title: Timing of copper intrauterine device insertion after medical abortion: a randomized controlled trial.
abstract: OBJECTIVE
  To compare intrauterine device (IUD) use at 6 months in women randomized to receive an intrauterine copper contraceptive 1 week compared with 1 month after medical abortion.
  
  
  METHODS
  We recruited women undergoing medical abortion with mifepristone and misoprostol and choosing the copper IUD for contraception. We randomly assigned participants to "immediate" insertion 1 week after mifepristone or "delayed" insertion 4-6 weeks later. We followed rates of IUD insertion, 6-month utilization, expulsion, removal, and pregnancy. Participants recorded bleeding in a diary for 4 weeks.
  
  
  RESULTS
  We randomized 156 participants. We inserted an IUD in 97% of participants in the immediate group and 76% in the delayed group (P<.001). At 6 months, 69% of participants in the immediate group used the IUD compared with 60% in the delayed group (P=.24). Expulsion rates were comparable; 12% (8 of 69) in the immediate group compared with 11% (7 of 65) in the delayed group. Removals occurred in 14% (10 of 69) of immediate and 8% (5 of 65) of delayed group participants (P=.21). Four pregnancies occurred in delayed group participants who did not return for IUD insertion (P=.09). The immediate and delayed groups reported a median of 20 and 19 bleeding or spotting days, respectively (P=.15). We detected no cases of serious infection, uterine perforation, or hemorrhage.
  
  
  CONCLUSIONS
  Immediate insertion increased uptake of the IUD without increasing expulsions or bleeding.
  
  
  BACKGROUND
  Clinicaltrials.gov, www.clinialtrials.gov, .
  
  
  METHODS
  I.
authors.affiliation: From the Columbia University Department of Obstetrics and Gynecology and New York Presbyterian Hospital, New York, New York.
authors.forename: Noa'a
authors.initials: N
authors.lastname: Shimoni
authors.forename: Anne
authors.initials: A
authors.lastname: Davis
authors.forename: Maria Elena
authors.initials: ME
authors.lastname: Ramos
authors.forename: Linette
authors.initials: L
authors.lastname: Rosario
authors.forename: Carolyn
authors.initials: C
authors.lastname: Westhoff
mesh_terms: D000028:Abortion, Induced; D000328:Adult; D005260:Female; D006801:Humans; D007433:Intrauterine Device Expulsion; D007435:Intrauterine Devices, Copper / Q000706:statistics & numerical data; D016015:Logistic Models; D010147:Pain Measurement; D010349:Patient Compliance; D011182:Postoperative Care; D011247:Pregnancy; D013997:Time Factors; D055815:Young Adult