IUD self-removal: A randomized controlled trial of a self-removal guide in clinical and non-clinical settings.

OBJECTIVE: Intrauterine device (IUD) users often encounter barriers to desired removal. Self-removal, while previously found to be successful only 19% of the time, may mitigate these obstacles. Our primary objective was to evaluate the effectiveness of our previously developed IUD self-removal guide. Our secondary objectives were to evaluate acceptability of the guide and characterize the self-removal process.

METHODS: This was a randomized controlled trial comparing IUD self-removal success rates with and without a guide. Participants selected a clinical or non-clinical setting for attempting self-removal. The primary outcome was the rate of successful IUD self-removal. Covariates of interest included demographic characteristics, parity, body mass index (BMI), and attempted removal in a clinical versus non-clinical setting.

RESULTS: Of the 116 participants, 35 (30%) successfully removed their IUDs, 20 (32%) of those randomized to the guide and 15 (28%) of those randomized to no guide (p = 0.7). While our guide was not associated with an increase in successful self-removal, the majority (97%) of those randomized to the guide reported it to be a helpful resource. Those who selected a non-clinical setting (80%) were more successful at self-removal (35% vs 9%, p = 0.01). Most participants would recommend IUD self-removal to a friend (68%) and would attempt again with a future IUD (80%).

CONCLUSION: The proportion of participants who successfully removed their IUDs was higher than previously shown, with or without use of our guide. Our study was novel in including a non-clinical setting, in which the proportion of successful self-removal was significantly higher. Providers should consider discussion of IUD self-removal, with a reasonable expectation about likelihood of success, as a means of increasing reproductive autonomy.

IMPLICATIONS: IUD self-removal was feasible and acceptable.