemic, but ensuring that self-care is more than just a temporary measure in health systems has the potential to increase access to SRH care and support women's autonomy and healthcare needs.
Collapse
Affiliation(s)
- Alice F Cartwright
- FHI 360, 359 Blackwell St, Suite 200, Durham, NC, 27701, USA.
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Marissa Velarde
- FHI 360, 359 Blackwell St, Suite 200, Durham, NC, 27701, USA
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mags Beksinska
- MRU (MatCH Research Unit), Department of Obstetrics and Gynecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Jennifer Smit
- MRU (MatCH Research Unit), Department of Obstetrics and Gynecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Margaret Kasaro
- Division of Global Women's Health, Department of Obstetrics and Gynecology, University of North Carolina (UNC) at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer H Tang
- Division of Global Women's Health, Department of Obstetrics and Gynecology, University of North Carolina (UNC) at Chapel Hill, Chapel Hill, NC, USA
| | - Cecilia Milford
- MRU (MatCH Research Unit), Department of Obstetrics and Gynecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Virginia Maphumulo
- MRU (MatCH Research Unit), Department of Obstetrics and Gynecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | | | | | | | - Christina Wong
- FHI 360, 359 Blackwell St, Suite 200, Durham, NC, 27701, USA
| | - Maria Fawzy
- FHI 360, 359 Blackwell St, Suite 200, Durham, NC, 27701, USA
| | | |
Collapse
|
5
|
Fay KE, Traore F, Amico JR. Intrauterine device self-removal practices during the COVID-19 pandemic among family planning clinics. Contraception 2023; 118:109889. [PMID: 36243126 PMCID: PMC9554323 DOI: 10.1016/j.contraception.2022.09.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 09/16/2022] [Accepted: 09/26/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To explore the prevalence of intrauterine device self-removal practices before and during the COVID-19 pandemic among family planning clinics. STUDY DESIGN This is a secondary analysis of data from a descriptive, longitudinal study using a clinic-based convenience sample from the Abortion Clinical Research Network assessing baseline and pandemic-adaptive family planning practices. RESULTS Of the 63 sites that provided contraception, 5 (7.9%) reported providing guidance on intrauterine device self-removal at baseline. Sixteen sites (25.4%) provided guidance on self-removal by the end of the study period. Self-removal counseling was associated with being an academic center and reporting a median lower number of monthly contraceptive encounters. CONCLUSIONS Endorsement of IUD self-removal increased to one-quarter of sites by the final timepoint. IMPLICATIONS Twenty-five percent of family planning clinics reported provision of intrauterine device self-removal guidance by eight months into the COVID-19 pandemic, a three-fold increase from baseline; these findings suggest clinician support for patient autonomy in contraceptive self-management and limited concern for safety issues with self-removal during a public health emergency.
Collapse
Affiliation(s)
- Kathryn E. Fay
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA, United States,Corresponding author
| | - Fadila Traore
- The Cambridge School of Weston, Weston, MA, United States
| | - Jennifer R. Amico
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| |
Collapse
|
6
|
Bowman N, Thwaites A. Menstrual cup and risk of IUD expulsion - a systematic review. Contracept Reprod Med 2023; 8:15. [PMID: 36670496 PMCID: PMC9863186 DOI: 10.1186/s40834-022-00203-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/19/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The menstrual cup is a safe, cost-effective, and environmentally friendly menstrual product which is increasing in usage, especially in younger women. The potential risk for concomitant menstrual cup use to increase IUD expulsion has been raised over the last 10 years, however, few studies assess this. This systematic review aims to identify, appraise and synthesize the current specific evidence on menstrual cup use and risk of partial or total IUD expulsion. METHODS PubMed, and the Cochrane Library were searched for publications available in English, until February 20th, 2021. Quantitative and qualitative studies, systematic reviews and case series reports were included. Websites of menstrual cup manufacturers LenaCup®, DivaCup®, Lunette®, AllMatters® and Saalt® were searched for warnings relevant to IUD expulsion. RESULTS Seven studies were included in this review, comprising 73 partial or total IUD expulsion events in patients with IUD contraception using menstrual cups. The case study reports included two individuals who each experienced two and three expulsions respectively. Of the seven publications, three reported expulsion rates of 3.7%, 17.3% and 18.6%. Time to expulsion ranged from less than one week to two and a half years. These three studies disagree on whether there is a statistically significant association between menstrual cup use and IUD expulsion. CONCLUSION There is a possible association between menstrual cup use and increased risk of IUD expulsion and this information should be shared with patients. However evidence is scarce and high-quality randomised controlled trials are needed to address this risk and the impact of factors such as age, menstrual cup removal technique, pelvic anatomy, IUD type, and measures such as cutting the IUD strings short or delaying menstrual cup use for a period post-insertion. This research gap is limiting patients' ability to make informed choices regarding intrauterine contraception and menstrual management and must urgently be addressed in the context of rising IUD and menstrual cup use, particularly among a younger demographic who are seeking highly effective contraception.
Collapse
Affiliation(s)
| | - Annette Thwaites
- grid.83440.3b0000000121901201Institute of Women’s Health, University College London, London, UK
| |
Collapse
|
7
|
Senderowicz L, Kolenda A. "She told me no, that you cannot change": Understanding provider refusal to remove contraceptive implants. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100154. [PMID: 37304900 PMCID: PMC10257102 DOI: 10.1016/j.ssmqr.2022.100154] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Enthusiasm for long-acting reversible contraception (LARC) is growing among donors and NGOs throughout the global reproductive health field. There is an emerging concern, however, that the push to insert these methods has not been accompanied by a commensurate push for access to method removal. We use data from 17 focus group discussions with women of reproductive age in an anonymized African setting to understand how users approach providers to request method removal, and how they understand whether or not such a request will be granted. Focus group participants described how providers took on a gatekeeping role to removal services, adjudicating which requests for LARC removal they deemed legitimate enough to be granted. Participants reported that providers often did not consider a simple desire to discontinue the method to be a good enough reason to remove LARC, nor the experience of painful side-effects. Respondents discussed the deployment of what we call legitimating practices, in which they marshalled social support, medical evidence, and other resources to convince providers that their request for removal was indeed serious enough to be honored. This analysis examines the starkly gendered nature of contraceptive coercion, in which women are expected to bear the brunt of contraceptive side-effects, while men are expected to tolerate no inconvenience at all, even vicarious. This evidence of contraceptive coercion and medical misogyny demonstrates the need to center contraceptive autonomy not only at the time of method provision, but at the time of desired discontinuation as well.
Collapse
Affiliation(s)
| | - Al Kolenda
- University of Wisconsin-Madison, Madison, USA
| |
Collapse
|
8
|
Cartwright AF, Mackenzie ACL, Callahan RL, Bahamondes MV, Dorflinger LJ. IUD self-removal as self-care: Research is needed in low and middle-income countries. Front Glob Womens Health 2022; 3:992639. [PMID: 36159884 PMCID: PMC9490080 DOI: 10.3389/fgwh.2022.992639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alice F. Cartwright
- FHI 360, Durham, NC, United States
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- *Correspondence: Alice F. Cartwright
| | | | | | | | | |
Collapse
|
9
|
Wang N, Sun H. Uterine Artery Rupture Caused by IUD Extraction: A Case Report. Int J Womens Health 2022; 14:831-836. [PMID: 35783676 PMCID: PMC9249381 DOI: 10.2147/ijwh.s345712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 05/24/2022] [Indexed: 11/23/2022] Open
Abstract
It’s been 100 years since the first intrauterine device (IUD) was invented in Germany in 1920. IUDS are widely favored by women of childbearing age for their efficiency, convenience, cheapness, and variety of materials. According to incomplete statistics, about 26 million people worldwide will need to have their IUDS removed from 2015 to 2025 alone. With such a large case base, we have to pay attention to the safety of IUD removal. There are few international guidelines on IUD placement and removal. Therefore, this paper will report a case of uterine artery rupture caused by ring removal, and discuss the important steps of ring removal surgery, so as to enhance the attention of physicians to the standard and safety of ring removal and improve the quality of medical treatment.
Collapse
Affiliation(s)
- Nan Wang
- Department of Obstetrics and Gynecology, Taizhou People's Hospital, Taizhou, Jiangsu Province, People's Republic of China.,Department of Graduate College, Dalian Medical University, Dalian, Liaoning Province, People's Republic of China
| | - HongZhan Sun
- Department of Obstetrics and Gynecology, Taizhou People's Hospital, Taizhou, Jiangsu Province, People's Republic of China
| |
Collapse
|