Once a woman decides to use an IUD, studies have shown that she has a very high likelihood of being pleased with her choice. In addition to being a Tier 1 form of birth control, the IUD has been shown to have the highest rates of satisfaction and continued use. The Contraceptive CHOICE Project, which surveyed more than 9,000 women who use contraception, found that approximately 86% of women who chose a LNG IUD and 81% of women who chose the copper IUD were satisfied with their chosen method. 7 This was compared with only half of those who chose non-LARC methods.8 The continuation rates for the LNG and copper IUD at 12 months (88% and 85%, respectively) and 24 months (79% and 77%, respectively) are also much higher, compared with those of non-LARC methods at 12 and 24 months (57% and 41%, respectively; Table 2).7-9
Continuation rates for nulliparous women are approximately the same as continuation rates for multiparous women, according to the Contraceptive CHOICE Project.7 LNG IUD users also have very similar continuation rates at 12 months, regardless of age, with the notable exception that copper IUD users who are aged less than 20 years have a slightly higher discontinuation rate (28%), compared with women older than age 20 years (15%).10 Common reasons for discontinuation within the first 6 months, according to a 2012 study of 5,928 participants by Grunloh et al,11 were pain, cramping, and irregular, frequent, or heavy bleeding.
The American College of Obstetricians and Gynecologists (ACOG) and the U.S. Medical Eligibility Criteria (MEC) for Contraceptive Use state that all 3 IUDs are safe for use in nulliparous women and adolescents. IUDs are also safe in women with a history of pelvic inflammatory disease (PID) or ectopic pregnancy, who are immediately postpartum, or immediately following abortion/miscarriage (except in the presence of puerperal sepsis).9 The ACOG also states that IUDs are safe in women with a history of IUD expulsion. The ACOG, along with 3 recent studies, have recommended LARC as first-line contraception for all women7,9,11; in fact, the ACOG endorses LARC methods as the “best form of reversible contraception.”9
- IUDs are safe for
- Nulliparous women
- Women who are
- immediately postpartum
- immediately postabortion/miscarriage
- Women with a history of
- ectopic pregnancy
- IUD expulsion
- IUDs should be offered as first-line contraception for all women
- IUDs are the best form of reversible contraception
IUD, intrauterine device; PID, pelvic inflammatory disease
Several factors potentially contribute to the reluctance of patients and providers to follow expert recommendations and embrace the use of IUDs. The next section will discuss research from studies that examined patient and provider perspectives on IUDs.