Removal Counseling Video - ACOG
/ Internet Link“In this video a provider and patient discuss a patient’s request to get her birth control implant removed.
“I really want my implant out,” the patient says, citing a common side effect. “I’m really tired of the bleeding. I thought that I could handle it, but it’s driving me crazy.”
“I’m sorry you’re having that side effect,” the provider responds. “One of the things we can talk about is ways to treat that bleeding… otherwise we could just take the implant out.”
“I think I just want to take a break from everything and have my implant out,” the patient responds. It’s clear she has made up her mind.
“Okay, great. Why don’t we go ahead and get that removed for you today.”
The patient’s concerns in this video illustrate commonly cited concerns from women who experience bad side effects from the IUD. “
With this case, we strengthen previous observations regarding mood changes under LNG-IUS. Moreover, we illustrate that psychiatric symptoms may also occur as ADRs during the subsequent insertion. Thus, we emphasize that psychiatric symptoms have to be clearly communicated as ADRs to patients with LNG-IUS within a written informed consent and should be routinely examined by gynecologists.
This study describes the reasons for IUD self-removal as documented in internet forums by IUD users discussing self-removal.
In our current climate focused on improving access to IUDs, it is essential to address and reduce barriers to IUD removal when desired, in order to preserve reproductive autonomy.
Reasons for discontinuation of IUD:
Bleeding Pattern (27.5%), Pain (25%), Weight Gain (5%); Other Reasons (42.5%)
Baseline generalized pelvic pain may not be a risk factor for IUD discontinuation within one year of placement.
IUD self-removal is an option that some patients may be interested in. Addressing concerns about safety may make self-removal more appealing to some patients. Addressing physicians' concern about "hasty" removal may require additional training so that providers are better able to support patients' decision-making around contraceptive use. Implications: The option of self-removal could have a positive impact on reproductive autonomy and patient-decision making.
LARC methods such as etonogestrel contraceptive implants and IUDs provide effective pregnancy prevention, but discontinuation rates are higher among adolescents and young women than among adults.
We encourage contraceptive counseling and removal protocols that directly address historical reproductive injustices and that honor patients' wishes.

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