"She just told me to leave it": Women's experiences discussing early elective IUD removal.

Objective: The objective of this study is to describe the thoughts and experiences of women who report discussing intrauterine device (IUD) removal within 9 months of insertion.

Study Design: This is a qualitative study, consisting of semistructured individual interviews with 16 women who considered early elective IUD removal. We identified eligible participants via chart review. We analyzed interviews using a modified grounded theory approach.

Results: While pain and bleeding were prominent reasons for removal, women also discussed many other symptoms and concerns. Most women reported a strong desire to have a successful IUD experience, and all reported waiting for symptoms to resolve prior to their visit. Some women reported that providers supported their choice, while others reported that providers preferred that they continue the IUD despite symptoms and concerns. Some women reported providers' resistance or refusal to remove the IUDs. The women who reported that their providers were neutral about IUD removal more frequently expressed satisfaction with the visit. When the provider resisted removal, women felt frustrated, even as they acknowledged their doctor's good intentions. In several cases, this may have hurt the doctor-patient relationship.

Conclusions: When physicians resist early elective IUD removal, it may impact patient satisfaction and even jeopardize the doctor-patient relationship.

Implications: Though IUDs are highly effective and well-liked contraceptives, some patients choose to discontinue the method. Because provision of patient-centered contraceptive care includes IUD removal when requested, providers must ensure that their counseling is unbiased and that they do not place perceived or real barriers to IUD removal.