Intrauterine Devices: Separating Fact From Fallacy

, Magee-Womens Hospital, University of Pittsburgh School of Medicine

Disclosures
In This Article

Abstract and Introduction

Abstract

IUDs currently available in the US provide safe and effective contraception. History has falsely led patients and clinicians alike to believe that IUDs are unsafe. For a woman in a long-standing, mutually monogamous relationship, no method of reversible contraception is more effective. The main risk associated with an IUD is infection; this is usually related to insertion, and the risk lasts for approximately 20 days. Currently available IUDs work by various mechanisms to prevent fertilization. The copper-containing IUD is also a highly effective form of emergency contraception. It is important for clinicians to re-educate themselves and their patients about the importance of the IUD as an option for contraception.

Introduction

The history of the intrauterine device (IUD) goes back to the early 1900s, when German physicians wound nickel-bronze wire around a catgut ring. The device was inserted through the cervical os, making it the first true intrauterine contraceptive. Expulsion was a problem until a Japanese physician attached a central piece to the ring, creating the Ota device. Subsequently, the use of IUDs decreased because of a worldwide pandemic of gonorrhea and the prothenatalist policies of Japanese and Nazi regimes.

Interest in IUDs arose again in the late 1950s in response to growing recognition of the need for improved contraception in an increasingly crowded world. The availability of modern plastics allowed Margulies and Lippes to design and evaluate IUDs that could be collapsed and then restored to their original shape after insertion into the uterine cavity. The medical community was also won over by the extensive evaluative efforts of The Population Council, which began to widely promote IUDs in family planning programs in developing countries. Enthusiasm for IUDs was high because they offered contraceptive protection that was at once highly effective, long lasting, inexpensive, independent of coitus, and completely reversible.

This was followed by disillusionment arising from problems with the Dalkon shield. Introduced in 1970, the Dalkon shield was associated with such a high rate of pelvic infection that its production was discontinued in 1975. Unfortunately, American women and their clinicians applied this negative experience to all IUDs, and interest in IUDs waned. Still, IUD development and improvement continued in the US. The addition of copper to the plastic stem of the IUD was found to further reduce pregnancy rates, leading to the availability of copper-containing products like the Copper-7 and TCu 200 (Tatum-T)(both made by G.D. Searle & Co., Chicago, Illinois.) Nonetheless, IUD marketing and distribution within the US dwindled in the face of rising concern over corporate liability and the economic burden of litigation related to the IUD. The number of women using the IUD in the US declined from 2.2 million to 0.7 million between 1981 and 1988.[1]

Worldwide, the development and use of the IUD proceeded. In the US, progesterone-containing IUDs were introduced and studied in the late 1970s.Copper IUDs were improved throughout the 1980s, building on knowledge gained from earlier experiences with successful, and unsuccessful, versions of the IUDs. More copper was added to IUDs in the course of investigations led by The Population Council, resulting in increased effectiveness and life span of the device. Better information about the risk factors for IUD-associated pelvic infection and infertility has promoted more intelligent selection of candidates for IUD use.

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