Copper IUD continuation, adverse effects, and cost

For younger women who use a copper intrauterine device (IUD), there are significant differences in continuation, reported undesirable effects, and estimated costs at 1 year, according to a secondary analysis of the European Active Surveillance Study for Intrauterine Devices (EURAS-IUD).¹

The analysis in The European Journal of Contraception & Reproductive Health Care found that copper IUD users were greatly influenced by IUD type: surface area, shape or design, width, and arms' flexibility.

A total of 5,796 copper IUD users under the age of 30 were identified at EURAS-IUD study recruitment, of whom 99.4% users were evaluated.

Overall, 98% of IUDs were framed, with the Nova T380 being the most popular brand. In addition, 32% of all IUDs were T-shaped IUDs with a copper surface area of 380 mm2 and copper bands on their rigid transverse arms, thus encompassing “gold standard” IUDs like the CuT380A or TCu380A.

Higher IUD continuation, fewer unwanted effects, and lower costs were noted for IUDs of the lowest copper content (<300 mm2), horse-shoe frame design, widths 18 mm to <30 mm, and flexible IUD arms.

Conversely, discontinuation, unwanted effects, and costs were greater with frameless IUDs and framed IUDs that were ≥30mm wide with 380 mm2 of copper and copper bands on their rigid transverse IUD arms.

Continuation at 1 year was highest in those aged 25 to 29, users of IUDs containing <300 mm2 of copper, IUDs with copper only on the vertical stem or string, and IUDs with flexible arms.

However, continuation rates were not impacted by previous pregnancy or birth.

Overall, 35.4% of participants experienced unwanted effects during the first year of IUD use: bleeding (18.8%), pain (16.9%), expulsion (3.3%), pregnancy (1.0%), and perforation 6 (0.1%).

Unwanted effects were lowest for IUDs with <300 mm2 of copper,horse-shoe design, and widths 18 mm to < 24 mm, whereas users of IUDs that had 380 mm2 of copper, gold standard IUDs, and frameless IUDs were more likely to report unwanted effects.

In total, 25% of participants had visited a health care professional due to undesirable effects.

The lowest costs were associated with IUDs of copper content <300mm2, horse-shoe design, widths 18 mm to < 30mm, and with IUD arms that flex down.

In contrast, frameless IUDs had the highest costs. Amongst framed IUD types, gold standard IUDs were linked to the highest expense.

The incidence of pregnancies in the first year did not differ significantly between IUD type. Of the 59 pregnancies reported, 13% (n = 8) were ectopic pregnancies: 6 in the 25 to 29 age group and 2 in the 20 to 24 age group.

Five of the 8 ectopic pregnancies were among gold standard IUD users; 1 of the 8 in a user of a 380mm2 T-shaped without arm bands IUD; and the remaining2 using IUDs of copper content 300 mm2 to <380 mm2, horse-shoe design, width 18 mm to <24 mm, and IUD arms that flex down.

For the analysis as a whole, “The more localized the copper on an IUD frame and the ability of the frame to conform to the uterine cavity, the more favorable were outcomes at one year,” wrote the authors.

The authors said clinicians should consider the study’s findings when counseling and selecting IUD types for younger women.

__

Reference:

1. Akintomide H, Brima N, Mansour D. Copper IUD continuation, unwanted effects and cost consequences at 1 year in users aged under 30 – a secondary analysis of the EURAS-IUD study. Eur J Contracept Reprod Health Care. 2021 Jun;26(3):175-183. doi:10.1080/13625187.2021.1879783