Many Providers Postpone IUDs for Women With LSIL


RIO GRANDE, P.R. — A majority of health care providers said they would not insert an IUD before obtaining Pap test or colposcopy results in a recently postpartum woman with low-grade squamous epithelial lesions, according to results of a survey of nearly 300 participants.

Although evidence does not support a connection between IUDs and an increased risk of cervical dysplasia, many providers require screening tests before inserting IUDs, which may leave women vulnerable to unintended pregnancy, the researchers said.

To determine health care providers' attitudes about screening tests and IUDs, Dr. Tara Stein and Dr. Marji Gold of Albert Einstein College of Medicine, New York, surveyed 294 providers: 214 colposcopy providers and 80 providers who do not perform colposcopies. The average age of the participants was 44 years. Approximately half of the providers reported that they had inserted 1–20 IUDs during the past year. The participants were recruited for the survey while attending academic conferences, and the results were presented in a poster at the annual meeting of the North American Primary Care Research Group.

Overall, 88% of colposcopy providers and 90% of noncolposcopy providers said that they would insert an IUD without Pap test or colposcopy results if the patient were a 30-year-old woman whose last normal Pap was 2 years ago.

By contrast, 27% of colposcopy providers and 17% of noncolposcopy providers said that they would insert an IUD without Pap or colposcopy results if the patient were a 28-year-old woman who was 6 weeks post partum with a history of low-grade squamous epithelial lesions (LSIL) during pregnancy.

Although the presence of LSIL increases the risk of cervical dysplasia, only 1% of the survey respondents said they believed that the copper T 380 and levonorgestrel intrauterine systems worsen cervical dysplasia.

The researchers had no financial conflicts to disclose.

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