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Can intrauterine device removals for bleeding or pain be predicted at a one-month follow-up visit? A multivariate
1Family Health International, Research Triangle Park, North Carolina 27709, USA. jstanback@fhi.org
Insights
Intrauterine device (IUD) users experiencing intermenstrual bleeding or excessive menstrual flow at their 1-month follow-up are significantly more likely to have their IUD removed due to pain or bleeding within the first year.
Area of Science:
- Reproductive Health
- Gynecology
- Contraception
Background:
- Intrauterine device (IUD) use is associated with potential side effects like bleeding and pelvic pain.
- High rates of IUD removal (4%-14%) in the first year are attributed to these adverse events.
- Previous research focused on baseline predictors for IUD removal, neglecting the predictive value of early follow-up information.
Purpose of the Study:
- To investigate if information gathered at the 1-month follow-up visit can predict IUD removal due to bleeding or pain.
- To identify specific symptoms reported at the 1-month visit that are associated with later IUD removal.
Main Methods:
- Analysis of data from an international multicenter randomized controlled trial.
- Comparison of 89 women who had IUD removals for bleeding/pain post-1-month visit with 2536 continuing users.
- Logistic regression analysis to identify significant predictors of IUD removal.
Main Results:
- Intermenstrual bleeding since the last menses was a significant predictor, increasing removal likelihood by nearly threefold (OR 2.9; 95% CI 1.4-5.9).
- Complaints of excessive menstrual flow were associated with a 3.5-fold increased likelihood of IUD removal within 12 months (95% CI 1.4-9.2).
Conclusions:
- Symptoms reported at the 1-month IUD follow-up visit, specifically intermenstrual bleeding and heavy menstrual bleeding, are strong predictors of early IUD removal.
- Early identification of these symptoms may allow for timely interventions, such as counseling or nonsteroidal anti-inflammatory drug (NSAID) treatment, to improve IUD continuation rates.
Abstract:
From 4%-14% of intrauterine device (IUD) users have their IUD removed due to bleeding or pelvic pain in the first year of use. Past studies have analyzed whether baseline patient information can help predict such removals, but no previous analysis has examined whether information provided at the recommended 1-month follow-up visit could improve such predictions. Using data from an international multicenter randomized controlled trial, 89 women with removals for bleeding and pain after the 1-month visit were compared with 2536 continuing users. Logistic regression indicated several significant predictors of removal. Women reporting intermenstrual bleeding since last menses were nearly three times more likely to have removals for bleeding or pain (odds ratio [OR] 2.9; 95% confidence interval [CI] 1.4-5.9). Similarly, those complaining of excessive menstrual flow were 3.5 times more likely to have removals within 12 months (95% CI 1.4-9.2). Women reporting these menstrual problems during scheduled revisits may benefit from counseling and treatment with nonsteroidal anti-inflammatory drugs (NSAID).
