Konia Trouton

Motivation and Experience of Nulliparous Women Using Intrauterine Contraceptive Devices

OBJECTIVES Use of an intrauterine contraceptive device (IUD) has not been recommended to nulliparous women in the past. There is now good evidence that there is no increased risk of pelvic inflammatory disease or infertility in nulliparas who use IUDs and the recommendations have changed. Our objective was to understand more about the motivations and experience of nulliparous women using IUDs. METHODS This was a mixed method study. First, we asked 44 nulliparous women who had had an IUD inserted within the previous six months about their reasons for seeking the IUD, their history with other forms of contraception, their perception of the insertion experience, and their feelings after insertion. Questionnaires were then distributed to 154 nulliparous women presenting for IUDs, asking about their past experience with hormonal contraception. RESULTS The main theme arising from the interviews was a desire to avoid hormonal contraception. Other reasons for choosing the IUD were greater contraceptive effectiveness than other methods, convenience of use, and lower cost. Responses to the questionnaire indicated that 138 women (89.7%) had used hormonal contraception in the past and, of those, 98 (63.0%) complained of mood side effects, 64 (41.6%) of sexual side effects, and 64 (41.6%) of physical side effects. CONCLUSION The most important motivation for nulliparous women in this study to choose IUDs was to avoid the potential or actual side effects of hormonal contraception. Despite experiencing some discomfort at the time of insertion, this group of nulliparous women was very positive about using IUDs for contraception.

Intrauterine device insertions: which variables matter?

Objectives Many factors are suspected to influence the intrauterine device (IUD) insertion process. This study sought to examine the effects of a few key variables on IUD insertion tolerability, complications and follow-up issues. Methods A retrospective chart review was undertaken of all IUD insertions over an 11-month period at an urban Canadian womens clinic. Linear regression analysis of 354 insertions assessed the effects of parity, age, local anaesthesia and other variables on insertion pain. Chi square (χ2) and analysis of variance statistics were employed to evaluate differences in insertion complications by parity and age. A χ2 test was performed to compare follow-up expulsion or removal rates by parity. Results Statistically significant differences were found, with nulliparous women and those who received local anaesthesia reporting more insertion pain. Age, IUD type and recent abortion status did not affect insertion pain. Nulliparous women did not experience significantly more insertion difficulty or complications, nor did they have higher rates of expulsion or removal at follow-up. Conclusions These findings suggest that the practice of providing cervical anaesthesia at IUD insertion may cause slightly more pain, without any obvious additional benefit. The difference in insertion pain by parity, although statistically significant, is small enough to be of questionable clinical importance. Overall, these findings add to the growing body of evidence for IUDs being safe and well-tolerated in nulliparous women.

Comparing continuation rates and side effects of hormonal contraceptives in East Asian and Caucasian women after abortion

BACKGROUND The purpose of this study was to determine whether East Asian women had more side effects and a higher discontinuation rate than Caucasian women when choosing to use hormonal contraceptives. STUDY DESIGN This was an observational cohort study of usual care using questionnaires for 2 months after being given hormonal contraceptives following an abortion in Vancouver, Canada. RESULTS In the first month, 73 (64.4%) of the 110 East Asian and 86 (80.4%) of the 107 Caucasian women took any of the sample provided (p=.020). In the second month, 52 (47.3%) of the East Asian and 62 (57%) of the Caucasian women used the prescription to buy and take their hormonal contraception (p=.12). Total side effects were similar, but there was more nausea in the East Asian women (23.3% vs. 8.1%) (p=.03) and more acne in the Caucasian women (8.2% vs. 20.9%) (p=.05). CONCLUSIONS There may be both physiological and cultural differences leading East Asian women to use less hormonal contraception.

Immediate vs. delayed insertion of intrauterine contraception after second trimester abortion: study protocol for a randomized controlled trial

BackgroundWe describe the rationale and protocol for a randomized controlled trial (RCT) to assess whether intrauterine contraception placed immediately after a second trimester abortion will result in fewer pregnancies than current recommended practice of intended placement at 4 weeks post-abortion. Decision analysis suggests the novel strategy could substantially reduce subsequent unintended pregnancies and abortions. This paper highlights considerations of design, implementation and evaluation of a trial expected to provide rigorous evidence for appropriate insertion timing and health economics of intrauterine contraception after second trimester abortion.Methods/DesignConsenting women choosing to use intrauterine contraception after abortion for a pregnancy of 12 to 24 weeks will be randomized to insertion timing groups either immediately (experimental intervention) or four weeks (recommended care) post abortion. Primary outcome measure is pregnancy rate at one year. Secondary outcomes include: cumulative pregnancy rates over five year follow-up period, comprehensive health economic analyses comparing immediate and delayed insertion groups, and device retention rates, complication rates (infection, expulsion) and, contraceptive method satisfaction. Web-based Contraception Satisfaction Questionnaires, clinical records and British Columbia linked health databases will be used to assess primary and secondary outcomes. Enrolment at all clinics in the province performing second trimester abortions began in May 2010 and is expected to complete in late 2011. Data on one year outcomes will be available for analysis in 2014.DiscussionThe RCT design combined with access to clinical records at all provincial abortion clinics, and to information in provincial single-payer linked administrative health databases, birth registry and hospital records, offers a unique opportunity to evaluate such an approach by determining pregnancy rate at one through five years among enrolled women. We highlight considerations of design, implementation and evaluation of a trial expected to provide rigorous evidence for appropriate insertion timing and health economics of intrauterine contraception after second trimester abortion.Trial registrationCurrent Controlled Trials ISRCTN19506752

Anxieties and Attitudes Towards Abortion in Women Presenting for Medical and Surgical Abortions

OBJECTIVE To examine the differences in anxiety levels and attitudes towards abortion between women having an early medical abortion and women having a surgical (manual vacuum aspiration) abortion. METHODS Women who presented for an early medical abortion or a surgical abortion at an urban, free-standing abortion clinic were invited to participate in this study. Fifty-nine women having a medical abortion and 43 women having a surgical abortion answered questionnaires before their scheduled abortion, and again 2 to 4 weeks after the abortion. Thirty women were interviewed about their answers. RESULTS Anxiety levels were similar in both groups before the abortion procedure. Anti-choice views about abortion were seen in 60.5% of women having a medical abortion and in 37.3% of women having a surgical abortion (P = .027). Women who were pro-choice had a mean anxiety score of 5.0 (range, 0-10) before and 2.7 after the abortion, whereas women who were anti-choice had a mean anxiety score of 5.2 before and 4.4 after the abortion (P = .005). CONCLUSION It is important for providers of abortion care to understand that women undergoing a medical abortion may be more ambivalent about abortion than women undergoing a surgical abortion, and women who are anti-choice but having an abortion may have unresolved anxiety after the procedure.

Does using tampons or menstrual cups increase early IUD expulsion rates

BACKGROUND Many intrauterine device (IUD) users utilize intravaginal menstrual cups or tampons during menses, but no studies have investigated the impact this practice may have on IUD expulsions. STUDY DESIGN Retrospective chart survey. RESULTS Of the 930 women having IUDs placed and reporting menstrual protection, 10.3% (96) used menstrual cups, 74.2% (690) used tampons, and 43.2% (402) used pads (many women reported using more than one method). In the 743 women with adequate follow-up information, there was a full or partial expulsion (i.e., part of the IUD in the cervical canal) rate of 2.5% (27) during the first 6 weeks after insertion. There was no difference in the women using cups, tampons or pads (confidence intervals overlap). CONCLUSIONS From this study, there is no evidence that women who report using menstrual cups or tampons for menstrual protection had higher rates of early IUD expulsion.

A Randomized Trial Comparing Oral Misoprostol With Intra-Amniotic Prostaglandin F2á for Second Trimester Terminations

First, I would like to challenge the authors on their statement that “the study investigators were not involved in the decision to terminate any pregnancy included in this trial.” Since a 1988 Canadian Supreme Court decision, abortion has no longer been a criminal offence,2 and it has been a woman’s choice to have an abortion. The therapeutic abortion committees (which were established from 1969 to 1988 in many hospitals in Canada) are no longer needed. Now, if a woman decides that it is in her best interest to terminate a pregnancy, she can seek care directly from a provider. Neither the physician nor any investigator has any role in that decision but should treat her only after adequate training in safely performing this procedure.