Sunday, July 25, 2010
To bleed or not to bleed
19 y/o G1P1 with 16 week old son being seen for IUD removal this visit. This pt had the Mirena IUD placed six weeks after giving birth with normal vaginal exam. In giving instruction with this birth control method, women are warned of spotting or break through bleeding between periods within the first six months then probable amenorrhea. This pt had little complications other than the annoyance of amenorrhea within 6 wks of placement. Pt states that not having a period felt unnatural for her and felt more comfort in having a regular cycle. Although most women I know would feel this is a worth while side-effect, it is very important to educate your pt that this is a possibility and if this is not what she would feel comfortable with then perhaps the paraguard or an alternate form of birthcontrol may be more suitable. We don't really discuss cost readily within the military system but having a patient maintain an IUD less than 6 months is an unnecessary expense to the military healthcare system. It would be more advantageous for the pt to utilize more cost effective measures better suited to her preference.
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Couldn't agree more - it's a lot of cost, and placing an IUD for 6 months is exposing her to unnecessary procedure risks (uterine perfortion, infection, etc) as well. It's all ABOUT education
ReplyDeleteAgree with your assessment. We don't think about the supply cost or human cost enough. Sounds like she would have been a much better candidate for the paraguard. Mirena's cost $300 plus placement fee and Paraguard $200. For the same price 5-10 women could be provided OCP's for a year. Things a public health or organization providing these services to people with less than adequate health insurance must consider.
ReplyDeleteI had 38 y/o monogomous G2P2 come in for IUD placement. It had been 5+ years since her last IUD. She was under the assumption it was a Mirena. She liked the options of the Mirena vs paraguard so we proceeded. Procedure was complicated by the fact it was poorly documented in her record. Type was not indicated, it was done on the economy in Germany. We were unable to see the strings and had to locate device using U/S. We were able to use a clamp and get string through cervix with minimal discomfort but in the process partially removed device. It turned out to be Paraguard like or copper based. She could have maintained for another 5 years. I re-eduacated her on the difference, and also emphasized the importance of holding on to manufacturers card from kit that had name of device, date placed, and lot number in case of product recall.
We could have saved cost their more effectively if we had known and not exposed her to the trauma of the procedure. I am told you can also tell difference by color of strings although in this case we could not see strings. ( I am also color-blind)
Finally in researching this case I learned attitudes in general in US vs Europe regarding IUD use are much different. Europe usage rate is as high as 27% of pop for IUD's. IUD's did not get the same press there as they did here regarding TSS and rel. risks associated with PID.