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Endometrial cancer accounts for 95% of uterine cancers, which are the fourth most common cancer in women in the US.1 Approximately 1 in 32 women in the US will develop endometrial cancer in their lifetimes. Eighty percent of endometrial cancer cases in the US are diagnosed in postmenopausal women, and the average age at diagnosis is 60 years. However, rates of endometrial cancer are increasing in both older and younger women in the US and worldwide.
A leading risk factor for endometrial cancer is obesity. Other common risk factors are diabetes and a personal or family history of inherited conditions such as Lynch syndrome (a genetic disorder that increases the risk of multiple types of cancer). Additional risk factors include use of estrogen without progesterone, tamoxifen (a medication to treat or prevent hormone receptor–positive breast cancer), and having never been pregnant. In contrast, combined oral contraceptives and progesterone therapy, including progesterone-releasing intrauterine devices, are associated with a decreased risk of endometrial cancer.
Background: Intrauterine devices (IUDs) are one of the most effective, long-lasting, and convenient contraceptive methods available in the United States. Unfortunately, the anticipated pain and anxiety associated with an IUD insertion procedure deter many people from using this contraceptive method.
Methods: A literature review was conducted on PubMed by searching the terms “IUD insertion”, “pain management”, “anxiety”, “gynecologic procedures”. The Cochrane database was also searched for reviews about pain management methods during IUD insertions. Findings were summarized using the American Academy of Family Physicians’ Strength of Recommendation Taxonomy (SORT) scale.
Results: Pharmacologic methods that can be used to reduce pain with IUD insertion include naproxen, tramadol, lidocaine paracervical blocks, 10% lidocaine spray, lidocaine-prilocaine cream, and EMLA cream. Non-pharmacologic methods for reducing pain or anxiety during gynecologic procedures include pre-insertion counseling, “verbal analgesia”, lavender aromatherapy, distraction with music or television, using Valsalva maneuver instead of tenaculum during IUD insertion, and use of heating pad during procedure.
Conclusion: Moderately effective pharmacologic and non-pharmacologic methods exist for reducing pain and anxiety with IUD insertion. These treatment methods should be offered to create a more comfortable experience for patients. Additional research is needed to determine the comparative efficacy of these methods.
Objective: To document the efficacy and safety of etonogestrel subdermal contraceptive implants, levonorgestrel (LNG) intrauterine systems (IUS), and copper (Cu) intrauterine devices (IUDs) for birth control when extended beyond prescription limits.
Data sources: A systematic search of MEDLINE, Embase, and Global Health electronic databases.
Study selection: The search identified articles published between January 2000 and June 2023 on long-acting reversible contraceptive (LARC) methods and extended duration of use. Publications on LNG subdermal implants or the "frameless" IUD (not marketed in Canada), case reports, case series, animal studies, and publications not written in English or French were excluded.
Synthesis: Twenty-five publications were included. No pregnancies were reported during prolonged use of the etonogestrel-releasing implant for 1 or 2 additional years beyond the recommended limits (783 participants and 306 participants, respectively), nor with the use of the TCu380A IUD for years 8 to 11 (682 participants), 8 to 12 (356 participants), and 11 to 16 (228 participants). No pregnancies were reported with the LNG-IUS in 9 studies with follow-up from 6 to 15 years, while 2 pregnancies were reported during year 6 in 2 studies, and 4 pregnancies during year 7 in 3 studies. The risk of expulsion persisted during prolonged use of the TCu380A device and the 52-mg LNG-IUS. Other adverse events were infrequent.
Conclusion: Prolonged use of LARCs is safe and much more effective than short-acting contraceptive methods. Prolonged use of LARCs might be beneficial for individuals requiring contraception especially those with disrupted access to social and health care services or living in more remote areas.
Long-acting reversible contraception (LARC), including contraceptive implants and intrauterine devices (IUDs), is highly effective, with typical-use failure rates of less than 1 pregnancy per 100 person-years of use.1 Fertility returns rapidly after discontinuation of LARC.
