Barriers to the use of intrauterine devices among healthcare professionals: Evidence against misconceptions. [Barreras al uso de los dispositivos intrauterinos entre los profesionales sanitarios: evidencia frente a creencias erróneas.]

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Abstract

Long-acting reversible contraception (LARC) refers to highly effective methods that are suitable for most women. Despite being the best known long-acting reversible contraception methods, the copper intrauterine device (Cu-IUD) and the hormonal (levonorgestrel) device (LNG-IUD) are used by only 6.9% of women of childbearing age in Spain who use any method of contraception. This may be a consequence of barriers to the use of IUDs among health professionals that affect young and/or nulliparous women in particular. The present review addresses available scientific evidence regarding the main factors creating barriers to the use of intrauterine devices. These factors include possible difficulties during insertion and associated pain, the risk of perforation during the insertion or of expulsion once inserted, the effects on dysmenorrhoea and on menstrual bleeding pattern, the risk of ectopic pregnancy or of pelvic inflammatory disease, the speed of recovery of fertility after removal, the impact of price, and the cost-benefit ratio of intrauterine devices. It also addresses the barrier that results from possible rejection of intrauterine devices by women owing to misconceptions.