Copper IUD insertion by nurses

A prospective longitudinal study of copper intrauterine devices (IUD) inserted mostly by nurses in a maternity hospital in Brazil has found that the vast majority of women continued with the device at 1 year.¹

The study in the Brazilian Journal of Nursing also found that the IUD complications were the same as those commonly cited in the literature.

The 87 study patients, all aged 18 and over, were inserted with a copper IUD at a usual risk-maternity hospital in the city of Curitiba, Paraná, Brazil, between September and October 2017.

Overall, 38.6% of the women had the IUD inserted by physicians and 61.4% by nurses.

In total, 67.5% of participants said they chose a copper IUD because it was a non-hormonal method and 24.1% selected it because there was no risk of forgetting to administer it.

Two other reasons cited were an easy and practical method and safety.

Data were collected at 1 month after insertion via a return visit, followed by a telephone call at 6 and 12 months after insertion.

Upon returning for maternity consultation 1 month after IUD insertion, 69.9% of women did not present with any complications.

When asked about the adaptation to the method, 16.9% reported dysmenorrhea, 4.8% had menorrhagia, 4.8% had bacterial vaginosis and 1.2% reported dyspareunia.

The four participants who had bacterial vaginosis underwent recommended treatment and continued use.

At 6 months follow-up, 86.7% of women continued with their IUD and 13.3% reported discontinuing use.

Only one patient (1.2%) had her IUD fall out, 2 months after inserting the device. She also presented with dysmenorrhea and menorrhagia but said she intended to perform retry insertion.

Of the remaining 10 users (12.1%) at 6 months who experienced complications and chose or had to have their IUD removed, five (6.0% of the overall cohort) reported irregular bleeding as the cause for discontinuation (removing the device between 2 and 6 months after insertion); four (4.8%) reported not having adapted to the method due to the initial side effects, such as dysmenorrhea and menorrhagia and/or headache (removing the device between 2 and 5 months after insertion); and one (1.2%) had endometrial perforation 2 months after insertion.

Of the 11 participants who did not continue with the method after 6 months, five were inserted by physicians and six by nurses. None of these participants reported contraceptive failure with the IUD.

Most complications occurred in the first 6 months.

At 12 months, 85.5% of women continued with a copper IUD and 14.5% discontinued use.

The four major complaints at 12 months were dysmenorrhea (34.9% of the overall cohort), menorrhagia (24.1%), irregular bleeding (10.8%) and headache (3.6%).

Of the women continuing with the device, 32.5% were inserted by physicians and 53.0% by nurses.

Altogether, 62.7% of the cohort reported good acceptance and adaptation to a copper IUD. In addition, 56.6% complimented the fact that it was not hormonal and 55.4% would recommend the IUD to other women.

When participants were asked if they were satisfied with their IUD, 90% said yes and only 10% said no.

“Nurse practitioners are the ones who most perform IUD insertion,” wrote the authors, noting that training courses in IUD insertion for nurses at the national level and the expansion of social dissemination of this contraceptive method is crucial, which is available free of charge in Brazil.

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Reference

1. Trigueiro TH, Ferrari JC, Souza SRRK, et al. Follow-up of copper intrauterine device insertion by nurses: a prospective longitudinal study. Rev Bras Enferm. Published online November 11, 2020. doi:10.1590/0034-7167-2020-0156.