IPPF Medical Bulletin
Contents IMAP statement on intrauterine devices ...........................1 Safety and efficacy oflong-term contraceptive methods for women Soledad Díaz, Olav Meirik .....................................................5
Efficacy and duration of use The most effective copper-bearing IUD is the TCu380A, followed by the Multiload Cu 375 and TCu220C. Failure rates are usually less than 1 per 100 women in the first year of use. The Multiload Cu 250 and Nova T200 have failure rates between 1% and 2% inthe first year of use. With the levonorgestrel-releasing IUD failure rates are well below 1% in the first year. With copper-bearing devices the duration of effectiveness depends on the surface area of copper. The TCu380A functions well for at least 12 years (cumulative pregnancy rate 2.2 per 100 women), while over the same length of time the performance of the TCu220C is less good (cumulativepregnancy rate 6–7 ). The Multiload Cu 375 is effective for at least 10 years with a 10-year cumulative pregnancy rate of 5.4. The Nova T200 is recommended for up to 3 years of use, after which failure rates increase substantially. The Nova T380 is effective for 5 years, with a cumulative pregnancy rate of 2.0. The levonorgestrel-releasing IUD lasts for more than 5 years with a cumulative pregnancyrate at 5 years of 0.3–1.1 per 100 women. Advantages Many women choose an IUD as their method of contraception for reasons of efficacy, safety, and the convenience of not requiring action daily or precautions with every act of sexual intercourse. Copper-bearing devices have no systemic side-effects, and in long-term users are less costly than other contraceptive methods. Both types of device can beused by breastfeeding women without affecting lactation or posing a risk to the infant, though in such women a levonorgestrel-releasing IUD should not be inserted until 6 weeks post-partum. Adverse effects Infection For a woman who with proper screening is found to be at low risk of STI and in whom the IUD is inserted with correct technique, the risk of pelvic inflammatory disease (PID) is as lowas 1 in 1000. When it does occur, PID is largely confined to the first 4 weeks after insertion and is presumably due to introduction of microorganisms during the procedure. If PID develops when an IUD is in place, the first priority is antibiotic treatment. There is no need to remove the IUD if the woman wishes to continue with it; but if she does not wish to keep the IUD it should be removedafter the start of antibiotic treatment. She should then be advised on alternative forms of contraception, and comprehensive management for STIs will include counselling about condom use. Condoms are the only contraceptive method that protects against STIs, including HIV. Bleeding Copper-bearing IUDs In the first three to six months after insertion of a copperbearing IUD, women commonly report thatmenstrual bleeding has become heavier or longer. Usually this does no
IMAP statement on intrauterine devices
The statement below was revised by the International Medical Advisory Panel (IMAP) at its meeting in January 2003. Introduction The intrauterine device (IUD) is now used by some 150 million women world-wide, and is the most cost-effective temporary contraceptive method for long-term use.Since the early 1960s, when IUDs were made of inert materials, the devices have undergone many improvements – by inclusion first of copper and subsequently a progestogen-releasing system. A large body of evidence testifies to the high efficacy of these methods, and to their safety in women who are at low risk of sexually transmitted infections (STIs). The IUD can also be used for emergency...