Current assessment of the use of intrauterine devices

Abstract

The need for effective, long-term contraception remains a significant issue. Intrauterine devices (IUDs) have evolved to the point where currently available devices are comparable, in safety and efficacy, to oral contraceptives. Due to concerns regarding previous devices, available IUDs remain largely underused by midwives and all other providers of reproductive health care. Recent medical data refute many of the medical-legal misconceptions. Currently available IUDs are safe and effective and represent a suitable contraceptive alternative for the appropriate patient.

PIP: Modern use of the intrauterine device (IUD) dates back to the early 1900s, when gynecologists in Germany began using contraceptive stem pessaries which extended into the uterus. IUDs then continued to evolve throughout the century. Introduced for use in the 1960s and 1970s, the Dalkon Shield was promoted as suitable for use in nulliparous women. By 1973, however, cases of septic abortion were reported to be associated with its use. The design of the Dalkon Shield was found to facilitate the ascension of bacteria from the vagina into the uterine cavity, leading to the development of pelvic infection. Dalkon Shield sales were discontinued in 1974, but the removal of inserted devices was not called for until the early 1980s. Many women who developed pelvic infections while using a Dalkon Shield joined in a class-action lawsuit against the manufacturer. The resultant negative media attention, as well as increased trepidation over liability by clinicians, contributed significantly to a sharp decrease in the use of all IUDs. The author explains that modern IUDs are now comparable in safety and efficacy to oral contraceptives, and that recent medical data refute many of the medical-legal misconceptions. Available IUDs are still largely underused by midwives and all other providers of reproductive health care due to concerns regarding earlier devices. The mechanism of IUD action; efficacy; pelvic inflammatory disease (PID), infection, and ectopic pregnancy; and product liability and malpractice are discussed.