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

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Intrauterine device (IUD) insertion timing postpartum and heavy menstrual bleeding influence perforation and expulsion risks. Counseling should incorporate these factors for informed patient decisions regarding IUD use.

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Area of Science:

  • Reproductive Health
  • Medical Device Safety
  • Clinical Gynecology

Background:

  • Intrauterine devices (IUDs) are widely used for contraception.
  • Understanding risks associated with IUD insertion, such as uterine perforation and expulsion, is crucial for patient safety.
  • Factors like postpartum timing and patient characteristics may influence these risks.

Purpose of the Study:

  • To evaluate the association between postpartum timing of IUD insertion, breastfeeding, heavy menstrual bleeding, and IUD type with uterine perforation and expulsion risks.
  • To inform clinical counseling and shared decision-making for patients considering IUDs.

Main Methods:

  • Retrospective cohort study using U.S. healthcare data (2001-2018).
  • Included individuals aged 50 and younger with IUD insertions and electronic health records.
  • Calculated cumulative incidences and estimated adjusted hazard ratios (aHRs) for perforation and expulsion.

Main Results:

  • Absolute risk of uterine perforation was low overall.
  • Elevated perforation risk observed for IUDs inserted within 1 year postpartum, especially 4 days to 6 weeks postpartum.
  • Greatest IUD expulsion risk occurred with immediate postpartum insertion (0-3 days).
  • Breastfeeding showed slightly elevated perforation and lowered expulsion risk.
  • Heavy menstrual bleeding was associated with greater expulsion and slightly elevated perforation risk.
  • Levonorgestrel-releasing IUDs had slightly higher perforation and lower expulsion risk compared to copper IUDs.

Conclusions:

  • Absolute risks of IUD-related adverse events are low.
  • Clinicians must consider specific postpartum insertion timings and heavy menstrual bleeding diagnoses when counseling patients.
  • Informed decision-making regarding IUD insertion should integrate these risk factors.