When can a woman have an intrauterine device inserted? A systematic review

Abstract

Background-Intrauterine device (IUD) insertion during menses may be viewed as preferable by some providers, as it provides reassurance that the woman is not pregnant. However, this practice may result in unnecessary inconvenience and cost to women. The objective of this systematic review is to evaluate the evidence for the effect of inserting IUDs on different days of the menstrual cycle on contraceptive continuation, effectiveness and safety.Study Design-We searched the MEDLINE database for peer-reviewed articles published in any language from database inception through March 2012 concerning the effect of inserting copper IUDs (Cu-IUD) or levonorgestrel-releasing IUDs (LNG-IUDs) on different days of the menstrual cycle on contraceptive continuation, effectiveness, and safety. The quality of each individual piece of evidence was assessed using the United States Preventive Services Task Force grading system. Results-We identified eight articles that met the criteria for review. Each study examined the Cu-IUD; no studies were identified that examined the LNG-IUD. Overall, these studies suggest that timing of Cu-IUD insertion has little effect on longer term outcomes (rates of continuation, removal, expulsion, or pregnancy) or on shorter term outcomes (pain at insertion, bleeding at insertion, immediate expulsion). Specifically, there was no evidence to suggest that outcomes were better when Cu-IUD insertions were performed during menses. Limitations of the studies include small sample sizes for insertions performed during later days of the menstrual cycle and non-randomized assignment to timing of insertion.Conclusions-There is fair evidence (body of evidence grading: II-2, fair) indicating that timing of Cu-IUD insertion has little effect on contraceptive continuation, effectiveness or safety.

Uptake of Long-Acting Reversible Contraceptive Methods in Enugu State University Teaching Hospital Enugu, South-East, Nigeria.

“…Enugu State University Teaching Hospital (ESUTH) Enugu is a state owned health institution that became a teaching hospital in June 2006 [28]. It is located in the center of Enugu metropolis and most of the population are Christians and of the Igbo tribe.…”

Timing of insertion of levonorgestrel‐releasing intrauterine system: a randomised controlled trial

“…8 Overall, the eight studies reviewed suggest that the timing of insertion of an IUD with copper has little effect on long-term outcomes (e.g. 8 Overall, the eight studies reviewed suggest that the timing of insertion of an IUD with copper has little effect on long-term outcomes (e.g.…”

“…5 The LNG-IUS is inserted into the uterine cavity by the general practitioner or gynaecologist. [8][9][10] Nevertheless, there is no literature on these findings for the LNG-IUS. This might be the reason that some women do not choose this treatment option.…”

Contraceptive Method Initiation

“…9 Specifically, for Cu-IUDs and LNG-IUDs, a systematic review did not suggest differences in continuation, expulsion, removal, or pregnancy rates when the devices are inserted at different times of the menstrual cycle. 10 Studies have examined the quick start method for CHCs, where a woman starts her contraceptive method either on the same day or shortly after her clinic visit, compared with the conventional start method, where the woman starts contraception with her next menses. The studies were not powered to detect a difference in effectiveness, but they did find improved continuation rates early in use, although this advantage diminished over time.…”