Study of IUD insertions and clinical performance in nulliparous women
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Transcript of Study of IUD insertions and clinical performance in nulliparous women
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Study of IUD insertions and clinical performance in nulliparous women
Dr Andrea Brockmeyer
Dr Meera Kishen
Abacus Clinics
Liverpool, UK
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Background
Increased interest in IUDs from nulliparous women
Proven efficacy and safety of standard IUDs
No increased risk of PID in nulliparous women
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Background
No studies about
acceptability removal rates for pain and bleeding rate of spontaneous expulsions
in the standard IUDs and the IUS in nulliparous
women in the UK
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Objectives
To assess experience of IUD/IUS fitting and use by nulliparous women (< 24 weeks)
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Methodology
Prospective pilot study Recruitment of 100 nulliparous women
at Central Abacus Routine IUD/IUS insertions or IUD
insertions for EC but long-term use Questionnaire at time of IUD/IUS
insertion
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Methodology
Follow-up by postal questionnaire or
contact by phone three months and one year after insertion
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STI screening
Sexual history CT/GC testing offered if appropriate Antibiotics (Azithromycin) offered if high
risk of CT
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Recruitment
Recruitment from May-October 2005 Total recruited 118 IUD/IUS fitted 113 Available for follow-up 112 Failed insertions 2 Other problems 4
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Age range
0
10
20
30
40
50
16-19 20-24 25-29 30-34 35-39 > 40
No
of
wo
men
Age in years
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Reasons for IUD/IUS fitting
EC and long-term use 30 (25.4%) Interval fitting 88 (74.6%)
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STI testingSTI testing
CT test at fittingCT test at fitting 4848 CT test in current relationshipCT test in current relationship 6565 CT test declinedCT test declined 5 5
Antibiotics givenAntibiotics given 1515
No positive CT tests reportedNo positive CT tests reported
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Fitting procedure
Local anaesthesia 27 (24%) Difficulty sounding 17 (15%) Use of dilators 10 (9%) Problems 10 (9%)
Failed IUD insertion 2 (1.8%)
Client felt faint 7 (6%)
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Clinicians impression of fitting
Easier than expected 46 (41%) As expected 56 (50%) Worse than expected 9 (8%)
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Client’s impression of fitting
0
5
10
15
20
25
30
1 2 3 4 5 6 7 8 9 10
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Client’s impression of fitting
Less painful than expected 37 (33%) As expected 51 (45%) More painful than expected 22 (19%)
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Three-month follow-up (interim results)
No of women contacted 112 Questionnaire received 72
(64.2%)
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Problems
No, not at all 23 (32%) Yes 49 (68%) Symptoms but not a problem
10
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Abnormal bleeding
Abnormal bleeding 46 (63.8%) Periods heavier 39 (54.1%)
-Unable to cope 4 (5.5%) Intermenstrual bleeding 21 (29.1%) Postcoital bleeding 5 (6.9%) Other 8 (11.1%)
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Pain
Pain 45 (62.5%) Periods more painful 35 (48.6%) Dyspareunia 10 (13.8%) Other 13 (18.0%)
- pain between periods 11
- constant pain 2
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Pelvic infection
Pelvic infection 1 (1.3%)
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Have you still got your IUD/IUS in?
Yes 65 (58%) No 7 (6%)
(+3 removed in 3/12) Expulsion 3 Removal 5 - Bleeding 2 - Pain 3
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Satisfaction with IUD/IUS
0
2
4
6
8
10
12
14
16
18
0 1 2 3 4 5 6 7 8 9 10
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Conclusion
In general, IUD/IUS fittings well tolerated
Majority of women satisfied with device NICE Guidance: All women should be
given full choice of methods incl. IUD/IUS
Numbers too small to compare devices