Priority 21 from the Contraception PSP

UNCERTAINTY: Are intrauterine contraceptives (IUC) affected if not correctly positioned (eg if low lying, embedded in or dislodged from the uterus)?  (JLA PSP Priority 21)
Overall ranking 21
JLA question ID 0049/21
Explanatory note There were 176 thousand prescriptions for IUCs in England in 2013-4. These maybe fitted by GPs or community SRH services.  Devices last between 3 to 10yrs.  FSRH Guideline (Oct 2015, p25)  Non-fundally placed IUC ; “There is currently insufficient evidence to confirm whether efficacy is reduced or maintained when intrauterine methods are non-fundally placed” The guideline goes onto suggest that because effectiveness is not guaranteed usually they are removed and replaced if more than 2cm from the fundus. The frequency of IUC expulsion is about 1 in 20, but the rate of malposition is not commonly sited. The effectiveness and cost associated with this are not known. 
Evidence

None available
Health Research Classification System category Reproductive Health and Childbirth
Extra information provided by this PSP
Original uncertainty examples

“how important is it for a coil to be correctly sited to be effective, do low lying coils still work?” (both)
Submitted by Healthcare Professionals x 1~Patients x 0~Both x 3
PSP information
PSP unique ID 0049
PSP name Contraception
Total number of uncertainties identified by this PSP. 57  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 21 April 2017