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Follow-Up After IUD Insertions: Managing IUD Expectations, Addressing Side Effects, and Providing Post-Insertion Counseling

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Abstract

While routine visits after intrauterine device (IUD) insertion are not recommended for adolescents and young adults by evidence-based guidelines, they can present valuable opportunities to answer patient questions, review method-specific information, and offer routine reproductive health care. It is important for providers to be aware of the range of bleeding and cramping that happens after IUD placement, both by timing and type of device. This knowledge helps clinicians provide reassurance, as well as understand the treatment options available for those whose symptoms are bothersome. Understanding additional IUD-related symptoms and how to provide counseling in a patient-centered manner can help to maintain the ongoing patient-clinician relationship and improve method satisfaction. This chapter will review the rationale for scheduled versus problem-based visits after IUD insertion, describe the common and less common patient concerns after IUD insertion, and provide information to help clinicians manage IUD concerns. Lastly, we will discuss how to integrate a reproductive justice framework into discussions around IUD removal.

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Abbreviations

AYA:

Adolescent and Young Adult

BV:

Bacterial Vaginosis

CDC:

Centers for Disease Control

IUD:

Intrauterine Device

LNG:

Levonorgestrel

NSAIDs:

Nonsteroidal Anti-inflammatory drugs

STI:

Sexually Transmitted Infection

References

  1. Curtis KM, Jatlaoui TC, Tepper NK, Zapata LB, Horton LG, Jamieson DJ, et al. U.S. selected practice recommendations for contraceptive use, 2016. MMWR Recomm Rep. 2016;65:1–66.

    PubMed  Google Scholar 

  2. Steenland MW, Zapata LB, Brahmi D, Marchbanks PA, Curtis KM. The effect of follow-up visits or contacts after contraceptive initiation on method continuation and correct use. Contraception. 2013;87:625–30.

    Article  PubMed  Google Scholar 

  3. Herceg-Baron R, Furstenberg FF Jr, Shea J, Harris KM. Supporting teenagers’ use of contraceptives: a comparison of clinic services. Fam Plan Perspect. 1986;18:61–6.

    Article  CAS  Google Scholar 

  4. Kirby D, Raine T, Thrush G, Yuen C, Sokoloff A, Potter SC. Impact of an intervention to improve contraceptive use through follow-up phone calls to female adolescent clinic patients. Perspect Sex Reprod Health. 2010;42:251–7.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Neuteboom K, de Kroon CD, Dersjant-Roorda M, Jansen FW. Follow-up visits after IUD-insertion: sense or nonsense? A technology assessment study to analyze the effectiveness of follow-up visits after IUD insertion. Contraception. 2003;68:101–4.

    Article  PubMed  Google Scholar 

  6. Bernard A, Satterwhite CL, Reddy M. Frequency of 6-week follow-up appointment scheduling after intrauterine device insertion. BMJ Sex Reprod Health. 2018;44:33–6.

    Article  PubMed  Google Scholar 

  7. Draper IB, Haque MS, McManus RJ. Routine intrauterine device checks: are they advisable? J Fam Plann Reprod Health Care. 2012;38:15–8.

    Article  PubMed  Google Scholar 

  8. Hameed W, Azmat SK, Ali M, Ishaque M, Abbas G, Munroe E, et al. Comparing effectiveness of active and passive client follow-up approaches in sustaining the continued use of Long Acting Reversible Contraceptives (LARC) in rural Punjab: a multicentre, non-inferiority trial. PLoS One. 2016;11:e0160683.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  9. L’Engle KL, Mangone ER, Parcesepe AM, Agarwal S, Ippoliti NB. Mobile phone interventions for adolescent sexual and reproductive health: a systematic review. Pediatrics 2016;138. https://doi.org/10.1542/peds.2016-0884.

    Article  Google Scholar 

  10. Chernick LS, Stockwell MS, Wu M, Castaño PM, Schnall R, Westhoff CL, et al. Texting to increase contraceptive initiation among adolescents in the emergency department. J Adolesc Health. 2017;61:786–90.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Haider S, Dodge LE, Brown BA, Hacker MR, Raine TR. Evaluation of e-mail contact to conduct follow-up among adolescent women participating in a longitudinal cohort study of contraceptive use. Contraception. 2013;88:18–23.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Alnakash AH. Influence of IUD perceptions on method discontinuation. Contraception. 2008;78:290–3.

    Article  PubMed  Google Scholar 

  13. Brown MK, Auerswald C, Eyre SL, Deardorff J, Dehlendorf C. Identifying counseling needs of nulliparous adolescent intrauterine contraceptive users: a qualitative approach. J Adolesc Health. 2013;52:293–300.

    Article  PubMed  Google Scholar 

  14. Dehlendorf C, Krajewski C, Borrero S. Contraceptive counseling: best practices to ensure quality communication and enable effective contraceptive use. Clin Obstet Gynecol. 2014;57:659–73.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Schivone GB, Glish LL. Contraceptive counseling for continuation and satisfaction. Curr Opin Obstet Gynecol. 2017;29:443–8.

    Article  PubMed  Google Scholar 

  16. Ylikorkala O, Kauppila A, Siljander M. Anti-prostglandin therapy in prevention of side-effects of intrauterine contraceptive devices. Lancet. 1978;2:393–5.

    Article  CAS  PubMed  Google Scholar 

  17. Diedrich JT, Desai S, Zhao Q, Secura G, Madden T, Peipert JF. Association of short-term bleeding and cramping patterns with long-acting reversible contraceptive method satisfaction. Am J Obstet Gynecol. 2015;212:50.e1–8.

    Article  Google Scholar 

  18. Fraser IS, Critchley HOD, Broder M, Munro MG. The FIGO recommendations on terminologies and definitions for normal and abnormal uterine bleeding. Semin Reprod Med. 2011;29:383–90.

    Article  PubMed  Google Scholar 

  19. Suvisaari J, Lähteenmäki P. Detailed analysis of menstrual bleeding patterns after postmenstrual and postabortal insertion of a copper IUD or a levonorgestrel-releasing intrauterine system. Contraception. 1996;54:201–8.

    Article  CAS  PubMed  Google Scholar 

  20. Ylikorkala O. Prostaglandin synthesis inhibitors in menorrhagia, intrauterine contraceptive device-induced side effects and endometriosis. Pharmacol Toxicol. 1994;75(Suppl 2):86–8.

    Article  PubMed  Google Scholar 

  21. Hubacher D, Chen P-L, Park S. Side effects from the copper IUD: do they decrease over time? Contraception. 2009;79:356–62.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Sanders JN, Adkins DE, Kaur S, Storck K, Gawron LM, Turok DK. Bleeding, cramping, and satisfaction among new copper IUD users: a prospective study. PLoS One. 2018;13:e0199724.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  23. Hubacher D, Reyes V, Lillo S, Pierre-Louis B, Zepeda A, Chen P-L, et al. Preventing copper intrauterine device removals due to side effects among first-time users: randomized trial to study the effect of prophylactic ibuprofen. Hum Reprod. 2006;21:1467–72.

    Article  CAS  PubMed  Google Scholar 

  24. Grimes DA, Hubacher D, Lopez LM, Schulz KF. Non-steroidal anti-inflammatory drugs for heavy bleeding or pain associated with intrauterine-device use. Cochrane Database Syst Rev. 2006:CD006034.

    Google Scholar 

  25. Nelson AL. LNG-IUS 12: a 19.5 levonorgestrel-releasing intrauterine system for prevention of pregnancy for up to five years. Expert Opin Drug Deliv. 2017;14:1131–40.

    Article  CAS  PubMed  Google Scholar 

  26. Mejia M, McNicholas C, Madden T, Peipert JF. Association of baseline bleeding pattern on amenorrhea with levonorgestrel intrauterine system use. Contraception. 2016;94:556–60.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Skyla (levonorgestrel-releasing intrauterine system). Highlights of prescribing information [Internet]. [cited 17 Dec 2018]. Available: http://labeling.bayerhealthcare.com/html/products/pi/Skyla_PI.pdf.

  28. Mansour D, Inki P, Gemzell-Danielsson K. Efficacy of contraceptive methods: a review of the literature. Eur J Contracept Reprod Health Care. 2010;15(Suppl 2):S19–31.

    Article  PubMed  Google Scholar 

  29. Godfrey EM, Folger SG, Jeng G, Jamieson DJ, Curtis KM. Treatment of bleeding irregularities in women with copper-containing IUDs: a systematic review. Contraception. 2013;87:549–66.

    Article  CAS  PubMed  Google Scholar 

  30. Friedlander E, Kaneshiro B. Therapeutic options for unscheduled bleeding associated with long-acting reversible contraception. Obstet Gynecol Clin N Am. 2015;42:593–603.

    Article  Google Scholar 

  31. Abdel-Aleem H, d’Arcangues C, Vogelsong KM, Gaffield ML, Gülmezoglu AM. Treatment of vaginal bleeding irregularities induced by progestin only contraceptives. Cochrane Database Syst Rev. 2013:CD003449.

    Google Scholar 

  32. Zigler RE, McNicholas C. Unscheduled vaginal bleeding with progestin-only contraceptive use. Am J Obstet Gynecol. 2017;216:443–50.

    Article  CAS  PubMed  Google Scholar 

  33. Simmons KB, Edelman AB, Fu R, Jensen JT. Tamoxifen for the treatment of breakthrough bleeding with the etonogestrel implant: a randomized controlled trial. Contraception. 2017;95:198–204.

    Article  CAS  PubMed  Google Scholar 

  34. Ylikorkala O, Viinikka L. Comparison between antifibrinolytic and antiprostaglandin treatment in the reduction of increased menstrual blood loss in women with intrauterine contraceptive devices. Br J Obstet Gynaecol. 1983;90:78–83.

    Article  CAS  PubMed  Google Scholar 

  35. Guiahi M, McBride M, Sheeder J, Teal S. Short-term treatment of bothersome bleeding for etonogestrel implant users using a 14-day oral contraceptive pill regimen: a randomized controlled trial. Obstet Gynecol. 2015;126:508–13.

    Article  CAS  PubMed  Google Scholar 

  36. Hou MY, McNicholas C, Creinin MD. Combined oral contraceptive treatment for bleeding complaints with the etonogestrel contraceptive implant: a randomised controlled trial. Eur J Contracept Reprod Health Care. 2016;21:361–6.

    Article  CAS  PubMed  Google Scholar 

  37. Akers AY, Steinway C, Sonalkar S, Perriera LK, Schreiber C, Harding J, et al. Reducing pain during intrauterine device insertion: a randomized controlled trial in adolescents and young women. Obstet Gynecol. 2017;130:795–802.

    Article  PubMed  Google Scholar 

  38. Ngo LL, Braaten KP, Eichen E, Fortin J, Maurer R, Goldberg AB. Naproxen sodium for pain control with intrauterine device insertion: a randomized controlled trial. Obstet Gynecol. 2016;128:1306–13.

    Article  CAS  PubMed  Google Scholar 

  39. Rapkin RB, Achilles SL, Schwarz EB, Meyn L, Cremer M, Boraas CM, et al. Self-administered lidocaine gel for intrauterine device insertion in nulliparous women: a randomized controlled trial. Obstet Gynecol. 2016;128:621–8.

    Article  CAS  PubMed  Google Scholar 

  40. Imai A, Matsunami K, Takagi H, Ichigo S. Levonorgestrel-releasing intrauterine device used for dysmenorrhea: five-year literature review. Clin Exp Obstet Gynecol. 2014;41:495–8.

    Article  CAS  PubMed  Google Scholar 

  41. Golightly E, Gebbie AE. Low-lying or malpositioned intrauterine devices and systems. J Fam Plann Reprod Health Care. 2014;40:108–12.

    Article  PubMed  Google Scholar 

  42. Rhudy JL, Meagher MW. Fear and anxiety: divergent effects on human pain thresholds. Pain. 2000;84:65–75.

    Article  CAS  PubMed  Google Scholar 

  43. Jatlaoui TC, Riley HEM, Curtis KM. The safety of intrauterine devices among young women: a systematic review. Contraception. 2017;95:17–39.

    Article  PubMed  Google Scholar 

  44. Dickerson LM, Diaz VA, Jordon J, Davis E, Chirina S, Goddard JA, et al. Satisfaction, early removal, and side effects associated with long-acting reversible contraception. Fam Med. 2013;45:701–7.

    PubMed  Google Scholar 

  45. Maguire K, Joslin-Roher S, Westhoff CL, Davis AR. IUDs at 1 year: predictors of early discontinuation. Contraception. 2015;92:575–7.

    Article  PubMed  Google Scholar 

  46. Davies A, Fleming C. Do intrauterine device/intrauterine system users check their threads? J Fam Plann Reprod Health Care. 2014;40:122–5.

    Article  PubMed  Google Scholar 

  47. Apter D, Gemzell-Danielsson K, Hauck B, Rosen K, Zurth C. Pharmacokinetics of two low-dose levonorgestrel-releasing intrauterine systems and effects on ovulation rate and cervical function: pooled analyses of phase II and III studies. Fertil Steril. 2014;101:1656–62.e1–4.

    Article  CAS  PubMed  Google Scholar 

  48. Mirena (levonorgestrel-releasing intrauterine system). Highlights of prescribing information [Internet]. [cited 13 Jan 2019]. Available: https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/021225s027lbl.pdf.

  49. Raifman S, Barar R, Foster D. Effect of knowledge of self-removability of intrauterine contraceptives on uptake, continuation, and satisfaction. Womens Health Issues. 2018;28:68–74.

    Article  PubMed  Google Scholar 

  50. Lopez LM, Ramesh S, Chen M, Edelman A, Otterness C, Trussell J, et al. Progestin-only contraceptives: effects on weight. Cochrane Database Syst Rev. 2016:CD008815.

    Google Scholar 

  51. Silva Dos Santos PN, Madden T, Omvig K, Peipert JF. Changes in body composition in women using long-acting reversible contraception. Contraception. 2017;95:382–9.

    Article  CAS  PubMed  Google Scholar 

  52. Achilles SL, Austin MN, Meyn LA, Mhlanga F, Chirenje ZM, Hillier SL. Impact of contraceptive initiation on vaginal microbiota. Am J Obstet Gynecol. 2018;218:622.e1–622.e10.

    Article  CAS  Google Scholar 

  53. Madden T, Grentzer JM, Secura GM, Allsworth JE, Peipert JF. Risk of bacterial vaginosis in users of the intrauterine device: a longitudinal study. Sex Transm Dis. 2012;39:217–22.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Stoddard AM, Xu H, Madden T, Allsworth JE, Peipert JF. Fertility after intrauterine device removal: a pilot study. Eur J Contracept Reprod Health Care. 2015;20:223–30.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Girum T, Wasie A. Return of fertility after discontinuation of contraception: a systematic review and meta-analysis. Contracept Reprod Med. 2018;3:9.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Higgins JA. Celebration meets caution: LARC’s boons, potential busts, and the benefits of a reproductive justice approach. Contraception. 2014;89:237–41.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Faundes A, Segal SJ, Adejuwon CA, Brache V, Leon P, Alvarez-Sanchez F. The menstrual cycle in women using an intrauterine device. Fertil Steril. 1980;34:427–30.

    Article  CAS  PubMed  Google Scholar 

  58. Nielsen D, Christensen OM, Nielsen R, Larsen J. Unwanted pregnancy after removal of the IUD. Ugeskr Laeger. 1990;152:3172–3.

    CAS  PubMed  Google Scholar 

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Correspondence to Mandy S. Coles .

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Coles, M.S. (2019). Follow-Up After IUD Insertions: Managing IUD Expectations, Addressing Side Effects, and Providing Post-Insertion Counseling. In: Coles, M., Mays, A. (eds) Optimizing IUD Delivery for Adolescents and Young Adults. Springer, Cham. https://doi.org/10.1007/978-3-030-17816-1_11

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  • DOI: https://doi.org/10.1007/978-3-030-17816-1_11

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