6th Int'l IUD Symposium - Day 3

Event 2
6th International Symposium on IUDs

December 9, 2020
Current IUD Technology and Performance
& IUD Adverse Events

(Day 3 of 7 Day Series)

Current IUD technology and performance
(Presenter: Bimla Schwarz)

“Levonorgestrel intrauterine systems (IUS) are more effective than copper IUDs. Challenges finding a clinician trained to place IUDs continue to impede access. Users should be informed of the safety of IUD self-removal.”

Intrauterine devices
and the risk of uterine perforation
(Presenter: Klaas Heinemann)

The risk of perforation from an IUD (LNG or Cu) is very low, about 2 per 1,000 insertions or lower. Only about 50% of perforations are diagnosed due to symptoms. There is some correlation between risk of perforation and breastfeeding.”

Infections
(Presenter: Beatrice Chen)

Sexually transmitted infections, not intrauterine devices, are associated with tubal infertility. Same day sexually transmitted infection screening for IUDs is safe and reduces barriers to IUD use. Since the highest risk of infection after IUD insertion is in the first 20 days after insertion and low thereafter, even in people at increased risk for infection, many patient populations are eligible for IUD use and prophylactic antibiotics are not indicated before IUD insertion, even in those at high risk for infective endocarditis.

Pain and intrauterine devices
(Presenter: Rebecca Allen)

“Pain on insertion of an IUD is fairly common. Effective tools for pain management include a paracervical block with injected lidocaine to reduce pain for both the tenaculum site and IUD insertion. There is some evidence that applying a lidocaine cream or gel before the procedure can also mitigate pain. Non-pharmacologic interventions such as distraction and a supportive environment can also be helpful. Delayed pain after insertion is uncommon and should prompt an examination for IUD location or, if properly located, other sources of uterine pain. Removal should be offered if desired. IUDs can be effective in managing certain conditions that cause uterine pain such as endometriosis.”

IUDs and bleeding
(Presenter: Maureen Baldwin)

“LNG-IUD users see a continued improvement in bleeding over the entire duration of use, including with the next IUD, with a steady state reached after approximately 40 days. Amenorrhea is a common side effect of the LNG-IUD, with baseline bleeding and uterine size measured on ultrasound being key predictors. Many users experience increased bleeding and anemia after Cu IUD placement. Initial bleeding amount does not vary significantly by timing of placement post-pregnancy.”

Common Reasons for Discontinuation
(Presenter: Luis Bahamondes)

“The Cu-IUD and the LNG IUS are devices associated with extremely low rates of contraceptive failure, comparable to female permanent contraception. Independently of the kind of IUD in use, bleeding disturbances and pelvic pain are the main reasons for discontinuation. IUD placement in adolescents and insertion performed by non-trained healthcare providers are the main variables associated with device expulsion.”

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