Women who receive a contraceptive known as an intrauterine device or IUD immediately following a first trimester abortion experience few complications and are less likely to have an unintended pregnancy than those who delay getting an IUD by several weeks, according to a new study at Oregon Health & Science University.
The findings are published in the June 9 New England Journal of Medicine.
Research has shown that IUDs are safe, highly effective, long-term reversible contraceptives that don't require active use once they've been inserted. IUDs are underused, however, in part because federal policy prohibits physicians from providing contraceptive services at the time of an abortion, the investigators report.
"Immediate use of any contraceptive method after abortion has been linked to a reduced risk of repeat abortion with the immediate use of an IUD being the most effective method for reducing this risk. However, federal policy makes access a challenge, particularly for low-income patients," said Paula Bednarek, M.D., principal investigator and an assistant professor of obstetrics and gynecology in the OHSU School of Medicine.
A primary concern with inserting an IUD immediately after an abortion is the risk of expulsion, or having it falling out. In the study, the researchers found the rate of expulsion after immediate insertion was higher but statistically not inferior to that of delayed insertion.
"Our data add to the growing body of evidence that IUDs are safe and highly effective, and supports expanding access to IUDs to a wider range of women," Bednarek said.
To conduct this research, Bednarek and colleagues enrolled 575 women, ages 18 and older, who requested abortions at Oregon Health & Science University and three other U.S. academic health centers. The women were randomized into two groups: one group received an IUD within 15 minutes of their abortion, and the other group received an IUD two to six weeks later.
At six months, the researchers found the 258 women who immediately received IUDs had no significant adverse affects and no pregnancies, and more than 90 percent of the women were still using the device. Of the 226 women who underwent delayed insertion, there were, likewise, no significant adverse events; however, five of the 226 women became pregnant -- all were not using IUDs -- and only 77 percent were using the device at six months.
"A significant number of women who were randomized to the delayed insertion group did not return to get an IUD placed and instead chose a substantially less effective contraceptive method or none at all," explained Bednarek. "Our results show that women who would like to receive an IUD after an abortion, but are asked to make an appointment for a later date, may not return to actually receive the IUD, and, therefore are at higher risk to have another unintended pregnancy."
- Paula H. Bednarek, Mitchell D. Creinin, Matthew F. Reeves, Carrie Cwiak, Eve Espey, Jeffrey T. Jensen. Immediate versus Delayed IUD Insertion after Uterine Aspiration. New England Journal of Medicine, 2011; 364 (23): 2208 DOI: 10.1056/NEJMoa1011600
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