Niklas Envall


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    Use of effective contraception six months after emergency contraception with a copper intrauterine device or ulipristal acetate - a prospective observational cohort study

    Niklas Envall1 ,2, Helena Kopp Kallner2 ,3, Nina Groes Kofoed3
    1The RFSU Clinic, Stockholm, Sweden, 2The Karolinska Institutet, Solna, Sweden, 3Danderyds Hospital, Danderyd, Sweden

    Introduction: Emergency contraception must be followed by the use of an effective method for contraception in order to reduce future risk of unintended pregnancy. Provision of long acting reversible contraception (LARC) such as the copper intrauterine device (Cu-IUD) is highly effective in preventing unintended pregnancy.
    Objectives: to compare use of an effective method of contraception 6 months following insertion of a Cu-IUD or intake of ulipristal acetate (UPA) for emergency contraception (EC).
    Method: Women (n=79) presenting with need for EC at an outpatient midwifery clinic chose either Cu-IUD or UPA according to preference. Follow up was three and six months later through telephone interviews. Primary outcome was use of an effective contraceptive method at the six month follow up. Secondary outcomes included use of an effective contraceptive method at three months follow-up and acceptability of Cu-IUD.
    Results: A total of 30/36 (83.3%) of women who opted for Cu-IUD had an effective contraceptive method 6 months after their first visit compared to 18/31 (58.1%) of the woman who used UPA (p=0.03). In the Cu-IUD group 28/36 (77.8%) where still using Cu-IUD at six months and 31/36 (86%) stated that they would recommend the Cu-IUD to others as an EC method.
    Conclusion: Significantly more women who chose Cu-IUD for EC used an effective method for contraception at the six month follow up. The results of this study support increased use of Cu-IUDs for EC.

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    Objective: To evaluate whether intrauterine instillation with Mepivacaine (Carbocain) before insertion of an intrauterine contraceptive device (IUD) decreases pain at insertion compared with placebo (NaCl). Design: Double-blind randomized controlled trial. Setting: Two outpatient clinics providing contraceptive services. Population: Women over 18 years of age opting for IUD for contraception. Methods: Women were randomized to intrauterine instillation of Mepivacaine (intervention) or placebo (placebo, NaCl) with a hydrosonography catheter before insertion of an IUD. During the procedure, women marked their pain on a 10-cm visual analogue scale (VAS). Data were analyzed by intention to treat, using descriptive and inferential statistics. Main outcome measures: Difference in pain score (VAS) at the time IUD insertion between intervention and placebo group. Results: A total of 86 women were randomized. Mean VAS-score was 4.63 in the intervention group (n=41, SD=2,21) compared to 5.67 in the placebo group (n=40, SD=2,62, P = 0.058). The intervention did not have a significant influence on pain but had a significant influence on the overall experience of the procedure (P = 0.003). Conclusions: Intrauterine instillation of Mepivacaine prior to IUD insertion did not significantly affect the pain score but had a significant influence on the overall experience of the procedure. Our findings support further studies with larger sample sizes.