IUD advice

A review by Perth sexual health clinicians has found a possible
link between intrauterine devices in women becoming unexpectedly
dislodged and the surging use of menstrual cups.

Cathy O’Leary reports


Doctors at Sexual Health Quarters in Perth started tracking clinic data last year after noticing reports of a phenomenon of IUDS being expelled in women who used the rubber or silicone cups to collect blood during their period.

The reusable feminine hygiene products have rapidly grown in popularity in Australia because they are considered an eco-friendly and cost-effective alternative to tampons and sanitary pads.

Dr Matilda Oke

Dr Matilda Oke and her colleagues reviewed 520 patients who had an IUD inserted in the 12 months from January 31, 2019, with the majority using Mirena hormonal IUDs (67%), followed by 28% with Copper T standard IUDs.

By the end of the follow-up in June last year, 22 of the IUDs had become unexpectedly dislodged, with almost half of them occurring in women who used menstrual cups and many of them noting that the IUD had been expelled at the time the cup was removed.

Dr Oke said her team believed there were two possible mechanisms that explained the IUDs becoming inadvertently dislodged.

One was that when women removed the menstrual cup, it might catch the IUD strings, and the other was that menstrual cups might apply a negative pressure to the cervix which could dislodge
the IUD.

Dr Oke said although they could not prove a causal link, they wanted to raise awareness among women and health care professionals of the potential for IUDs to be dislodged.

“We’ve seen a huge increase in the number of women using menstrual cups and while they’ve been around for a long time, they’ve been given this new lease on life for environmental reasons, and the fact that they’re cost effective and last a long time,” she said.

“I think they’ll continue to grow in popularity, and we’re not trying to scare people off using them, it’s just about being sensible.

“If women opt to use menstrual cups, we want to make sure they’re using them correctly, so this is an opportunity for education around that.”

The Perth review found that of the 10 IUDs dislodged in women using menstrual cups, six were Copper T standard IUDs and the remaining four were Mirena IUDs.

The clinicians believe Copper T IUDs are more prone to expulsion because they tend to make menstrual flow heavier and longer, and therefore women are more reliant on the cups. But the Mirena tends to make periods lighter, so women might not be as fussed about using menstrual cups.

Dr Oke said that, as a result of the review, SHQ clinicians now routinely asked patients about the menstrual products they used and advised those who used a cup to take care not to pull out the IUD.

She said more research was needed to firm up the association between the use of menstrual cups and IUDs being dislodged.

“If that research finds there is an association, then people can be advised and make an informed decision for themselves,” she said.

“It’s about being able to use these cups alongside contraceptives as effectively and safely as possible.”