Assessing the Intrauterine Device

Abstract

The data that have accumulated in the 15 years of use of the IUD are examined, the problems involved in attempting to derive meaningful data are discussed and important research directions are highlighted in an attempt to assess the IUD as a contraceptive measure in light of negative reports appearing in the news media. Reliable epidemiologic information about IUD experience before 1970 are available in the reports of the Cooperative Statistical Program. Currently available IUD designs include the Lippes loop, copper-7, double coil, copper T and progesterone T. It has been observed that several factors may be responsible for the variation in performance of IUDs. These include: patient population, physician experience, side effect tolerance, clinic attitude and additional contraceptives (whether a patient is encouraged to use additional contraception with the IUD). The only valid method of comparison of different IUDs is to perform randomized insertion of the devices in the same clinic using the same personnel and the same time period and to analyze the methods by life table analysis. Medical problems in IUD use were discussed including bleeding (either heavy and/or prolonged menses or intermenstrual bleeding), perforation, pregnancy with an IUD in situ, and infection. The contraceptive action of the IUD is associated with the production of a local sterile inflammatory reaction caused by the presence of the foreign body in the uterus. Research should be directed toward improving the design of IUD inserters because placement of the IUD within the uterine cavity is of extreme importance for IUD effectiveness.