The IUD After 20 Years: A Review of Worldwide Experience

Abstract

Unrealistic expectations that the IUD would be a contraceptive panacea have not been met in spite of the emergence in the 1970s of a 2nd generation of safer more effective IUDs containing slowly released bioactive copper or progesterone. This article reviews recent IUD research to present findings that will assist family planning practitioners and their clients in making informed decisions about the use of this method. The theoretical effectiveness of the IUD ranges from 97% to 99%; in developed countries IUDs are the 2nd most effective method of reversible contraception in use after oral contraceptives. However in developing countries the use effectiveness of IUDs frequently exceeds that of oral contraceptives. Researchers probably agree that IUD development must be directed toward ways to reduce side effects and complications such as 1) bleeding and heavy menstrual blood loss; 2) pain during insertion for a few days thereafter and during menstruation; 3) expulsion 4) uterine perforation; 5) pelvic inflammatory disease (PID); and 6) ectopic pregnancy. Women who want to use an IUD should receive careful screening services--including counseling a medical history and a physical examination--to enhance the advantages and minimize the disadvantages associated with this method. Clinical evidence has consistently shown that nulliparous women particularly those who have just begun to menstruate encounter more problems with IUD use than do older women. The insertion procedure can affect all major events that determine IUD effectiveness and continued use--pregnancy perforation expulsion pain bleeding and infection. Despite the trouble the Dalkon Shield has created for women using it overall of all the available methods of contraception IUDs are among the most effective with an average pregnancy rate after 1 year of 3-5 per 100 typical users.