Intrauterine contraceptive devices: Present status and future prospects

Abstract

Intrauterine devices are playing an increasingly important role in modern contraceptive practice. Although the method has been known since the turn of the century, its use remained limited until the past decade because of a general reluctance to insert any foreign material into the uterine cavity. Experience with the IUD technique in numerous clinical studies has shown that most such prejudice against the method has been unwarranted. Large-scale use of intrauterine devices has shown that many complications attributed to intrauterine contraceptives are in fact due to technical lapses during insertion, or are merely coincidental gynecologic complaints.During the past decade, over 12,000,000 women have been fitted with intrauterine devices around the world—over 3,000,000 in the United States alone. Fears that the use of IUD's carries a significant hazard of inducing pelvic sepsis or neoplasia have been dispelled by extensive clinical studies. At the same time, the incidence of side effects associated with intrauterine devices has been greatly reduced by the development of designs compatible with uterine anatomy and physiology. The unique advantages of the method are making it increasingly important in the clinical practice of contraception.Despite the many advantages of modern IUD's, however, the method cannot be considered a universal panacea. Every physician is not skilled in the use of the devices, nor is every woman a suitable candidate for the method. Observance of contraindications, careful timing of insertions and meticulous insertion technique are important factors in obtaining first class results with this, as with other birth control methods.During the early 1960's, linear coils and loops were promoted for population control, primarily because they were cheap and required little motivation to provide moderately effective contraception. In clinical practice, the poor retention and high complication rates of the older devices relegated the IUD to a secondary position in the contraceptive armamentarium. Intrauterine contraception is now achieving increasing popularity for clinical applications on the basis of the excellence and unique advantages of the method. Second generation devices have imporved retention, diminished IUD side effects and enhanced patient satisfaction. Clarification of the mechanism of action of IUD's has made possible devices approaching the ideal of virtually 100 per cent efficacy. The lack of systemic complication associated with the IUD method, combined with the excellent performance of improved devices, has today advanced intrauterine contraception to the front rank of medical methods of conception control.