Presentation on theme: "Study of IUD insertions and clinical performance in nulliparous women"— Presentation transcript:
1Study of IUD insertions and clinical performance in nulliparous women Dr Andrea BrockmeyerDr Meera KishenAbacus ClinicsLiverpool, UK
2Background Increased interest in IUDs from nulliparous women Proven efficacy and safety of standard IUDsNo increased risk of PID in nulliparous womenThe 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.
3Background No studies about acceptability removal rates for pain and bleedingrate of spontaneous expulsionsin the standard IUDs and the IUS in nulliparouswomen in the UKBut there is hardly any data about the clinical performance of the IUD and IUS in this client group
4ObjectivesTo 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.
5Methodology Prospective pilot study Recruitment of 100 nulliparous women at Central AbacusRoutine IUD/IUS insertions or IUD insertions for EC but long-term useQuestionnaire at time of IUD/IUS insertionThis 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.
6Methodology Follow-up by postal questionnaire or contact by phone three months and one year after insertionClients are followed up by postal questionnaire or by phone three months and one year after insertion.
7STI screening Sexual history CT/GC testing offered if appropriate Antibiotics (Azithromycin) offered if high risk of CTAll 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.
8Recruitment Recruitment from May-October 2005 Total recruited 118 IUD/IUS fitted 113Available for follow-up 112Failed insertions 2Other problems 4We 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.
9Age rangeThis is the age range of our clients. The majority were under 25 years of age.
10Reasons 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.
11STI testing CT test at fitting 48 CT test in current relationship 65 CT test declinedAntibiotics given 15No positive CT tests reportedAlmost 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.
12Fitting 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.
13Clinicians 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.
14Client’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.
15Client’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.
16Three-month follow-up (interim results) No of women contacted 112Questionnaire 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%
17Problems No, not at all 23 (32%) Yes 49 (68%) Symptoms but not a problemAbout a third stated they had no problems at all, but even of those who had symptoms 10 stated this was not a problem.
18Abnormal 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
19Pain Pain 45 (62.5%) Periods more painful 35 (48.6%) Dyspareunia (13.8%)Other (18.0%)- pain between periods 11- constant pain 2Followed very closely by pain. Having said that several women stated that their symptoms were getting better after two to three months.
20Pelvic 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.
21Have you still got your IUD/IUS in? Yes (58%)No (6%)(+3 removed in 3/12)Expulsion 3Removal 5- Bleeding 2- Pain 358% 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.
22Satisfaction with IUD/IUS In general, satisfaction was very high with most scores between 8 and 10.
23Conclusion In general, IUD/IUS fittings well tolerated Majority of women satisfied with deviceNICE Guidance: All women should be given full choice of methods incl. IUD/IUSNumbers too small to compare devicesSo, 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.