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Study of IUD insertions and clinical performance in nulliparous women

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Presentation on theme: "Study of IUD insertions and clinical performance in nulliparous women"— Presentation transcript:

1 Study of IUD insertions and clinical performance in nulliparous women
Dr Andrea Brockmeyer Dr Meera Kishen Abacus Clinics Liverpool, UK

2 Background Increased interest in IUDs from nulliparous women
Proven efficacy and safety of standard IUDs No increased risk of PID in nulliparous women The reason why we decided to do this study is tha twe noted an increased interest in IUDs and the IUS by nulliparous women. Studies have shown that IUDs are effective and safe, no increased risk of PID in nulliparous women.

3 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 But there is hardly any data about the clinical performance of the IUD and IUS in this client group

4 Objectives To assess experience of IUD/IUS fitting and use by nulliparous women (< 24 weeks) Therefore we decided to perform a pilot study to assess experience of IUD/IUS fitting and use by nulliparous women. Nulliparity is defined as no pregnancies of 24 weeks and over.

5 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 This prospective study is conducted at the main sexual health clinic Central Abacus in Liverpool. Our aim was to recruit about 100 nulliparous women who attended for routine or emergency insertions. A questionnaire was filled out at the time of the insertion recording any problems and the fitting experience.

6 Methodology Follow-up by postal questionnaire or
contact by phone three months and one year after insertion Clients are followed up by postal questionnaire or by phone three months and one year after insertion.

7 STI screening Sexual history CT/GC testing offered if appropriate
Antibiotics (Azithromycin) offered if high risk of CT All women had their sexual history taken and were offered STI screening. If they were suspected to be high risk of an STI but insertion could not be delayed as for emergency contraception they had a course of antibiotics. We usually give a dose of Azithromycin.

8 Recruitment Recruitment from May-October 2005 Total recruited 118
IUD/IUS fitted 113 Available for follow-up 112 Failed insertions 2 Other problems 4 We recruited 118 women within 6 months but actually fitted 113 devices as some women decided not to have the IUD inserted. One device was removed soon after insertion, therefore 112 women were eligible for follow-up.

9 Age range This is the age range of our clients. The majority were under 25 years of age.

10 Reasons for IUD/IUS fitting
EC and long-term use 30 (25.4%) Interval fitting 88 (74.6%) These were the reasons for fitting the IUD/IUS.

11 STI testing CT test at fitting 48 CT test in current relationship 65
CT test declined Antibiotics given 15 No positive CT tests reported Almost all women had a CT test at fitting or a recent negative CT test in the current relationship. 15 women were considered high risk and had antibiotics.No positive CT were reported.

12 Fitting procedure Local anaesthesia 27 (24%)
Difficulty sounding 17 (15%) Use of dilators (9%) Problems (9%) Failed IUD insertion 2 (1.8%) Client felt faint 7 (6%) Only a quarter of women had local anaesthesia/ mainly for IUS and Gynefix fitting. We had two failed IUD insertions.

13 Clinicians impression of fitting
Easier than expected 46 (41%) As expected (50%) Worse than expected (8%) And surprisingly over 40% of clinicians found the fitting easier than expected.

14 Client’s impression of fitting
We asked the clients how painful they thought the fitting was with 0 not painful and 10 very painful and this is the variation we got but score did not always related to the next answer. Most women described it like period pain.

15 Client’s impression of fitting
Less painful than expected 37 (33%) As expected (45%) More painful than expected 22 (19%) Only about 20% thought it was more painful than expected.

16 Three-month follow-up (interim results)
No of women contacted 112 Questionnaire received 72 (64.2%) I can present you the 3 months follow-up figures, the one year figures will not be available until the end of October. We had a response of 64%

17 Problems No, not at all 23 (32%) Yes 49 (68%)
Symptoms but not a problem About a third stated they had no problems at all, but even of those who had symptoms 10 stated this was not a problem.

18 Abnormal bleeding Abnormal bleeding 46 (63.8%)
Periods heavier (54.1%) -Unable to cope (5.5%) Intermenstrual bleeding 21 (29.1%) Postcoital bleeding (6.9%) Other (11.1%) Heavy periods was the main symptom although the majority thought they could cope

19 Pain Pain 45 (62.5%) Periods more painful 35 (48.6%)
Dyspareunia (13.8%) Other (18.0%) - pain between periods 11 - constant pain 2 Followed very closely by pain. Having said that several women stated that their symptoms were getting better after two to three months.

20 Pelvic infection Pelvic infection 1 (1.3%)
One reported a pelvic infection which was confirmed by swabs but she did not require hospital admission. This was about 4 weeks after insertion.

21 Have you still got your IUD/IUS in?
Yes (58%) No (6%) (+3 removed in 3/12) Expulsion 3 Removal 5 - Bleeding 2 - Pain 3 58% of the original 112 have still got their device, about 9% had it either removed or it had fallen out . One had anotherIUD inserted, One the IUS.

22 Satisfaction with IUD/IUS
In general, satisfaction was very high with most scores between 8 and 10.

23 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 So, in general IUD/IUS fittings were well tolerated in this client group and many women were satisfied with their device. This supports the new guidance of the National Institute for Clinical Excellence that nulliparous women should be given full choice of methods incuding the IUD and IUS. We need followup studies tocompare the devices as the numbers were too small for comparison. Thank you.


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