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Can Fam Physician. 2008 Apr;54(4):560-6.

The evidence is in. Why are IUDs still out?: family physicians' perceptions of risk and indications.

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Intrauterine devices (IUDs) for contraception are used infrequently in Canada despite their well-studied safety and efficacy. The purpose of this study was to investigate FPs' perceptions of the risks of and indications for using IUDs, as these perceptions might be a key factor in why IUDs are underused.


Mailed survey.


Kingston, a midsized city in Ontario.


All FPs practising in Kingston.


The primary outcome was the proportion of FPs who ranked the importance of risks of and contraindications to using IUDs in keeping with rankings in established clinical guidelines.Secondary outcomes were FP IUD prescription and insertion patterns, their perceptions of patients' access to physicians who insert IUDs, and their interest in a course on IUD insertion.


Response rate was 81%. Contrary to the evidence, more than 60% of FPs thought pelvic inflammatory disease and ectopic pregnancy were major risks, and nearly half thought failure of IUDs was a major risk. Fewer than one-third would recommend IUDs as an option for nulliparous women, for postcoital contraception, for women with moderate-sized fibroids, or for women with pelvic inflammatory disease during the last year,though none of these are contraindications according to established clinical guidelines. About 82% of FPs prescribed IUDs, and 41% inserted them. Newer graduates were more likely than older graduates to prescribe only levonorgestrel IUDs (36% vs 8%). About 93% of survey respondents reported that patients' access to physicians who insert IUDs was not a factor in recommending IUDs to them.


A substantial proportion of surveyed FPs believed that the side effects of IUDs were more severe than is supported by clinical guidelines and were misinformed about the range of women who could benefit from IUDs. These misconceptions likely contribute to the low rate of IUD use in Canada.

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