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Welcome to Women's Health Matters, an online resource to support healthcare professionals involved in the area of Women's Health.

Counselling patients

Straight to the point: talking IUC

The following section is an introduction to the INTRA initiative which provides simple steps to successfully counselling women about intrauterine contraception (IUC) in under 7 minutes.

intra logo

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

Aims of this section:

  • Guide 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 (by 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 Healthcare.

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

Establish her contraceptive needs

45 seconds

2

Introduce long-acting reversible contraception (LARC)

Introduce long-acting reversible contraception (LARC)

30 seconds

3

Communicate the potential benefits of IUC

Communicate the potential benefits of IUC

90 seconds

4

Provide reassurance and address her concerns

Provide reassurance and address her concerns

90 seconds

5

Help her decide

Help her decide

60 seconds

6

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

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

60 seconds

    In this step, HCPs should:

    • Understand what a woman wants from her contraception

    • Discover what previous methods of contraception she has used including the pros and cons

    • Establish her goals in the coming years

    Step 1 - Starting the conversation

    To establish a woman’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:

    • Use a woman’s contraceptive needs to link to LARC (if appropriate)

    • Introduce IUC as a method of LARC

    • Increase a woman’s awareness and knowledge of LARC

    • Bear in mind that a woman’s contraceptive needs change through her life – LARC may be an option in the future if it isn’t right now

    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.’

    IUC is more than 99% effective in the first year2

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

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

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

    In this step, HCPs should:

    • Discuss the potential benefits of IUC, linking back to her contraceptive needs

    • Use extra time to compare benefits to other methods

    • Discuss non-contraceptive benefits of some IUC methods

    Step 3 - Discussing the benefits of IUC

    Discuss the key potential benefits of IUC with the woman:

    Highly effective1

    No need for daily, weekly or monthly administration1

    Rapidly reversible4

    Cost-effective for the NHS2

    Potential non-contraceptive benefits3

    Inserted quickly

    Supporting information is provided for HCPs

    This step includes discussion points for extra time

    1. NHS. Intrauterine system (IUS) - Your contraception guide [online]. Updated 22 February 2018. Available from: https://www.nhs.uk/conditions/contraception/ius-intrauterine-system/ [Last accessed: November 2019].
    2. NICE clinical guideline [CG30]. Long-acting reversible contraception [online]. Updated July 2019. Available from: https://www.nice.org.uk/guidance/cg30 [Last accessed: September 2019].
    3. Brant AR. Curr Obstet Gynecol Rep (2017) 6:109–117
    4. Carr BR, et al. Return of fertility in nulliparous and parous women after levonorgestrel 52 mg intrauterine system discontinuation [ASRM abstract O-104]. Fertil Steril. 2018;110(45 suppl):e46.

    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:

    hourGlassLargeColor1_

    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:

    • Build clinical knowledge to dispel common misperceptions around IUC

    • Feel confident in addressing these with a woman to reassure her

    • Put risks and side effects into perspective in relation to other methods and pregnancy itself

    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 discussion1

    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:

    The risk of PID, infertility and ectopic pregnancy

    The difficulty and risks of insertion of IUCs

    The mechanism of action

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

    Health system barriers include

    Pharmaceutical guidelines

    Lack of understanding of the value/cost effectiveness of IUCs

    The number of trained providers

    User barriers include:

    Lack of awareness and
    understanding of IUC

    Fear of IUC, particularly pain on insertion

    Cost of IUC

    1. Buhling KJ. The European Journal of Contraception and Reproductive Health Care, 2014; 19: 448–456

    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:

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

    1. 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.

    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:

    hourGlassLargeColor1_

    Over 9,000 adolescents and women at risk of unintended 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

    1. Birgisson NE. J Womens Health (Larchmt). 2015 May 1; 24(5): 349–353.
    2. PCWHF. 10 Top Tips for Intrauterine Contraception (IUC) [online]. Updated November 2019. Available from: https://pcwhf.co.uk/wp-content/uploads/2019/01/PCWHF-10-Tips-IUC.pdf [Last accessed: November 2019].
    3. Peipert J, et al. Obstet Gynecol, 2011;117:1105–13.

    In this step, HCPs should:

    • Use clinical experience to support a woman in deciding whether to use IUC – referring back to her initial contraceptive needs

    • Address any further concerns a woman may have openly and honestly

    • Offer personal experience

    Step 5 - Use clinical experience & 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:

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

    • Explain that insertion can take place within 7 days of the onset of menstruation. This is to ensure she is not pregnant. If Mirena is inserted more than 7 days since menstruation, abstinence or barrier contraception is recommended for 7 days1

    • Answer any final questions

    • Run through final formalities ahead of insertion

    Step 6 - Provide reassurance

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

    IUC placement can be performed at any time during her menstrual cycle provided there is absolutely no risk that she is pregnant1

    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

    1. Mirena® Summary of Product Characteristics.
    2. Mirena® Product Monograph

    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 prerequisite2

    1. Johnson BA. Insertion and removal of intrauterine devices, American Family Physician. January (2005).
    2. Mirena® Product Monograph

    Effective 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.

    Counselling on Long-Acting Reversible Contraception (LARC)

    To support contraceptive counselling in the UK, the Bayer Women’s Health team have developed virtual reality technology to help deliver LARC counselling to patients. The LARC VR programme offers virtual reality and interactive content to help women understand the different options available when considering Long Acting Reversible Contraceptives. The following video is a brief introduction to the VR programme.

    If you would like to learn more, or are interested in using LARC VR patient counselling 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

    time estimate

    This symbol represents the estimated time allowance for each section of the counselling booklet

    hourGlass

    This symbol represents any extra time allowance for each section of the counselling booklet

    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, to ensure the relevant topics have been covered without needing to refer to the full booklet

    Recommendations

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    Fitter resources

    Read more

    Report Adverse Events
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    • PP-PF-WHC-GB-0252 November 2019

    Copyright © 2019,
    Bayer plc

    This website is intended for UK healthcare professionals only. Women’s Health Matters is organised and funded by Bayer and contains promotional content.

    Prescribing Information (PI) can be found via the links below:
    Mirena® (52 mg intrauterine delivery system Levonorgestrel)
    Kyleena® (19.5 mg intrauterine delivery system Levonorgestrel)
    Jaydess® (13.5 mg intrauterine delivery system Levonorgestrel)
    Qlaira® (estradiol valerate/dienogest)
    Microgynon® (levonorgestrel/ethinylestradiol)

    Page last modified Tue, 08/11/2020 - 10:21

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