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

Anthony, Mary S.; Zhou, Xiaolei; Schoendorf, Juliane; Reed, Susan D.; Getahun, Darios; Armstrong, Mary Anne; Gatz, Jennifer; Peipert, Jeffrey F.; Raine‐Bennett, Tina; Fassett, Michael J.; Saltus, Catherine W.; Ritchey, Mary E.; Ichikawa, Laura; Shi, Jiaxiao; Alabaster, Amy; Wahdan, Yesmean; Wang, Jinyi; Xie, Fagen; Hunter, Shannon; Chiu, Vicki; Postlethwaite, Debbie; Rothman, Kenneth J.; Im, Theresa M; Chillemi, Giulia; Takhar, Harpreet; Asiimwe, Alex; Pisa, Federica Edith

doi:10.1097/aog.0000000000005000

Cited by 5 publications

(2 citation statements)

References 23 publications

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“…Whereas older studies did not include nulliparas, newer studies including nulliparas show that nulliparity, age < 25 years, obesity, parity of four or more, baseline heavy menstrual bleeding, and prior vaginal delivery are risk factors for expulsion [4,[6][7][8][9][10][11].…”

Section: J O U R N a L P R E -P R O O Fmentioning

confidence: 99%

Menstrual cup use and intrauterine device expulsion in a copper intrauterine device randomized trial

Brown,

Creinin,

et al. 2024

Contraception

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Section: J O U R N a L P R E -P R O O Fmentioning

confidence: 99%

Menstrual cup use and intrauterine device expulsion in a copper intrauterine device randomized trial

Brown,

Creinin,

et al. 2024

Contraception

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“…[6][7][8][9][10][11] A separate analysis, requested by the European Medicines Association, evaluated whether certain demographic, reproductive, and medical variables, including younger age at IUD insertion, race and ethnicity, body mass index (BMI, calculated as weight in kilograms divided by height in meters squared), parity, history of heavy menstrual bleeding, and history of dysmenorrhea, were independent risk factors for IUD expulsion among nonpostpartum individuals. 12 The aim of this article is to summarize the clinically important findings from previous APEX-IUD publications to inform counseling, shared decision making, and consent for individuals who use or are considering IUD use (Box 1).…”

mentioning

confidence: 99%

Risks of Uterine Perforation and Expulsion Associated With Intrauterine Devices

Fassett

Reed

Rothman

et al. 2023

Obstetrics &Amp; Gynecology

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OBJECTIVE: The APEX-IUD (Association of Perforation and Expulsion of Intrauterine Devices) study evaluated the association of postpartum timing of intrauterine device (IUD) insertion, breastfeeding, heavy menstrual bleeding, and IUD type (levonorgestrel-releasing vs copper) with risks of uterine perforation and IUD expulsion in usual clinical practice. We summarize the clinically important findings to inform counseling and shared decision making. METHODS: APEX-IUD was a real-world (using U.S. health care data) retrospective cohort study of individuals aged 50 years and younger with IUD insertions between 2001 and 2018 and with electronic health record data. Cumulative incidences of uterine perforation and IUD expulsion were calculated. Adjusted hazard ratios (aHRs) and 95% CIs were estimated from proportional hazards models with control of confounding. RESULTS: Among the study population of 326,658, absolute risk of uterine perforation was low overall (cumulative incidence, 0.21% [95% CI 0.19–0.23%] at 1 year and 0.61% [95% CI 0.56–0.66% at 5 years]) but was elevated for IUDs inserted during time intervals within 1 year postpartum, particularly among those between 4 days and 6 weeks postpartum (aHR 6.71, 95% CI 4.80–9.38), relative to nonpostpartum insertions. Among postpartum insertions, IUD expulsion risk was greatest for insertions in the immediate postpartum period (0–3 days after delivery) compared with nonpostpartum (aHR 5.34, 95% CI 4.47–6.39). Postpartum individuals who were breastfeeding had a slightly elevated risk of perforation and lowered risk of expulsion than those not breastfeeding. Among nonpostpartum individuals, those with a heavy menstrual bleeding diagnosis were at greater risk of expulsion than those without (aHR 2.84, 95% CI 2.66–3.03); heavy menstrual bleeding also was associated with a slightly elevated perforation risk. There was a slightly elevated perforation risk and slightly lower expulsion risk associated with levonorgestrel-releasing IUDs compared with copper IUDs. CONCLUSION: Absolute risk of adverse outcomes with IUD insertion is low. Clinicians should be aware of the differences in risks of uterine perforation and expulsion associated with IUD insertion during specific postpartum time periods and with a heavy menstrual bleeding diagnosis. This information should be incorporated into counseling and decision making for patients considering IUD insertion. FUNDING SOURCE: Bayer AG. CLINICAL TRIAL REGISTRATION: EU PAS register, EUPAS33461.

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Heavy menstrual bleeding in women with inherited bleeding disorders in use of LNG-IUS: A systematic review and single-arm meta-analysis

Oliveira,

Eskandar,

Chagas

et al. 2024

Contraception

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

Abstract: Of the risk factors evaluated, intrauterine device expulsion risk was highest among individuals with chronic, persistent heavy menstrual bleeding.

Cited by 5 publications

References 23 publications

Menstrual cup use and intrauterine device expulsion in a copper intrauterine device randomized trial

Menstrual cup use and intrauterine device expulsion in a copper intrauterine device randomized trial

Risks of Uterine Perforation and Expulsion Associated With Intrauterine Devices

Heavy menstrual bleeding in women with inherited bleeding disorders in use of LNG-IUS: A systematic review and single-arm meta-analysis

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