The Intrauterine Device: Still Misunderstood After All These Years

, Division of Maternal Health, Center for Maternal and Child Health, Maryland Department of Health and Mental Hygiene, Baltimore.

South Med J. 2000;93(9) 

In This Article

The Paragard IUD

Throughout the T 380A IUD's 10-year life span, annual pregnancy rates are less than 1 woman per 100.[7] The cumulative 10-year rate is 2.1 per 100 women at 10 years; no pregnancies were reported after year 8.7 This is comparable to the cumulative 10-year pregnancy rate seen overall with surgical sterilization -- 1.9 per 100 women.[8] Some methods of sterilization (spring clip application and bipolar coagulation) had higher 10-year cumulative pregnancy rates than the copper IUD.[8]

Taking into account the initial cost and the cost of treating side effects and unintended pregnancies, a recent comparison of 15 methods of contraception over 5 years showed that the copper IUD was the most cost effective.[9] In fact, the copper IUD was the most cost-effective method after only 2 years' use.

Expected side effects associated with the copper IUD are increased duration and volume of menstrual blood flow and increased dysmenorrhea. Removal rates for bleeding or pain are 11.9% in the first year and approximately 3.5% in the fourth through the tenth years.[7]

The expulsion rate for the T 380A is 5.7% during the first year, with the majority of expulsions occurring within the first month after insertion.[7] Expulsions after the first year decrease to 2.5% for the second year and less than 2% per year thereafter.[7]

Perforation is a rare complication of IUD use, occurring in less than 1 per 1,000 insertions.[7] Uterine perforation occurs at the time of insertion and correlates directly with the skill of the clinician.

Pregnancy with an IUD in situ is associated with three times the rate of spontaneous abortion as that of the general population.[10] If the IUD is removed shortly after conception, the spontaneous abortion rate is reduced to 20% -- only slightly higher than the incidence for pregnant women not using contraception.[10] There is no increased risk of septic abortion if pregnancy occurs with any IUD other than the Dalkon Shield.[11] Also, no evidence indicates any increased risk of teratogenesis to infants born to women with an IUD in situ.[12] Recent findings suggest that the incidence of preterm labor and delivery in a woman with an IUD in situ may be up to four times greater than the general population.[11,12,13] Removal of an IUD is therefore recommended whenever possible during pregnancy.

Because the copper IUD works locally, its use has few contraindications. Women with cardiac disease, epilepsy, migraines, hypertension, or liver disease may have trouble with hormonal methods but can use the IUD without problems. The only absolute contraindications to its use are acute pelvic infections (current or during the past 3 months), pregnancy, unexplained genital bleeding, severely distorted uterine cavity, pelvic cancer awaiting treatment, malignant trophoblast disease, and pelvic tuberculosis.[14]


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