(270) Does The Shape of The Copper Intrauterine Device Affect Device Expulsion? Results from The Ongoing European Active Surveillance Study on LCS12

Publication Number: 944

Background: One major concern when using an intrauterine device (IUD) is partial or complete expulsion which may lead to an unintended pregnancy. It was claimed that the rigid frame of the conventional T-shaped IUD is a key trigger for expulsions, bleeding, and women’s discomfort as it might be incompatible with the anatomy of the uterus. Therefore, copper-containing IUDs with other than T-shapes were developed, such as Omega-shaped devices, copper chains, and balls which are today available on the European market.

Purpose: To compare the incidence of partial and complete expulsion for different copper IUD shapes.

Materials and methods: A secondary analysis of the ongoing, prospective, non-interventional European Active Surveillance Study on LCS12 (EURAS-LCS12). Women with newly inserted IUDs were recruited in 10 European countries (Austria, Germany, Poland, Czech Republic, Spain, Italy, United Kingdom, France, Sweden, Finland) via a network of approximately 1,200 health care professionals. Cumulative incidence, crude and adjusted hazard ratios for expulsion were calculated.

Results: Overall, 27,822 copper IUD users from the EURAS-LCS12 study were considered for this analysis. The most frequently used IUD shape was T/Y (73.7%) followed by chains (12.1%), Omega (10.5%), and balls (3.8%). Cox regression analysis regarding partial expulsions yielded an adjusted HR of 1.8 (95% CI, 1.3-2.4), 0.2 (95% CI, 0.2-0.4) and 2.9 (95% CI, 2.1-3.9) for Omega-shape, chain and ball versus T/Y-shape, respectively. For complete expulsions, the adjusted HR was 0.5 (95% CI, 0.3-0.8), 1.7 (95% CI, 1.3-2.3) and 2.9 (95% CI, 2.0-4.2) for Omega-shape, chain and ball versus T/Y-shape, respectively.

Conclusion: The shape of the copper IUD is associated with the risk of device expulsion and thus, should be considered at the time of contraceptive counseling.