IUDs unpopular among US obstetrician/gynecologists

By Keith Mulvihill

NEW YORK (Reuters Health) – While the intrauterine devices (IUD) available today are a safe and effective means of contraception, survey results suggest many US obstetrician/gynecologists rarely prescribe them to patients. This may be due to outdated beliefs about the contraceptive device's safety, the researchers report.

Although the Dalkon Shield was pulled off the US market in 1974, lead author Dr. Nancy L. Stanwood, of the University of Rochester Medical Center in New York, notes that the negative image of IUDs still persists. Currently only 0.8% of US women who use birth control use IUDs, while worldwide 12% of married women of reproductive age are IUD users.

Dr. Stanwood and her colleagues polled obstetrician/gynecologists to investigate their attitudes toward and use of IUDs. The findings are published in the February issue of Obstetrics & Gynecology.

One in five survey respondents had not inserted an IUD during the past year, and of those who had, 79% had inserted 10 or fewer. And while 95% of the 400 physicians polled said they thought copper IUDs were safe, and 98% respondents believed they were effective, almost one third said they believed IUDs increase the risk of PID by 10% or more.

"Some obstetricians and gynecologists still falsely believe that IUDs increase the risk of pelvic inflammatory disease in the long term," Dr. Stanwood told Reuters Health in an interview. "It is contracting a sexually transmitted infection [chlamydia or gonorrhea] that causes pelvic inflammatory disease."

Modern copper IUDs are associated with a low rate of PID–about 16 cases per 10,000 women, Dr. Stanwood and her colleagues note.

Another controversy surrounding IUD use is the belief that it works by causing abortion, but Dr. Stanwood said this idea is incorrect. "Modern IUDs work by setting up an environment in the cervix and uterus that kills sperm," she said. "And by preventing unintended pregnancies, they actually prevent abortions."

Nevertheless, 20% of the respondents agreed that the IUD caused abortion and 16% believed it could lead to lawsuits against them.

The survey also revealed that most obstetricians and gynecologists appropriately select women as IUD candidates who are in monogamous sexual relationships and have not had PID in the past.

Another factor that may explain the low usage rate of IUDs may be economic. Dr. Stanwood pointed out that many insurance programs do not cover the cost of contraception, and IUDs cost $300 to $450, a large up-front cost for most women to pay out of pocket.

But over the long term, Dr. Stanwood said, IUDs are actually the most cost-effective means of contraception.

Dr. Stanwood said she found IUDs easy to promote in her own practice. "When the pros and cons of available contraceptive methods are weighed out, the copper IUD and 5-year progesterone IUD rise to the top for many women as methods that are as effective as tubal ligation but completely reversible and do not require daily pill taking or return visits to the office for shots," she added.

Dr. Stanwood and her co-authors conclude their findings suggest that educational programs could be used to target physicians to expand their IUD use.

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