Forum Healthcare For Women

Intrauterine Contraception: Effective, Safe, and Under the Radar

Release Date: October 2008
Expiration Date: October 31, 2010

FACULTY CHAIR

David A. Grimes, MD
Vice President of Biomedical Affairs
Family Health International
Research Triangle Park, NC
Clinical Professor
Department of Obstetrics and Gynecology
University of North Carolina School of Medicine
Chapel Hill, NC

FACULTY

David Hubacher, PhD
Senior Epidemiologist
Family Health International
Research Triangle Park, NC

Frances E. Likis, DrPH, NP, CNM
Editor-in-Chief
Journal of Midwifery & Women’s Health
Associate Director of Graduate Studies Institute for Medicine and Public Health
Vanderbilt University Medical Center
Nashville, TN

Kirtly Parker Jones, MD
Professor
Vice Chair for Educational Affairs
Department of Obstetrics and Gynecology
University of Utah
Salt Lake City, UT

Statement of Need:

Nearly half—49%—of all pregnancies occurring in the United States are unintended.¹ Whether those pregnancies are unwanted or merely mistimed, and whether they result in elective termination or live birth, they constitute an important public health issue of particularly vital interest to clinicians who provide health care for women.

Indeed, Healthy People 2010, the US Department of Health and Human Services project that outlines health-related goals for the nation as a whole, aims to reduce rates of unintended pregnancy to 30%.² Healthy People 2010 proposes to reach that goal by increasing the percentage of contraception users among women aged 14 to 44 years (and their partners) who are at risk of unintended pregnancy from the current rate of 93% to 100%.²

The fact that 93% of women at risk of unintended pregnancy already use contraception, yet half of all pregnancies are unplanned, suggests strongly that the contraceptive methods being used are not effective, possibly due to flaws inherent in the methods themselves or to inconsistent or incorrect use. Clinicians who provide contraceptive care are obligated to help each patient find the most effective method for her—one that is safe, effective, and that suits her medical needs, lifestyle patterns, and short- and long-term family planning goals.

The two intrauterine contraceptives available in the United States—the copper T and the levonorgestrel-releasing intrauterine system (LNG-IUS) are extremely effective; are safe; can be used for up to 5 or 10 years, depending on the device chosen; and once inserted, require virtually no attention from the user, eliminating the prospect of incorrect or inconsistent use. Both have first-year typical-use failure rates of less than 1%—0.8% for the copper T and 0.2% for the LNG-IUS.³

Intrauterine contraception is the most popular reversible method of contraception in the world, used by more than 14% of contracepting women in developing countries and 7.6% of those in industrialized countries; in the United States it is used by just 2%.⁴ The reasons for this discrepancy are largely related to misunderstandings, myths, or outdated ideas among patients and health-care providers alike.

Research points to confusion and unfounded wariness about associations between intrauterine contraception and pelvic inflammatory disease (PID), tubal infertility, and ectopic pregnancy, as well as misunderstandings about contraindications and about which women are candidates for this method of contraception, as obstacles to wider use of this method.⁵

Responsible health care for reproductive-aged women includes helping them select and use a safe and effective means of birth control. Doing so also supports the societal goal of reducing the currently high proportion of unintended pregnancies.

References

Finer LB, Henshaw SK. Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspect Sex Reprod Health. 2006;38:90-96.
US Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health. 2nd ed.Washington, DC: US Government Printing Office, November 2000. http://www.healthypeople.gov. Accessed November 12, 2007.
Trussell J. Contraceptive efficacy. In: Hatcher RA, Trussell J, Nelson AL, et al. Contraceptive Technology. 19th rev ed. New York, NY:Ardent Media; 2007.
United Nations. World Contraceptive Use 2005. http://www.un.org/esa/population/publications/contraceptive2005/2005_World_Contraceptive_files/ WallChart_WCU2005.pdf. Accessed March 12, 2008.
Hubacher D. The checkered history and bright future of intrauterine contraception in the United States. Perspect Sex Reprod Health. 2002;34:98-103.

Intended Audience:

Obstetrician-gynecologists, primary care physicians, and nurse practitioners in women’s health.

Content:

Intrauterine contraception is a highly effective method of contraception that is considered by authoritative bodies to be underused in the United States. This program is intended to educate clinicians about the risks and benefits (including noncontraceptive benefits) associated with this contraceptive method and to provide a balanced, evidence-based review of myths and misperceptions that have unnecessarily restricted the range of women who are considered suitable candidates. The overall goal is to increase clinicians’ awareness of intrauterine contraception so that they can consider it as one of the options they present to their patients seeking contraception.

Learning Objectives:

Upon completion of this publication, participants will be able to:

List 3 barriers to wider use of intrauterine contraception in the United States
Explain why pelvic inflammatory disease is not increased by use of intrauterine contraception
Identify appropriate candidates for intrauterine contraception
Name 3 distinctions between the levonorgestrel-releasing intrauterine system and the copper T intrauterine device

Accreditation Statement:

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of the Dannemiller Memorial Educational Foundation and Haymarket Medical Education LP. The Dannemiller Memorial Educational Foundation is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation Statement:

The Dannemiller Memorial Educational Foundation designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit^TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

This activity has been evaluated and approved by the Continuing Education Approval Program of the National Association of Nurse Practitioners in Women’s Health for 1.0 contact hour of continuing education credit, including .25 contact hours of pharmacology credit.

Method of Participation:

This activity should take approximately 1.0 hours to complete. The participant should read the objectives, read the newsletter, take the post-test, complete the registration, and complete the evaluation form. The evaluation form provides each participant the opportunity to comment on the extent to which educational objectives were met, the quality of the instructional process, the perception of enhanced professional effectiveness, the perception of commercial bias, and his or her views on future educational needs.

This credit is valid through October 31, 2010.
No credit will be given after that date.

The content and views presented in this educational activity are those of the authors and do not necessarily reflect those of the Dannemiller Memorial Educational Foundation, the National Association of Nurse Practitioners in Women’s Health, Bayer HealthCare Pharmaceuticals, or Haymarket Medical Education LP. The material is prepared based upon a review of multiple sources of information, but it is not exhaustive of the subject matter. Therefore, health-care professionals and other individuals should review and consider other publications and materials on the subject matter before relying solely upon the information contained within this educational activity.

Faculty Disclosures:

In accordance with the Accreditation Council for Continuing Medical Education (ACCME), the Dannemiller Memorial Educational Foundation requires that any person who is in a position to control the content of a CME activity must disclose all relevant financial relationships they have with a commercial interest. Accordingly:

David A. Grimes, MD, reports that he is a consultant or on the advisory board of Bayer HealthCare Pharmaceuticals and Duramed Pharmaceuticals, Inc.
David Hubacher, PhD, reports that he has received grant and research support from Duramed Pharmaceuticals, Inc.
Frances E. Likis, DrPH, NP, CNM, reports that she has nothing to disclose.
Kirtly Parker Jones, MD, reports that she has nothing to disclose.

The Dannemiller and Haymarket Medical Education LP staff members who were involved in the development of this activity have no financial relationships with any commercial interests that are relevant to this activity.

To resolve identified conflicts of interest, the educational content was fully peer-reviewed by a physician member of the Dannemiller Clinical Content Review Committee, who has nothing to disclose. The resulting certified activity was found to provide educational content that is current, evidence-based, and commercially balanced.

Off-label Discussion:

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The opinions expressed in the educational activity are those of the faculty. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings. Further, attendees/participants should appraise the information presented critically and are encouraged to consult appropriate resources for any product or device mentioned in this program.