Good reasons to reconsider the copper intrauterine device for contraception

Abstract

Modern Copper Intrauterine Devices [Cu IUDs] are extremely safe highly effective long acting yet rapidly reversible contraceptives. They are also very cost effective and suitable for use by a wide range of women including nulliparous as well as HIV infected women. Despite a large body of scientific evidence attesting to its safety and efficacy the IUD remains underutilized except in a few countries such as China where it provides 43% of contraceptive use. Use in other countries varies from a low 1% in USA 5% in UK to around 20% in France and Germany. The DHS (1998) reported that Cu IUDs accounted for less than 3% of total contraceptive use in South Africa. Much of the resistance to use can be traced back in history. Various IUDs were developed in the early 1900s but only achieved wide acceptance in the 1960s in the form of the Lippes Loop. In the 70s reports of numerous pregnancies many of which resulted in septic spontaneous miscarriages with several maternal deaths were associated with the use of the Dalkon Shield a device specifically marketed for nullipara. Clearly this device was of poor design being far less effective than other IUDs of the time. More important was the unique structure of the multifilament thread passing through the cervix all other IUDs had monofilament threads. This braided thread acted like a wick actively drawing infection up from the lower genital tract. The Dalkon Shield was taken off the market and the manufacturer forced out of business by massive litigation. Sadly but perhaps not surprisingly both the public and health professionals alike regarded all IUDs in the same light despite clear evidence to the contrary. This was the start of the IUDs undeserved reputation for causing pelvic inflammatory disease [PID] and fears about subsequent infertility. (authors)