The following is a summary of “Demographic, Reproductive, and Medical Risk Factors for Intrauterine Device Expulsion” published in the December 2022 issue of Obstetrics & Gynecology by Anthony et al.

For a study, researchers sought to investigate the connection between clinical and demographic risk factors and intrauterine device (IUD) ejection.

The APEX-IUD (Association of Perforation and Expulsion of IntraUterine Devices) research, which was conducted in the United States, utilized electronic health records from three integrated healthcare systems (Kaiser Permanente Northern California, Southern California, and Washington) as well as a health information exchange (Regenstrief Institute). Individuals, 50 years of age or younger who had IUD insertions between 2001 and 2018 were included in the studies. They assessed the cumulative incidence and incidence rates of intrauterine device ejection. The hazard ratios with 95% CIs were calculated using Cox regression models, both before and after the risk variables of interest (age, race and ethnicity, parity, body mass index [BMI], heavy menstrual bleeding, and dysmenorrhea) and possible confounders were taken into account.

A total of 228,834 people were identified, of whom 184,733 (or 80.7%) had an intrauterine system that releases levonorgestrel and had not given birth in the preceding 52 weeks. The best predictor of IUD ejection was a diagnosis of severe menstrual bleeding, especially if it occurred both recently and in previous cycles. Within each risk category, those with a diagnosis of overweight, obesity, or morbid obesity, those in younger age groups, notably those aged 24 or younger, and those with a parity of four or more had the highest chance of having their IUD expelled. The lowest Non-Hispanic White people experienced the lowest incidence and risk adjustment; the highest risk was experienced by those of Asian or Pacific Islander descent. After controlling for excessive menstrual bleeding, dysmenorrhea was not independently linked with ejection risk. 

Most ejection risk variables in the study were congruent with physiologic factors that alter uterine morphology and physiology (age, BMI, heavy menstrual bleeding, parity). There had to be more research done since people of color were more likely to have their IUDs ejected. Intrauterine contraceptives are beneficial for long-term use; although expulsion is rare, patients should get the appropriate counseling.