Developing an intrauterine device self-removal guide: a mixed methods qualitative and small pilot study

Abstract

Background The intrauterine device (IUD) is a highly effective form of long-acting reversible contraception (LARC) with few contraindications. Users, however, often encounter barriers to desired removal. IUD self-removal may mitigate these obstacles. We sought to develop a guide for IUD self-removal with the aim of increasing user control over the method. Methods This was a two-phase mixed-methods qualitative and small pilot study with the aim of developing an IUD self-removal guide. We conducted an online content analysis of advice for IUD self-removal as well as interviews with expert key informants to develop an IUD self-removal guide. We next recruited IUD-users who had previously attempted self-removal to participate in focus group discussion and individual interviews to further refine the guide. In the second phase of the study, we piloted the guide among eight IUD-users seeking removal interested in attempting self-removal. Results Expert key informants agreed that IUD self-removal was safe and low risk. The primary components of successful IUD self-removal elicited were ability to feel and grasp the strings, a crouched down position, and multiple attempts. A preference for presenting IUD self-removal as safe was emphasized. In the second phase, participants in the clinical pilot suggested more information for non-palpable strings, but liked the style and information provided. One participant successfully removed their IUD. Conclusions IUD-users reported satisfaction with our guide. In our small pilot, the majority were unable to remove their own IUD. A larger study is needed to assess acceptability, feasibility, and efficacy in increasing successful self-removal.

Menstrual cup and risk of IUD expulsion – a systematic review

“…Patients who choose IUD discontinuation may face barriers to removal including clinical objection, difficulty accessing contraception services, appointment waiting times, and cost [ 32 ]. There has been growing interest in intentional IUD self-removal to bypass barriers for removal.…”

“…Analysis of online content has shown a growing interest in online resources offering guidance for intentional IUD self-removal [ 33 ]. IUD self-removal is safe and low risk; however success rates are estimated to be 20% [ 32 , 34 ]. Given the lack of evidence regarding the risk of menstrual cup use and IUD expulsion this should not be recommended as a mechanism to facilitate IUD self-removal, and therefore this topic requires further investigation.…”

Increasing access to LARC removal in pediatrics to support adolescent reproductive justice in the United States

“…33 In addition, an IUD self-removal patient guide developed with key expert informants and adults who successfully self-removed their IUD was pilot-tested with no adverse events, 34 and a larger clinical trial is underway to test the efficacy of an educational video simulating IUD users' willingness and success with self-removal. 35 While we recommend that IUD self-removal guides be offered during IUD insertion, 36,34 developmentally-tailored education on adolescent and young adult IUD self-removal is still needed. Pediatricians should encourage open communication when patients attempt IUD self-removal, to prioritize safety and facilitate on-going support of reproductive health needs.…”

“…The Society of Family Planning recommends counseling patients about IUD self‐removal as a safe and accessible option; 32 however, few adolescents and young adults are aware that this option exists 33 . In addition, an IUD self‐removal patient guide developed with key expert informants and adults who successfully self‐removed their IUD was pilot‐tested with no adverse events, 34 and a larger clinical trial is underway to test the efficacy of an educational video simulating IUD users' willingness and success with self‐removal 35 . While we recommend that IUD self‐removal guides be offered during IUD insertion, 36,34 developmentally‐tailored education on adolescent and young adult IUD self‐removal is still needed.…”