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Demographic, Reproductive, and Medical Risk Factors for Intrauterine Device Expulsion.

Mary S Anthony1, Xiaolei Zhou, Juliane Schoendorf

  • 1RTI Health Solutions, Research Triangle Park, North Carolina; Bayer OY, Espoo, Finland ; the Department of Obstetrics and Gynecology, University of Washington, and Kaiser Permanente Washington Health Research Institute, Seattle, Washington; the Department of Research & Evaluation, Kaiser Permanente Southern California, the Department of Health Systems Science and the Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, the Division of Research, Kaiser Permanente Northern California, Oakland, and the Department of Obstetrics & Gynecology, Kaiser Permanente West Los Angeles Medical Center, Los Angeles, California; the Regenstrief Institute, and Indiana University, Indianapolis, Indiana; RTI Health Solutions, Waltham, Massachusetts; Bayer Pharmaceuticals, Whippany, New Jersey; and Bayer AG, Berlin, Germany .

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Summary

Heavy menstrual bleeding and younger age are key risk factors for intrauterine device (IUD) expulsion. Certain demographic groups, including Asian or Pacific Islander individuals, face higher expulsion risks, warranting further investigation.

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Area of Science:

  • Reproductive Health
  • Contraception
  • Medical Device Efficacy

Background:

  • Intrauterine devices (IUDs) are highly effective long-term contraceptives.
  • Understanding IUD expulsion risk factors is crucial for patient counseling and optimizing contraceptive choices.

Purpose of the Study:

  • To investigate the association between demographic and clinical factors and the risk of IUD expulsion.
  • To identify specific risk factors that predict IUD expulsion in a large cohort.

Main Methods:

  • A U.S. cohort study (APEX-IUD) analyzed electronic health records from 2001-2018.
  • Cox regression models were used to estimate hazard ratios for IUD expulsion, adjusting for various risk factors.

Main Results:

  • Heavy menstrual bleeding was the strongest predictor of IUD expulsion.
  • Higher risk was observed in individuals with overweight/obesity, younger age (≤24 years), and high parity (≥4).
  • Non-Hispanic White individuals had the lowest risk, while Asian or Pacific Islander individuals had the highest adjusted risk.

Conclusions:

  • Physiologic factors like age, BMI, heavy menstrual bleeding, and parity influence IUD expulsion.
  • The elevated expulsion risk among individuals of color requires further research.
  • While IUD expulsion is uncommon, patient counseling on associated risks is essential.