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J Am Board Fam Med. 2014 Jan-Feb;27(1):26-33. doi: 10.3122/jabfm.2014.01.130142.

Evidence-based selection of candidates for the levonorgestrel intrauterine device (IUD).

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the Departments of Obstetrics and Gynecology and Family Medicine and the Departments of Epidemiology and Department of Health Services, School of Public Health, University of Washington, Seattle; the Departments of Medical Informatics and Clinical Epidemiology and Obstetrics and Gynecology, Oregon Health & Science University, Portland.



Recent evidence-based guidelines expanded the definition of appropriate candidates for the levonorgestrel-releasing intrauterine system (LNG-IUS). We investigated correlates of evidence-based selection of candidates for the LNG-IUS by physicians who offer insertion.


We conducted a mixed-mode (online and mail) survey of practicing family physicians and obstetrician-gynecologists in Seattle.


A total of 269 physicians responded to the survey (44% response rate). Of the 217 respondents who inserted intrauterine devices, half or fewer routinely recommended the LNG-IUS to women who are nulliparous, younger than 20 years old, or have a history of sexually transmitted infections (STIs). In multivariable analyses, training/resident status was positively associated with recommending the LNG-IUS to women <20 years old (adjusted odds ratio [aOR], 3.6; 95% confidence interval [CI], 1.6-8.0) and women with history of STI (aOR, 3.7; 95% CI, 1.6-8.4). Perceived risk of infection or infertility was negatively associated with recommending the LNG-IUS to nulliparous women (aOR, 0.2; 95% CI, 0.1-0.5) and women with a history of STI (aOR, 0.3; 95% CI, 0.1-0.8).


Many family physicians and obstetrician-gynecologists who insert the LNG-IUS are overly restrictive in selecting candidates, although those who train residents are more likely to follow evidence-based guidelines. Interventions that address negative bias and perceptions of risks, in addition to improving knowledge, are needed to promote wider use of the LNG-IUS.


Contraception; Evidence-based Medicine; Graduate Education; Intrauterine Devices

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