Simple steps from INTRA to successfully counsel women about intrauterine contraception (IUC) in under 7 minutes.
Aims of this section:
The global INTRA group is a panel of independent physicians with an expert interest in intrauterine contraception.*
*Formation of the INTRA group and its ongoing work is supported by Bayer Healthcare
The global INTRA group is a panel of independent physicians with an expert interest in intrauterine contraception.*
The Global INTRA group identified six key steps, which they believe form the basis of an effective counselling session about IUC.
Every step includes a short explanation, example questions and an estimated time recommendation.
If you would like to learn more, click here to access the downloads at the bottom of the page.
1
Establish her contraceptive needs
45 seconds
2
Introduce long-acting reversible contraception (LARC)
30 seconds
3
Communicate the potential benefits of UIC
90 seconds
4
Provide reassurance and address her concerns
90 seconds
5
Help her decide
60 seconds
6
Confirm her choice and schedule placement(if choice was IUC)
60 seconds
Understand what a woman wants from her contraception
Establish her goals in the coming years
Discover what previous methods of contraception she has used including the pros and cons
To establish a women’s contraceptive needs:
‘Do you have any plans to get pregnant?
If yes, how soon?’
‘How important is it for you not to be pregnant right now?’
‘What contraception do you use now (if any)?
What have you used before (if any)?’
‘How happy are/were you with those methods?
What did you like most about your previous/current method?
What did you like least?’
Use a women’s contraceptive needs to link to LARC (if appropriate)
Increase a woman’s awareness and knowledge of LARC
Introduce IUC as a method of LARC
Bear in mind that a woman’s contraceptive needs change through her life – LARC may be an option in the future if it isn’t right now
Contraception options have a
range of levels of effectiveness
– one of the most effective
and reversible methods is
intrauterine contraception…
IUC is more than
99% effective in
the first year2
‘There are many myths associated with intrauterine
contraception, let me tell you some of the real facts which
may help…’
‘You seem quite knowledgeable about intrauterine
contraception, is there something that has stopped you
considering it as an option in the past?’
‘You mentioned you have heavy periods, one benefit of
some types of intrauterine contraception can be reduced
bleeding or for your periods to stop altogether.’
Discuss the potential benefits of IUC, linking back to her contraceptive needs
Discuss non-contraceptive benefits of some IUC methods
Use extra time to compare benefits to other methods
Build clinical knowledge to dispel common misperceptions around IUC
Put risks and side effects into perspective in relation to other methods and pregnancy itself
Feel confident in addressing these with a woman to reassure her
Addresses HCP misconceptions regarding:
The risk of PID, infertility and ectopic pregnancy
The difficulty and risks of insertion of IUCs
The mechanism of action
Health system barriers include
Pharmaceutical guidelines
Lack of understanding of the value/
cost effectiveness of IUCs
The number of trained providers
User barriers include:
Lack of awareness and
understanding of IUC
Fear of IUC, particularly pain on insertion
Cost of IUC
Pain on insertion has been shown to be lower than often feared:
A study of 117 women found that 62% of women taking part felt no more than ‘period pain’ during insertion of IUC1
‘The most common side effects can be headaches and abdominal
pains but not all women experience these. Just be aware that
having an IUC won’t protect you against STIs so as you would with
the pill, you’ll need to use a condom if you think you might be at risk.’
Use clinical experience to support a woman in deciding whether to use IUC – referring back to her initial contraceptive needs
Offer personal experience
Address any further concerns a woman may have openly and honestly
‘Based on what you’ve told me these are the most
effective options to suit your needs – which of these do
you think would suit you best?’
‘For most women, placement can cause a little pain, a bit
like period pain, which quickly passes.’
‘In our practice we have a large number of women using
this method.’
‘Amongst the patients I see, there are many who opt for an IUC.’
‘Many of the women who work here use IUC.’
(If you and your colleagues are comfortable)
Offer guidance to confirm a woman’s choice of IUC
Answer any final questions
Explain that insertion can take place within 7 days of the onset of menstruation. This is to ensure she is not pregnant.
Run through final formalities ahead of insertion
IUC placement can be performed at any time during her menstrual
cycle provided there is absolutely no risk she is pregnant1
STI screening can be performed on the same day as placement
and, if the screen comes back positive, the infection can be treated
with the device/system in situ. Mirena must be removed if the
woman experiences recurrent endometritis or pelvic infection, or if
an acute infection is severe2
If she has any concerns following placement, she can return to
discuss these with you at any time or call the clinic
You meet your local requirements for informed consent at the time
when the woman returns for the device to be inserted. When gaining
this consent, remind her of the potential risks and side effects1
If the woman does experience side effects she should contact her
healthcare professional immediately including pain, fever, unusual
discharge, or severe bleeding2
It is important to note that cervical screening is independent of IUC
placement and not a pre-requisite2
These videos demonstrate that it is possible to have a simple, short, & very effective counselling session about IUC in under 7 minutes.
16 page, A5 booklet entitled ‘Straight to the Point: Talking IUC’
Aim: to assist HCPs when counselling women about IUC in under 7 minutes
This symbol represents the estimated time allowance for each section of the counselling booklet
This symbol represents any extra time allowance for each section of the counselling booklet
A one page A4 summary of the key topics, including the most important questions
Follows the same six key themes for discussion, as advised by the Global INTRA group
Aim: to act as a quick reference during a consultation, and to ensure the relevant topics have been covered without needing to refer to the full booklet
To support contraceptive counselling on the IUS, the Bayer women’s health team have developed the Which IUS to Prescribe guide.
Which IUS to Prescribe
This guide includes a flowchart which will gives guidance on which IUS - Kyleena®, Mirena® or Jaydess®▼ - best meets your patients needs.
Reporting adverse events and quality complaints
If you want to report a side effect or quality complaint, please contact your health care professional (e.g. physician or pharmacist) or The Health Products Regulatory Authority, Reports can also be reported directly to Bayer through this link or by emailing directly on adr-reland@bayerhealthcare.com