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

Background: recent evidence-based guidelines expanded the definition of appropriate candidates for the levonorgestrel-releasing intrauterine system (lng-ius). we investigated correlates of evidencebased selection of candidates for the lng-ius by physicians who offer insertion. methods: we conducted a mixed-mode (online and mail) survey of practicing family physicians and obstetrician-gynecologists in seattle. results: 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). conclusions: 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.