An intrauterine device (IUD) is a highly effective long-acting and reversible contraceptive method widely available around the world and safe for nearly all women. However, very few women in Southwestern Ethiopia use.

To identify factors influencing an intention to use the intrauterine device among family planning users in Southwestern, Ethiopia.

A facility-based cross-sectional study was conducted among 784 modern family planning users from 15th October to 15th November 2020. An interviewer-administered questionnaire was used. Estimates were generated using logistic regression model.

Thirty percent intended to use IUD. The most commonly cited reasons for their lack of an intention to use IUD were fear of side effects, lack of knowledge, and husband disapproval. Being able to read and write (AOR = 3.33 [95% C.I. 1.48, 7.49]) compared to those unable to read and write; Being rich (AOR = 1.69 [95% C.I. 1.02, 2.82]) compared to the poor; being knowledgeable about IUD (AOR = 2.74 [95% C.I. [1.67, 4.51]); having higher reproductive health autonomy (AOR = 1.53 [95% C.I. [1.09, 2.16]) were found to be significant factors influencing women’s intention to use an IUD.

Nearly one-third of women who attend health facilities are currently using contraception reported an intention to use an IUD in the future. Public health interventions should focus on the cited reasons reaching all the community in need, and give priority for women who unable read and write, and lowest wealth status. Further interventional studies were recommended to determine effective interventions to increase women’s intention to use intrauterine device.

Stress, a major risk factor for mental health problems, is influenced by hormonal fluctuations from the menstrual cycle and hormonal oral contraceptives (OC). Despite widespread use, the impact of hormonal intrauterine devices (IUDs) on stress is limited to one study.

This study examines psychoendocrine stress responses in women using IUDs, OCs and women with a natural, regular menstrual cycle (NC) to better understand how endogenous and exogenous hormones influence stress.

Using a repeated-measures design, we investigated stress responses in IUD and OC users and NC women. The Maastricht Acute Stress Task and its control task were applied twice within 4 months to assess subjective, endocrine and physiological stress correlates. Detailed endogenous and exogenous hormonal profiles were obtained, and women completed a 7-day diary (via ecological momentary assessment) after each appointment.

Based on subjective, physiological and cortisol responses, stress induction was successful in all groups. IUD users reported higher subjective stress, negative affect and anxiety and lower positive affect compared to NC women. OC users exhibited a blunted cortisol response and higher heart rate but reported less acute stress and negative emotions than the other groups in the 7-day diary. Oestradiol and progesterone were suppressed in OC and IUD users compared with NC women. Progesterone, testosterone and oestradiol were differently associated with skin conductance, socio-emotional stress and negative affect.

IUD and OC use distinctly affect stress response, possibly because of their diverging metabolic pathways and hormone levels. IUD users showed higher emotional reactivity to stress in both lab and daily life, while OCs influenced physiological correlates. These findings highlight that exogenous hormone administration, previously thought to have limited systemic effects, affects women’s psychological well-being, underscoring the need for further research into stress-related disorders among women using hormonal contraceptives.