From the School of Sociology and Population Sciences, Nanjing University of Posts and Telecommunications, Nanjing, China.
the Department of Family and Community Medicine, University of California, San Francisco, CA.
Menopause. 2022 Sep 1;29(9):1077-1082. doi: 10.1097/GME.0000000000002022. Epub 2022 Aug 2.
More women in China have received intrauterine devices (IUDs) than in the rest of the world combined. Recent reports have recognized a growing problem of delayed removal of these IUDs after menopause, especially in rural China, but few studies have examined women's knowledge and other risk factors for delayed removal.
A total of 1,014 perimenopausal and postmenopausal women aged 45 to 64 years participating in a pilot program providing free IUD removal in rural China completed a questionnaire. We examined their knowledge about when IUDs should be removed and other demographic and reproductive health characteristics and the association of these factors with whether their IUD removal was on time or delayed using bivariate contingency analysis and multivariate logistic regression.
A total of 40.2% of women were having their IUDs removed more than 2 years after menopause, and 67.9% did not know the correct time for IUD removal. Women who were older, less educated, had one child, had their IUD placed in a rural facility, and with no gynecological examination in the past 2 years were less likely to know when an IUD should be removed. In multivariate analysis, knowledge, the facility where the IUD was placed, and a recent gynecological examination were independent predictors of on-time removal. At least 170 women had received a gynecological examination after menopause without the IUD being removed at that time.
Lack of knowledge about timing for IUD removal and structural barriers in health service organization must be addressed to improve care for millions of women with IUDs in rural China.
中国使用宫内节育器（IUD）的妇女人数多于世界其他地区的总和。最近的报告认识到绝经后这些 IUD 延迟取出的问题日益严重，尤其是在中国农村，但很少有研究检查过妇女对延迟取出的认识和其他风险因素。
共有 1014 名年龄在 45 至 64 岁的围绝经期和绝经后妇女参加了中国农村一项提供免费 IUD 取出的试点计划，她们完成了一份问卷。我们检查了她们关于何时应取出 IUD 的知识以及其他人口统计学和生殖健康特征，并用双变量列联分析和多变量逻辑回归检查这些因素与 IUD 取出是否及时或延迟的关联。
共有 40.2%的妇女在绝经后 2 年以上取出 IUD，67.9%的妇女不知道取出 IUD 的正确时间。年龄较大、受教育程度较低、有一个孩子、在农村医疗机构放置 IUD 且过去 2 年没有妇科检查的妇女，不太可能知道何时应取出 IUD。在多变量分析中，知识、放置 IUD 的机构和最近的妇科检查是及时取出的独立预测因素。至少有 170 名妇女在绝经后接受了妇科检查，但当时没有取出 IUD。
必须解决对 IUD 取出时间缺乏了解和卫生服务组织结构障碍的问题，以改善中国农村数百万使用 IUD 的妇女的护理。
