Saltus C, Reed S, Peipert J, Fassett M, Merchant M, Asiimwe A, Ritchey ME, Xie F, Amstrong MA, Gatz N, Ichikawa L, Getahun D, Lynen R, Wang J, Hunter S, Chillemi G, Anthony M. IUD type and indicators of difficult insertion among women with intrauterine devices. Poster presented at the 2020 36th ICPE International Virtual Conference on Pharmacoepidemiology & Therapeutic Risk Management; September 16, 2020.

BACKGROUND: Approximately 16% of women who use contraception in the United States use long-acting reversible contraceptives such as an intrauterine device (IUD). There are two types of IUDs: copper and levonorgestrel-releasing (LNG). Both types are indicated for prevention of pregnancy. Difficulty with device insertions that might be associated with negative outcomes for the user may differ by IUD type.

OBJECTIVES: To describe the proportion of women who have indicators of potentially difficult insertion during IUD placement for LNG and copper IUDs.

METHODS: Women receiving IUDs were identified at each of four sites (three Kaiser Permanente sites—Northern California, Southern California, and Washington—and Regenstrief Institute, Indiana). Structured (National Drug Codes, International Classification of Diseases 9 and 10-Clinical Modification (ICD 9/10), Current Procedural Terminology) and unstructured (clinical notes) data were used to identify IUD type, and five indicators of potentially difficult IUD insertion (cervical dilation, ultrasound guidance, paracervical block, provider note for “difficult insertion,” and misoprostol use). ICD 9/10 was also used to identify recent menorrhagia. The proportion of women with difficult insertion was assessed overall as well as by IUD type and by recent menorrhagia diagnosis.

RESULTS: Among 326,658 women with IUD insertions, 63,664 (19.5%) received copper, and 259,234 (79.4%) received LNG-IUDs. Overall, 9.1% of women (site range, 3.5%-16.3%) experienced some indication of difficult insertion; a lower proportion of women with copper IUDs had any of these five indicators of difficult insertion (7.3%) versus women with LNG IUDs (9.5%). As expected, women with menorrhagia and concomitant procedures were more likely to receive LNG IUDs than copper IUDs (12.% vs. 1.3% and 8.9% vs. 4.2%, respectively), and the proportion of women with an indicator of difficult insertion was higher among women with recent menorrhagia (11.5%) than among those without this diagnosis (8.8%). The most common indicator was paracervical block (4.5% of insertions); however, misoprostol use and cervical dilation were more common at some sites.

CONCLUSIONS: The proportion of women with an indicator of potentially difficult insertion was higher among those receiving LNG IUDs compared with those receiving copper IUDs. However, as LNG are also secondarily indicated for heavy menstrual bleeding and more likely to be inserted with concomitant procedures, these factors might play a mediating role in this difference.

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