Experience with IUCD insertion outside of menses in Kenya

Objective: To determine if women receiving intrauterine devices (IUCDs) out side of menses have an acceptable rate of insertion problems and subsequent IUCD-related complications. Design: Cross-sectional and prospective cohort study of insertions at times other than during menses. Setting: The study was carried out in two government family planning (FP) c linics in Nairobi, Kenya. Subjects: After appropriate pre-test and post-test HIV counselling, 1686 wo men requesting IUCDs at two FP clinics between 1994 and 1995 in Nairobi wer e enrolled at baseline into a study examining the effect of human immune-de ficiency virus (HIV) infection on IUCD-related complications. Six hundred a nd forty nine women (156 HIV-infected and 493 HIV-uninfected) were selected for the four month follow up study. They were classified according to thei r menstrual cycle status at time of IUCD insertion. Main outcome measures: Problems at the time of insertion (pain, bleeding, i mmediate expulsion) and IUCD-related complications through four months. Results: Rates of immediate insertion problems were low in the women who ha d insertions during menses (7.0%), outside Of menses (4.0%) or had oligomen orrhea/amenorrhea (2.6%), The adjusted odds ratios for IUCD insertion probl ems outside of menses and in oligomenorrhea/amenorrhea (versus women with i nsertion during menses) were 0.54 (95% CI 0.18-1.59) and 0.39 (95% CI 0.12- 1.29) respectively. IUCD-related complications were higher in the oligomeno rrhea/amenorrhea (11.5%) or insertion outside of menses (6.9%), than the wi thin menses (4.3%) groups. However, the differences were not statistically significant, Adjusted odds ratios for IUCD outside of menses and oligomenor rhoea/amenorrhea groups were 1.65 (95% CI 0.21-12.91) and 2.72 (95% CI 0.33 -21.71) respectively. Conclusion: The results confirm that the IUCD can be safely inserted outsid e of menses with minimal insertion difficulties and subsequent complication s. Availability of IUCDs outside of menses may enhance IUCD acceptance in K enya and create better opportunity for visual screening of the cervix for s exually transmitted infections.