WEDNESDAY, June 8 (HealthDay News) -- Women offered an
intrauterine device (IUD) for birth control at the same time
they're having a uterine aspiration due to miscarriage or abortion
are much more likely to get one compared to women offered one later
on, new research suggests.
The study also found that while the expulsion rate for IUDs
inserted immediately after a uterine aspiration is higher than it
is when women wait to get the device, this difference isn't
statistically significant. In addition, the study found that
complication rates were the same whether an IUD was immediately
placed or inserted later.
"There were more expulsions in the immediate group. It was a little bit higher, but not exceptionally so," said study author Dr. Paula Bednarek, an assistant professor in the department of obstetrics and gynecology at Oregon Health and Science University in Portland, Ore.
"IUDs are a safe, extremely effective form of birth control. They're more effective than the pill, condoms and diaphragms at preventing pregnancy. But, IUDs are underutilized," she added.
Results of the study are published in the June 9 issue of the
New England Journal of Medicine.
In the United States, more than half of unintended pregnancies
are caused by the inconsistent or nonexistent use of birth control
methods, according to background information in the study.
Intrauterine devices are effective forms of birth control that
don't require active use once they have been inserted, the study
The study also pointed out that when birth control options are
given to women just after an abortion, the risk of having a repeat
abortion is reduced.
The use of IUDs fell out of favor decades ago when the devices
were linked to an increased risk of pelvic inflammatory disease,
said Dr. Mary Rosser, an obstetrician and gynecologist at
Montefiore Medical Center in New York City. But that increased risk
was due to the design of past devices, she added. An IUD is
T-shaped, and has a string or tail that hangs out of the cervix
that aids in the removal of the device. Older devices had strings
that were braided or contained numerous strings twisted
That design, explained Rosser, seemed to allow for the growth of
bacteria, which then contributed to pelvic inflammatory disease.
"Those tails were acting like wicks," she said.
Newer IUDs have better designs, and haven't been associated with
an increased risk of pelvic inflammatory disease, she noted.
For the current study, the researchers recruited 575 adult women
at four sites across the United States. All of the women were
undergoing uterine aspiration (sometimes referred to as D and C)
due to miscarriages or planned abortion. All of the women in the
study expressed an interest in getting an IUD.
The women were randomly selected to receive the IUD just after
the uterine aspiration (immediate placement) or were scheduled to
have the IUD inserted at their follow-up appointment two to six
weeks later (delayed placement).
All of the women in the immediate group had an IUD inserted,
while just 71.3 percent of those in the delayed group ended up
getting an IUD, according to the study. No pregnancies occurred in
the immediate placement group, while five of the women in the
delayed group who had never gotten the IUD became pregnant.
After six months, 5 percent of the women in the immediate
placement group had experienced an IUD expulsion, while 2.7 percent
of the delayed insertion group did. Rates of complications didn't
differ between the groups, the researchers noted.
Bednarek said that most of the women in the delayed group who
ended up not getting an IUD hadn't changed their minds about
wanting an IUD, but instead cited logistical reasons, such as
transportation or not being able to get time off work or find child
care as the reasons they didn't make their appointment.
Rosser also noted that guilt or privacy issues may play a role
for some women, particularly if they've been treated at a clinic
where there were anti-abortion protestors. "There's a sense of
women wanting to put that bad experience behind them, and you often
don't get women returning for follow-ups," she said.
In the current study, 150 women didn't complete the six-month
Both experts agreed that IUDs are an effective form of birth
control that is currently underutilized.
To learn more about IUDs, visit the
American Congress of Obstetricians and
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