Long term use of inert intrauterine contraceptive devices in 94 women in Israel

Abstract

A 22 year retrospective survey was undertaken in an Israeli family practice to determine how long inert (plastic only, unmedicated) intrauterine contraceptive devices could be safely left in place. Ninety four women were identified who had used 100 inert intrauterine contraceptive devices continuously for between five and 19 years. Fifty nine women complained of pain, increased uterine bleeding or increased vaginal discharge, but these were the reasons for removal of the device in only 32 women. There was only one case of pelvic inflammatory disease but this was treated without removal of the intrauterine contraceptive device. Of 14 women who requested to have their device removed after between five and nine years without having had any side effects, 11 women conceived within nine months. The results of the study indicate that inert intrauterine contraceptive devices can be safely left in place until the menopause. As it will take many years before the new type of copper devices can be shown to be as safe for long term use, it seems an appropriate time to reintroduce inert intrauterine contraceptive devices for women.

PIP: A retrospective study of 94 Israeli women who had worn an inert IUD for 5-19 years was made from records in a family practice including 1 Arab village, 2 Jewish coops, and 3 Jewish kibutzim. The IUDs, 74 Lippes Loops and 26 Saf-T-Coils, were inserted at a mean age of 34 years and at mean parities of 3-6. Removals for an IUD-related event, such as bleeding, pain, vaginal discharge, broken IUD or positive cervical smear, were very common in the first 60 months, less so between 60 and 108 months, and even less common up to 168 months. After 168 months only 1 was removed for a medical event at 226 months. Of the 94 first IUDs, 27 were in place between 5 and 19 years. 20 were removed for bleeding or pain between 5 and 9 years, and only 4 between 10 and 19 years. 50 women complained of side effects, but only 32 requested removal. There was 1 spontaneous expulsion at 8 years, 2 intrauterine pregnancies at 60 and 82 months, and 1 case of pelvic inflammatory disease treated without removal and 3 broken IUDS. 2 IUDS were difficult to remove, one requiring curettage. 11 of the 14 women who requested removal were known to have conceived within 9 months. These data, and those cited in the discussion, suggest that the long-term safety of inert IUDs should be re-examined.