Trend of Increase in the Use of Hormonal Intrauterine Devices in Women From a Health Insurance Company in Brazil: What Is the Explanation?

OBJECTIVES: This study aims to investigate the factors contributing to the increased use of intrauterine devices (IUDs) between 2014 and 2023 within a Brazilian private health insurance provider.

METHODS: The entire cohort of beneficiaries receiving L-IUD 19.5mg, L-IUD 52mg, and Cu-IUD (375mg and 380mg) devices from Aug/2014 to Jul/2023 was analyzed. Stratification based on age and device type was performed, and annual data assessments were conducted.

RESULTS: A total of 51,667 IUDs were inserted, with 33,258 (L-IUD 52), 10,790 (L-IUD 19.5), and 7,619 (Cu-IUD). L-IUD 52 showed an upward trend, surpassing 4/5 (16,036) in the last three years. In 2020, 68.30% of 5,322 insertions were L-IUD 52, 18.19% L-IUD 19.5, and 13.51% Cu-IUD. Between 2021 and 2023, L-IUDs constituted almost 90% (24,776). L-IUD 19.5 reached 38.67% in 2020 and 70% between 2021 and 2023. Predominance of L-IUD 52 among adolescents (13-19) until 2020 shifted to L-IUD 19.5 from 2021 to 2023, exceeding 70%. L-IUD 19.5 and Cu-IUD were more inserted in the 20-33 age group (2020 and 2023). In the 27-40 age group, L-IUD 52 predominated from 2015 to 2019 and remained above 48% between 2020 and 2022. In 2014 and 2023, the 34-47 age group was predominant, with variations of 80.87% and 66.92%, respectively.

CONCLUSIONS: The study reveals an increase in L-IUD insertions, suggesting a decline in Cu-IUD use. Beyond contraception, this trend may be attributed to desires for reduced menstrual flow and challenges with pill adherence. The age-specific preferences indicate nuanced considerations, such as L-IUD 52 for abnormal uterine bleeding treatment and L-IUD 19.5 for younger age groups, driven by early sexual activity and amenorrhea preferences, highlighting the significant rise in L-IUD usage.