Women’s Health
Removals and more invasive treatments following insertion of a hormonal intrauterine device to treat benign gynecological conditions Michael J Green* Michael Green Mollie E Wood Erin T Carey Joacy G Mathias Lauren G Anderson Kemi M Doll Whitney R Robinson
Introduction: Hormonal intrauterine devices (IUDs) are recommended first-line treatments for symptomatic benign gynecological conditions, but little is known about prognosis following insertion. We describe frequency and timing of IUD removal and more invasive follow-up treatments and assess whether this differed by race or ethnicity.
Methods: With records from a healthcare system in the US South (2014-2019), we established a cohort of 779 pre-menopausal patients (aged 18-45 years; Non-Hispanic White n=455; Non-Hispanic Black n=204; Hispanic n=120) who had IUDs inserted with associated diagnostic codes for a benign gynecological condition. Additional treatments were tracked over a median follow up time of 1.9 years (707 days). We abstracted data on symptoms in the 4 months prior to insertion, constructing scores for severity of bulk, bleeding, and gynecological pain. Cox regression models assessed how race/ethnicity was associated with time to removal or more invasive treatment, with adjustment for age at insertion, symptom severity, prior IUD use and insurance status.
Results: 34 patients (4%) had their IUD removed, an average of 275 days following insertion. 78 patients (10%) received a more invasive treatment (75 hysterectomies, 3 endometrial ablations) at an average of 382 days later. Compared to White patients and after adjustment for covariates, Hispanic patients were more likely to have had the IUD removed (HR: 2.9[1.1-7.8]), while removal rates for Black patients were similar to those of White patients (HR: 1.5[0.6-3.4]). Rates of receiving more invasive treatments were lower for Black (HR: 0.7[0.4-1.1]) and Hispanic (HR: 0.7[0.3-1.4]) patients but confidence intervals over-lapped the null.
Conclusion: Within ~2 years following insertion of a hormonal IUD for a benign gynecological condition, rates of IUD removal and receiving more invasive treatment were both low. There were no clear racial differences in rates of receiving more invasive treatment.