Modern intra-uterine devices

Abstract

Modern intrauterine devices (IUDs) provide effective, safe and long-term contraception and could be recommended to most women. The mechanism of action of an IUD is still not fully understood, but most recent research suggests that copper-IUDs as well as hormone-releasing intrauterine systems (IUSs) prevent conception. In women in mutually monogamous relationships the risk of PID is low and related to the insertion procedure. IUD/IUS use should be discouraged if there is a suspicion of increased risk of sexually transmitted disease. The risk of ectopic pregnancy is extremely low if modern, highly effective IUDs/IUSs are used. Copper-IUDs increase menstrual blood loss by around 50%, whereas hormone-releasing IUSs substantially reduce menstrual blood loss. Careful patient selection and counselling are the most important tools in order to provide acceptable and safe IUD use.

PIP: IUDs have the advantages of being highly effective, safe, long-acting, easy to administer, reversible, and inexpensive. At present, copper IUDs and levonorgestrel-releasing intrauterine systems are the most commonly used and studied. A review of recent clinical and epidemiologic research suggests the following recommendations: 1) the IUD may not be the method of choice for young nulliparous women; 2) the copper IUD is not the first choice for women suffering from heavy menstrual flow given its tendency to increase blood loss by 50%, whereas the levonorgestrel-releasing device may be ideal since it has been associated with dramatic reductions in bleeding; 3) although recent studies have failed to document an increased risk of ectopic pregnancy in IUD users, women with such a history should be given a levonorgestrel IUD or a device with a copper surface that exceeds 300 sq. mm; 4) the levonorgestrel-releasing IUD can be recommended to breast feeding women given the minimal transfer to breast milk; 5) IUD insertion should be preceded by history taking, counseling, and pelvic examination; 6) postpartum insertion of levonorgestrel-containing IUDs should be delayed for six weeks; and 7) a follow-up visit should be scheduled three to six weeks after insertion since this is the risk period for post-insertion infection.