Clinicians' views on low-lying intrauterine devices or systems

Area of Science:

• Contraceptive technology
• Reproductive health
• Clinical practice guidelines

Background:

• Lack of consensus exists regarding the management of low-lying or malpositioned intrauterine contraceptive devices (IUDs) or systems (IUS).
• Limited published guidance is available for clinicians managing these scenarios.

Purpose of the Study:

• To survey current practices and opinions of senior medical staff in contraceptive services regarding malpositioned IUDs/IUS.
• To identify variations in management approaches for intrauterine devices and systems that are not optimally positioned.

Main Methods:

• A short e-mail questionnaire was distributed to senior medical staff involved in contraceptive services.
• The questionnaire aimed to gather data on the management of low-lying or malpositioned IUDs/IUS.

Main Results:

• Significant variation in management views was confirmed among respondents.
• Most clinicians would replace IUDs/IUS located entirely or partially in the cervical canal.
• Devices closer to the fundus were more likely to be left in situ, with less concern for IUS, potentially due to hormonal effects.
• Abnormal bleeding or pain was typically investigated for other causes rather than attributed to a low-lying device.
• Uncertainty exists regarding increased failure rates of low-lying devices, with about half believing upward migration is possible.

Conclusions:

• The survey underscores a critical need for evidence-based guidance in managing malpositioned IUDs/IUS.
• Developing clear clinical guidelines is essential to standardize practice and improve patient care in contraceptive services.