Intrauterine method making inroads in use
Intrauterine contraception is highly convenient. It provides long-term protection against pregnancy, and the method is promptly reversible. Where does it fit in your facility's cafeteria of options?
According to participants in the 2006 Contraception Survey conducted by Contraceptive Technology Update, the intrauterine device (IUD) is moving up the list of contraceptive choices. About 46% of participants say they have performed six or more insertions in the past year, a 10% jump from the 35% level reported in 2005.
Two intrauterine contraceptives are available in the United States: the Mirena levonorgestrel intrauterine system (Mirena LNG IUS, Berlex; Wayne, NJ) and the Copper T 380A intrauterine device (ParaGard IUD, Duramed, a subsidiary of Barr Pharmaceuticals, Pomona, NY). The ParaGard IUD is approved for 10 years of contraception; the Mirena is approved for five years of birth control.1
What has led to the uptick in use? More aggressive marketing may have influenced the growth; while the Copper T 380A has been in use in the United States since 1988, its ownership now is under Duramed, which markets several women's health care products. Duramed acquired the marketing rights to the ParaGard with its November 2005 acquisition of North Tonawanda, NY-based FEI Women's Health, the longtime manufacturer of the ParaGard device.
More providers may be looking at the LNG IUS as a treatment option for menorrhagia. A 2006 systematic review of scientific studies indicates that while use of conservative surgery reduces blood loss more than the IUS, the two treatments appear about equal in terms of patient satisfaction.2
Edward Linn, MD, chairman of the OB/GYN department and director of the Centre for Women's Health at Rush North Shore Medical Center in Skokie, IL, says his facility is performing more IUD insertions and is using more Mirena (IUSs) for control of menorrhagia. More patients are aware of the IUD's effectiveness and safety, he says.
IUDs are very safe for most women, according to the Association of Reproductive Health Professionals (ARHP).3 Almost all women can use IUDs safely, including nursing mothers. Those who should not have an IUD inserted include:
- currently have a sexually transmitted infection;
- are allergic to copper or the hormone levonorgestrel;
- do not have a normal-shaped uterus;
- or have cervical or endometrial cancer.3
More women are potential candidates for ParaGard following the Food and Drug Administration (FDA) 2005 updated labeling for the device. The updated labeling now states:
- The device is approved for nulliparous women in stable relationships from ages 16 through menopause.
- ParaGard no longer is contraindicated for women with a history of sexually transmitted diseases (STDs) or pelvic inflammatory disease (PID) unless a patient currently has acute PID or engages in sexual behavior suggesting a high risk for PID.
- Mutual monogamy no longer is a user requirement, although use by women in a stable relationship is encouraged.4
When it comes to birth control, women are looking for simple, effective methods that do not interfere with their hectic lifestyles. According to a new national survey, more women than men say that romance is one of the top three activities they postpone due to life's everyday demands. Two-thirds of these women say they are not in the mood for romance after a stressful day as compared to 50% of men. However, more than three-quarters of both sexes agree that simplifying their busy lives would free them to be more romantic.5
Philip Ivey, MD, FACOG, an obstetrician/ gynecologist in private practice in Casa Grande, AZ, says he is seeing more insertions of the Mirena IUS at his office due to the method's ease of use, as well as its effect on the menses and cramping, and efficacy.
"Several office staffers use it," Ivey says of the method. "Patients query them and are quickly convinced."
References
- Hatcher RA, Trussell J, Stewart F, et al. Contraceptive Technology. 18th revised edition. New York City: Ardent Media; 2004.
- Marjoribanks J, Lethaby A, Farquhar C. Surgery versus medical therapy for heavy menstrual bleeding. Cochrane Database Syst Rev 2006; 2:CD003855.
- Association of Reproductive Health Professionals (AHRP). A Woman's Guide to Understanding IUDs. Accessed at: www.arhp.org//files/UnderstandingIUDs.pdf.
- FEI Women's Health LLC. FDA Approves Expanded Patient Profile For Non-Hormonal Intrauterine Device. Press release. Sept. 13, 2005.
- Berlex. New Survey Suggests Couples May Need Help Keeping Their Romance Alive This Summer. Press release. June 7, 2006.
Resource
- The Association of Reproductive Health Professionals (ARHP) has a new freely downloadable patient information brochure, A Woman's Guide to Understanding IUDs, available in English and Spanish at its web site, www.arhp.org. Click on "Patient Education," "Online Brochures," and the brochure title.
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