Intrauterine devices and the myth of their unsafeness

Posted February 21, 2020

A study conducted by the Centro INCT Hormona at Universidade Estadual de Campinas (Unicamp) points out that most cases of device expulsion (from 3% to 4% of insertions) take place within the first six months of use; thus, one follow-up visit is enough to ease the worries of both patients and healthcare professionals.

The perception that some physicians and healthcare professionals believe that periodic visits should be conducted to review the placement of the intrauterine device (IUD) in their patients has motivated a group of researchers from INCT Hormona to investigate whether frequent follow-up assessments may prevent the expulsion of the abovementioned contraceptive agent. The results of this study comprise the article entitled “Follow-up visits to check strings after intrauterine contraceptive placement cannot predict or prevent future expulsion”, which was published in The European Journal of Contraception & Reproductive Health Care ( and may be incorporated into new public health recommendations in Brazil.

“There is a myth that the IUD must be frequently checked in order to prevent its expulsion by the patient, which would compromise the effectiveness and the safety of the method. In order to make this kind of control, a culture has been created encouraging maintenance visits. We asked the following question: are these visits actually necessary? Furthermore: can the control promoted by the follow-up visits really prevent an expulsion?,” the coordinator of Hormona Center at Universidade Estadual de Campinas (Unicamp), Prof. Dr. Luís Bahamondes, explains.

He believes that, in alignment with the questioning reproduced among the healthcare professionals themselves, concerns spread among patients of using something hazardous, that could stop working at any time, leaving women unprotected in terms of their reproductive healthcare.

“This method is safe. Only 3% to 4% of women experience an IUD expulsion. Our results indicate that only one follow-up visit is required at the first four to six months after insertion. The study also shows that additional visits do not seem to reduce device expulsions or help predict whether this will occur in the future,” the researcher informs.

The study reviewed the medical records of 1,607 women who experienced a device expulsion among over 40,000 who received an IUD insertion in Brazilian public institutions from January 1980 to December 2017. The patients attended a mean number of 10 follow-up medical visits throughout the period when they used the contraceptive method, from five to ten years. However, most IUD expulsions occurred within the first six months after IUD insertion, especially within the first three months after its insertion.

Dr. Bahamondes highlights that the results of study analyses, taking into account patients’ age and their reports of pain and bleeding episodes, point out that the number of follow-up visits may not be significantly associated and did not show to have an influence on IUD expulsion.

Dr. Bahamondes states that the use of this method requires further dissemination and argues that the results of the published study should be incorporated into care practices for women’s health care in Brazil. The researcher also advocated for permanent professional training and qualification in order to keep high standards in IUD insertion procedures.

Text and editing: Luiz Sérgio Dibe