Patient and physician experiences with early elective IUD removals
Awarded 2013
Complex Family Planning Fellowship Research
Jennifer Amico, MD, MPH
Albert Einstein College of Medicine

While IUDs are well-liked contraceptives, some patients will discontinue them within the first 9 months, and the experiences of these doctor-patient interactions are not well known. This study aims to describe the perspectives and experiences of patients and physicians when patients request an IUD removal within 9 months of insertion. In this qualitative study, we conducted semi-structured individual interviews with 16 patients and 12 physicians involved in visits to discuss IUD removal within 9 months of insertion. We analyzed interviews using deductive and inductive techniques to identify content and themes. Most patients reported a strong desire to have a successful IUD experience, and all reported waiting for symptoms to resolve prior to their visit. Some patients reported that providers supported their choice, while others reported that providers preferred that they continue the IUD despite symptoms and concerns. When the provider resisted removal, patients felt frustrated, even as they acknowledged their doctor’s good intentions. Most physicians reported having mixed or negative feelings when patients opted to remove the IUD. Most physicians encouraged their patients to continue the IUD, hoping to delay removal until symptoms resolved so that removal was not needed. Many providers reported a conflict between valuing patient autonomy and feeling that early removal was not in the patient’s best interest. Both patients and physicians cited concerns about and potential benefits of IUD self-removal. While patients cited concerns about safety, physicians did not share this concern. Physicians were apprehensive about not being involved in the discussion to remove the IUD. Both patients and physicians valued having the provider “in the loop”. Patients may face resistance to IUD removal by providers, which has implications for both reproductive autonomy as well as the doctor-patient relationship. More work is needed to reduce barriers to IUD discontinuation.