Resources

Counselling patients

Straight to the point: Talking IUC

Simple steps from INTRA to successfully counsel women about intrauterine contraception (IUC) in under 7 minutes.

 

Aims of this section:

 

  • Guided six-step discussion with women to help them reach an informed decision where IUC is actively considered as a contraceptive option
  • Increase the number of HCPs proactively integrating IUC as part of routine contraceptive care in a way that women can easily understand
  • Demonstrate (video) it is possible to have a simple, short, & very effective counselling session about IUC in under 7 minutes

 

*Formation of the INTRA group and its ongoing work is supported by Bayer

Intra logo

 

The global INTRA group is a panel of independent physicians with an expert interest in intrauterine contraception.*

An introduction to INTRA

The Global INTRA group identified six key steps, which they believe form the basis of an effective counselling session about IUC.

 

Every step includes a short explanation, example questions and an estimated time recommendation.

 

If you would like to learn more, click here to access the downloads at the bottom of the page.

1

Establish her contraceptive needs

 45 seconds

2

Introduce long-acting reversible contraception (LARC)

 30 seconds

3

Communicate the potential benefits of IUC

 90 seconds

4

Provide reassurance and address her concerns

 90 seconds

5

Help her decide

 60 seconds

6

Confirm her choice and schedule placement(if choice was IUC)

 60 seconds

    In this step, HCPs should:

    Step 1 - Starting the conversation

    To establish a women’s contraceptive needs:

     

    • Form questions that match a woman’s goals and needs, for example:

    ‘Do you have any plans to get pregnant?
    If yes, how soon?’

    ‘How important is it for you not to be pregnant right now?’

    • Understand her experience of different methods:

    ‘What contraception do you use now (if any)?
    What have you used before (if any)?’

    ‘How happy are/were you with those methods?
    What did you like most about your previous/current method?
    What did you like least?’

    In this step, HCPs should:

    Step 2 - Linking to LARC

    • Encourage HCPs to continue to ask a woman about her contraception as her needs change throughout her reproductive life1
    • Use simple linking phrases to increase awareness and knowledge about LARC using her established contraceptive needs:

    Contraception options have a
    range of levels of effectiveness
    – one of the most effective
    and reversible methods is
    intrauterine contraception…

    right-arrow

    IUC is more than
    99% effective in
    the first year2

    • Merki-Feld GS et al. Eur J Contracept Reprod Health Care. 2018:183-193. Return to content
    • Trussell J. Contraceptive failure in the United States. Contraception 2011;83:397−404. Return to content

    Step 2 - Introducing IUC

    • Once interest in a long-acting method of contraception is confirmed, introduce IUC as a potential method:

    ‘There are many myths associated with intrauterine
    contraception, let me tell you some of the real facts which
    may help…’

    ‘You seem quite knowledgeable about intrauterine
    contraception, is there something that has stopped you
    considering it as an option in the past?’

    ‘You mentioned you have heavy periods, one benefit of
    some types of intrauterine contraception can be reduced
    bleeding or for your periods to stop altogether.’

    In this step, HCPs should:

    Step 3 - Discussing the benefits of IUC

    • Discuss the key potential benefits of IUC with the woman:
       
      • Highly effective1
      • Cost-effective2
      • No need for daily, weekly or monthly administration1
      • Potential non contraceptive benefits3
      • Rapidly reversible4
      • Inserted quickly
         
    • Supporting information is provided for HCPs
    • This step includes discussion points for extra time

    Step 3 - Extra time?

    • In certain cases, you may find that you have a little more time available with your patient. If so, consider discussing:
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    • The effectiveness of IUC compared to oral contraceptives and/or other methods
       
    • The effect of some IUC methods on menstrual blood loss in women experiencing heavy menstrual bleeding

    In this step, HCPs should:

    Step 4 - Background Reading - Common barriers and myths

    • Many HCPs have misconceptions about IUC which results in them not proactively discussing or offering it as part of their contraceptive discussion
    • To dispel many of the common barriers and myths, the Global INTRA Group have developed a review paper published in EJC.

    Addresses HCP misconceptions regarding:

    tabs-down-arrow

    The risk of PID, infertility and ectopic pregnancy

    The difficulty and risks of insertion of IUCs

    The mechanism of action

    • Further barriers the use of IUC covered in this review paper include:

    Health system barriers include

    tabs-down-arrow

    Pharmaceutical guidelines

    Lack of understanding of the value/
    cost effectiveness of IUCs

    The number of trained providers

    User barriers include:

    tabs-down-arrow

    Lack of awareness and
    understanding of IUC

    Fear of IUC, particularly pain on insertion

    Cost of IUC

    • Black K et al. Eur J Contracept Reprod Health Care; 2012: 17(5): 340-50) Return to content

    Step 4 - Addressing ‘user’ barriers

    • Women also have a number of misconceptions about IUC which may need to be addressed within a consultation:

    Pain on insertion has been shown to be lower than often feared:

    tabs-arrow

    A study of 117 women found that 62% of women taking part felt no more than ‘period pain’ during insertion of IUC1

    • Brockmeyer A, et al. Experience of IUD/IUS insertions and clinical performance in nulliparous women–a pilot study. Eur J Contracept Reprod Health Care. 2008 Sep;13(3):248-54. doi: 10.1080/02699200802253706. Return to content

    Step 4 - Putting risks and side-effects into perspective

    • Any method of contraception has risks and side effects. Helping a woman make an informed choice about IUC involves an appropriate discussion of these, using your clinical knowledge and experience.

     

    For example:

    • Risk of ectopic pregnancy
    • Perforation
    • Expulsion
    • Infection
    • Changes to her monthly bleeding pattern

    ‘The most common side effects can be headaches and abdominal
    pains but not all women experience these. Just be aware that
    having an IUC won’t protect you against STIs so as you would with
    the pill, you’ll need to use a condom if you think you might be at risk.’

    Step 4 - Extra time?

    • If possible, this theme can be expanded upon by discussing the CHOICE study:
    Loading-large
    • Over 9,000 adolescents and women at risk ofunintended pregnancy were offered a choice of all reversible methods of contraception at no cost1
    • 60% of women chose IUC2
    • Where LARC methods were compared with oral contraceptive pills: (OCPs) IUC had higher continuation rates (86%) and higher satisfaction rates (80%) at one year, than OCPs3

    In this step, HCPs should:

    Step 5 - Use clinical experience and be honest when addressing concerns

    • Share your knowledge and clinical experience to support her decision to use IUC
    • Bear in mind that IUC won’t be the right choice for every woman

    ‘Based on what you’ve told me these are the most
    effective options to suit your needs – which of these do
    you think would suit you best?’

    • Include risks and potential side effects into your counselling

    ‘For most women, placement can cause a little pain, a bit
    like period pain, which quickly passes.’

    Step 5 - Offer personal experience

    • If pertinent, personal disclosure has been found to be useful at this time:

    ‘In our practice we have a large number of women using
    this method.’

    ‘Amongst the patients I see, there are many who opt for an IUC.’

    ‘Many of the women who work here use IUC.’
    (If you and your colleagues are comfortable)

    In this step, HCPs should:

    Step 6 - Provide reassurance

    • Offer guidance to confirm a woman’s choice of IUC including:

    IUC placement is done within 7 days of menstruation, and the IUC can be replaced at any time in the cycle.1

    STI screening can be performed on the same day as placement
    and, if the screen comes back positive, the infection can be treated
    with the device/system in situ. Mirena must be removed if the
    woman experiences recurrent endometritis or pelvic infection, or if
    an acute infection is severe2

    If she has any concerns following placement, she can return to
    discuss these with you at any time or call the clinic

    Step 6 - Ahead of insertion

    • Before proceeding with IUC insertion, ensure that:

    You meet your local requirements for informed consent at the time
    when the woman returns for the device to be inserted. When gaining
    this consent, remind her of the potential risks and side effects1

    If the woman does experience side effects she should contact her
    healthcare professional immediately including pain, fever, unusual
    discharge, or severe bleeding2

    It is important to note that cervical screening is independent of IUC
    placement and not a pre-requisite2

    Example of IUC counselling – video demonstration

    These videos demonstrate that it is possible to have a simple, short, & very effective counselling session about IUC in under 7 minutes.

    Which option best suits the needs of the trainee teacher?

    YYMMDD Author/Uploaded by

    INTRA-straight to the point: talking IUC

    YYMMDD Author/Uploaded by

    Digital Counselling on Long-Acting Reversible Contraception

    To support contraceptive counselling in the UK, the Bayer Women's Health team have developed technology to help deliver LARC counselling to patients. The Digital Contraceptive Counselling tool offers interactive content to help women understand the different options available when considering contraceptive methods, including Long Acting Reversible Contraceptives. The following video is a brief introduction to the Digital Contraceptive Counselling tool.

    Digital Counselling on Long-Acting Reversible Contraception

    YYMMDD Author/Uploaded by

    If you would like to learn more, or are interested in using Digital Contraceptive Counselling tool in your practice, please submit a request via the contact a rep. page.

     

    Downloads

    Counselling Booklet

    16 page, A5 booklet entitled ‘Straight to the Point: Talking IUC’


    Aim: to assist HCPs when counselling women about IUC in under 7 minutes

     

    • Guides HCPs through a simple, brief, six step discussion
    • Developed by the Global INTRA Group, the contents reflect the evidence-based opinion of its members

     

    Download

    Counselling Checklist

    A one page A4 summary of the key topics, including the most important questions

     

    Follows the same six key themes for discussion, as advised by the Global INTRA group

     

    Aim: to act as a quick reference during a consultation, and to ensure the relevant topics have been covered without needing to refer to the full booklet

     

    Download

    Reporting adverse events and quality complaints

    Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard. Adverse events should also be reported to Bayer plc.

     

    If you want to report an adverse event or quality complaint, reports can be directed to: Tel: 01182063500 or email: pvuk@bayer.com

     

    Further information is available on the “contact” tab at www.bayer.co.uk.