Abstract

PIP: The IUD has evolved from ring designs through plastic radio-opaque spirals to devices containing hormones or bio-active copper. 70% of IUDs are now used in China, where the preferred from is the stainless steel ring; the Lippes loop is preferred in other developing countries. The contraceptive mechanism of the IUD may consist of a combination of effects such as irritation of the uterine environment, and the indirect effect of the copper on sperm motility. Effectiveness rates of different IUDs vary, but generally fall between 1 and 3 pregnancies/100 women/year. Important IUD side effects include menstruation disorders and heavy bleeding, pain, expulsion of the IUD, perforation of the uterine wall, increased risk of pelvic inflammatory disease, and increased risk of ectopic pregnancy. The IUD is generally not belived to have extreme effects on the post-removal return to fertility. Given these complications, it seems clear that IUD users should be carefully screened and counselled, and followed closely post-insertion in case of side effects. Generally, risks are higher for younger women. Different risk factors have been identified as IUD contraindications, e.g nulliparity, multiple sexual partners. Protocols for insertion and extraction include recommendations that IUDs be placed at the rear of the uterus, or that the type be selected based on uterine measurements. Discussion of the safety of the method has been affected by serious side effects attributed to the Dalkon shield, an IUD introduced in the 1970s.