Immediate IUD Insertion Not Inferior to Delayed Insertion

Immediate IUD insertion has higher expulsion rates but higher rates of use at six-months

WEDNESDAY, June 8 (HealthDay News) -- Immediate insertion of intrauterine devices (IUDs) after uterine aspiration is associated with a slightly higher, but not inferior, risk of expulsion and a higher rate of IUD use at six months compared to delayed insertion, according to a study published online June 9 in the New England Journal of Medicine.

Paula H. Bednarek, M.D., M.P.H., from Oregon Health and Science University in Portland, and colleagues investigated the effects of immediate and delayed IUD insertion following uterine aspiration on IUD expulsion. Women undergoing uterine aspiration for induced or spontaneous abortion at five to 12 weeks of gestation were randomly allocated to receive insertion of an IUD immediately (258 women) or delayed insertion after two to six weeks (226 women). The rate of IUD expulsion six months later was the primary outcome measured, with inferiority defined as an 8 percent higher expulsion rate in the immediate insertion group.

The investigators found that the six-month expulsion risk was 5 percent in the immediate insertion group and 2.7 percent in the delayed insertion group. At six months, immediate insertion was associated with a significantly higher rate of IUD use (92.3 percent), versus delayed insertion (76.6 percent). Adverse events were similar and rare for both groups.

"The six-month rate of expulsion of an IUD after immediate insertion was higher than but not inferior to that after delayed insertion. Immediate insertion resulted in higher rates of IUD use at six months, without an increased risk of complications," the authors write.

Duramed Pharmaceuticals donated ParaGard IUDs for use in the study; several authors disclosed financial relationships with pharmaceutical companies, including Duramed.

Full Text (subscription or payment may be required)

Physician's Briefing