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Long-acting reversible contraception use is increasing, reducing teen pregnancies. Physicians may face challenges with intrauterine device (IUD) and contraceptive implant insertions/removals due to anatomical or patient-specific factors.

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Area of Science:

  • Reproductive Health
  • Contraception Technologies
  • Gynecology

Background:

  • Long-acting reversible contraception (LARC) use is rising in the US, correlating with decreased teen pregnancies.
  • Increased LARC adoption presents clinical challenges for healthcare providers regarding device insertion and removal.
  • Specific patient populations, including transgender and gender nonconforming individuals, require tailored approaches for LARC procedures.

Purpose of the Study:

  • To review common challenges encountered during intrauterine device (IUD) and contraceptive implant procedures.
  • To highlight techniques and considerations for managing difficult IUD insertions and removals.
  • To discuss strategies for overcoming difficulties in contraceptive implant removal.

Main Methods:

  • Literature review of clinical guidelines and case reports on LARC procedures.
  • Analysis of factors influencing IUD insertion and removal difficulty.
  • Examination of techniques for managing difficult contraceptive implant removals.

Main Results:

  • Uterine anatomy (e.g., anteversion, retroversion, postpartum tone) complicates IUD insertion.
  • Missing IUD strings necessitate advanced removal tools and imaging (e.g., ultrasound).
  • Deeply inserted or non-palpable implants require ultrasound-guided removal with specialized instruments.

Conclusions:

  • Effective management of LARC procedures requires awareness of anatomical and patient-related challenges.
  • Specialized techniques and equipment are crucial for successful IUD and implant removal.
  • Patient-centered care, including psychosocial support, is vital for transgender and gender nonconforming individuals undergoing LARC procedures.