Removals for pain and bleeding with intrauterine contraception - a comparison of two ‘gold standard' copper intrauterine devices 12 months post-fitting.
ESC Congress Library. Akintomide H. May 10, 2018; 208121; ESC146
Dr. Hannat Akintomide
Dr. Hannat Akintomide
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Background T-shaped intrauterine devices with a copper surface area of 380mm2 and copper bands on the transverse arms such as the TT380 Slimline® are the most effective copper intrauterine devices (IUDs) available and are seen as ‘gold standard' IUDs worldwide.   However little is known about patient outcomes with standard sized IUDs compared to smaller framed IUDs regarding removals for pain and bleeding.  The most commonly used gold standard IUD in our service is the TT380 Slimline®, measuring 32mm in width and 32mm in length. The Mini TT380 Slimline® is a smaller version with a width of 23.2mm and length of 29.5mm and is less frequently prescribed.  Aim To determine removal rates, including removals for pain and bleeding, with the Mini TT380 Slimline® compared to its standard sized counterpart, the TT380 Slimline® 12 months post-fitting. Method A service case notes review was undertaken looking at the records of women fitted with a Mini TT380 Slimline® (‘mini') and similar women fitted with a standard sized TT380 Slimline® (‘standard') IUD over a three-year period (2013 to 2016) to determine and compare removal rates, including removals for pain and bleeding, within the first 12 months of IUD insertion.   Results Records were available for 36 women fitted with a ‘mini' IUD (average age 23 years; 86%, n = 31 of whom were nulliparous) and 33 women (average age 25 years; 45%, n = 15 of whom were nulliparous) fitted with a ‘standard' IUD.  Fourteen percent (n = 5) of ‘mini' users had their IUD removed by 12 months, with complaints of pain and bleeding accounting for 40% (n = 2) of these removals.  Thirty percent (n = 10) of the ‘standard' users had their IUD removed by 12 months, with pain and bleeding accounting for 80% (n = 8) of these removals.  All five ‘mini' removals were in nulliparous women aged 20 to 24, while the 10 ‘standard' removals were in women aged 16 to 35, six of whom were parous.  Twice as many ‘standard' users had removed their IUDs compared to 'mini' users, with complaints of pain and bleeding four times more common in those discontinuing the use of 'standard' IUDs. Conclusion This case notes review suggests that more women using a ‘standard' IUD rather than a ‘mini' IUD complain of pain and bleeding leading to a higher removal rate by 12 months. We suggest the need for further studies looking at the association between IUD size and removals, especially for pain and bleeding.
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