A
copper IUD (also
intrauterine device,
IUD,
copper-T, or
coil) is a type of
intrauterine deviceA copper IUD is a type of intrauterine device. Most IUDs have a plastic T- or U-shaped frame which is wrapped in copper wire, with the exception of Gynefix, which is a plastic string with several copper beads, affixed to the fundus of the uterus...
. Most IUDs have a plastic T- or U-shaped frame which is wrapped in copper wire, with the exception of Gynefix, which is a plastic string with several copper beads, affixed to the
fundusFundus is an anatomical term referring to the portion of an organ opposite from its opening. Examples include:* Fundus * Fundus of gallbladder* Fundus * Fundus...
of the uterus. The device has to be fitted inside and removed from the uterus by a doctor or qualified
medical practitionerA physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
. It remains in place the entire time pregnancy is not desired.
The IUD is a
long acting reversible contraceptiveLong-acting reversible contraceptive methods are birth control methods that provide effective contraception for an extended period of time without requiring user action.-LARC methods:Available LARC methods include:* Intrauterine device...
, with different IUDs intended to last for different lengths of time, between 3 and 10 years. Trials have demonstrated the copper T 380A to be effective for at least 12 years. The length of time that the device lasts depends mainly on the amount of exposed copper, which is indicated, in square millimeters, by a number in the name of each device (i.e., the Paragard T-380A has 380 square millimeters of exposed copper).
The IUD is the world's most widely used method of reversible birth control, currently used by nearly 160 million women (just over two-thirds of whom are in
ChinaChina , officially the People's Republic of China , is the most populous country in the world, with over 1.3 billion citizens. Located in East Asia, the country covers approximately 9.6 million square kilometres...
where it is the most widely used birth control method, surpassing sterilization).
History
According to popular legend, Arab traders inserted small stones into the uteruses of their camels to prevent pregnancy during long desert treks. The story was originally a
tall taleA tall tale is a story with unbelievable elements, related as if it were true and factual. Some such stories are exaggerations of actual events, for example fish stories such as, "that fish was so big, why I tell ya', it nearly sank the boat when I pulled it in!" Other tall tales are completely...
to entertain delegates at a scientific conference on
family planningFamily planning is the planning of when to have children, and the use of birth control and other techniques to implement such plans. Other techniques commonly used include sexuality education, prevention and management of sexually transmitted infections, pre-conception counseling and...
; although it was later repeated as truth, it has no known historical basis.
Precursors to IUDs were first marketed in 1902. Developed from stem
pessariesA pessary is a small plastic or silicone medical device which is inserted into the vagina or rectum and held in place by the pelvic floor musculature. - Therapeutic pessaries :...
(where the stem held the pessary in place over the cervix), the 'stem' on these devices actually extended into the uterus itself. Because they occupied both the vagina and the uterus, this type of stem pessary was also known as an intrauterine device. Use of intrauterine devices was associated with high rates of infection; for this reason, they were condemned by the medical community.
The first intrauterine device (contained entirely in the uterus) was described in a
GermanGermany , officially the Federal Republic of Germany , is a federal parliamentary republic in Europe. The country consists of 16 states while the capital and largest city is Berlin. Germany covers an area of 357,021 km2 and has a largely temperate seasonal climate...
publication in 1909, although the author appears to have never marketed his product.
In 1929, Dr.
Ernst GräfenbergErnst Gräfenberg was a German-born physician and scientist...
of
GermanyGermany , officially the Federal Republic of Germany , is a federal parliamentary republic in Europe. The country consists of 16 states while the capital and largest city is Berlin. Germany covers an area of 357,021 km2 and has a largely temperate seasonal climate...
published a report on an IUD made of silk suture. He had found a 3% pregnancy rate among 1,100 women using his ring. In 1930, Dr. Gräfenberg reported a lower pregnancy rate of 1.6% among 600 women using an improved ring wrapped in silver wire. Unbeknownst to Dr. Gräfenberg, the silver wire was contaminated with 26% copper.
CopperCopper is a chemical element with the symbol Cu and atomic number 29. It is a ductile metal with very high thermal and electrical conductivity. Pure copper is soft and malleable; an exposed surface has a reddish-orange tarnish...
's role in increasing IUD efficacy would not be recognized until nearly 40 years later.
In 1934, Japanese physician Tenrei Ota developed a variation of the
Gräfenberg ring that contained a supportive structure in the center. The addition of this central disc lowered the IUD's expulsion rate. These devices still had high rates of infection, and their use and development was further stifled by World War II politics: contraception was forbidden in both Nazi Germany and Axis-allied Japan. The Western world did not learn of the work by Gräfenberg and Ota until well after the war ended.
The first plastic IUD, the
Margulies Coil or
Margulies Spiral, was introduced in 1958. This device was somewhat large, causing discomfort to a large proportion of women users, and had a hard plastic tail, causing discomfort to their male partners. The modern colloquialism "coil" is based on the
coilA coil is a series of loops. A coiled coil is a structure in which the coil itself is in turn also looping.-Electromagnetic coils:An electromagnetic coil is formed when a conductor is wound around a core or form to create an inductor or electromagnet...
-shaped design of early IUDs.
The
Lippes Loop, a slightly smaller device with a monofilament tail, was introduced in 1962 and gained in popularity over the Margulies device.
The
stainless steelIn metallurgy, stainless steel, also known as inox steel or inox from French "inoxydable", is defined as a steel alloy with a minimum of 10.5 or 11% chromium content by mass....
single-ring IUD was developed in the 1970s and widely used in China because of low manufacturing costs. The Chinese government banned production of steel IUDs in 1993 due to high failure rates (up to 10% per year).
Dr. Howard Tatum, in the USA, conceived the plastic T-shaped IUD in 1968. Shortly thereafter Dr. Jaime Zipper, in Chile, introduced the idea of adding copper to the devices to improve their contraceptive effectiveness. It was found that copper-containing devices could be made in smaller sizes without compromising effectiveness, resulting in fewer
side effectIn medicine, an adverse effect is a harmful and undesired effect resulting from a medication or other intervention such as surgery.An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect. If it results from an unsuitable or incorrect dosage or...
s such as pain and bleeding. T-shaped devices had lower rates of expulsion due to their greater similarity to the shape of the uterus.
The poorly designed
Dalkon ShieldThe Dalkon Shield was a contraceptive intrauterine device developed by the Dalkon Corporation and marketed by the A.H. Robins Company. The Dalkon Shield was found to cause severe injury to a disproportionately large percentage of its users, which eventually led to numerous lawsuits in which...
plastic IUD (which had a multifilament tail) was manufactured by the A. H. Robins Company and sold by Robins in the United States for three and a half years from January 1971 through June 1974, before sales were suspended by Robins on June 28, 1974 at the request of the FDA because of safety concerns following reports of 110 septic spontaneous abortions in women with the Dalkon Shield in place, seven of whom had died.
Robins stopped international sales of the Dalkon Shield in April 1975.
Second-generation copper-T IUDs were also introduced in the 1970s. These devices had higher surface areas of copper, and for the first time consistently achieved effectiveness rates of greater than 99%. In addition to T-shaped IUDs, there are also U-shaped IUDs (such as the Multiload) and 7-shaped Gravigard Copper 7 (with a mini version for nulliparous women introduced in the 1980s). More recently, a frameless IUD called Gynefix was introduced.
Mechanism of contraception and effectiveness
The mechanism of IUDs is not well understood. It is known however that the presence of a device in the uterus prompts the release of leukocytes and
prostaglandinA prostaglandin is any member of a group of lipid compounds that are derived enzymatically from fatty acids and have important functions in the animal body. Every prostaglandin contains 20 carbon atoms, including a 5-carbon ring....
s by the
endometrium-Function:The endometrium is the innermost glandular layer and functions as a lining for the uterus, preventing adhesions between the opposed walls of the myometrium, thereby maintaining the patency of the uterine cavity. During the menstrual cycle or estrous cycle, the endometrium grows to a...
. These substances are hostile to both sperm and eggs; the presence of copper increases the spermicidal effect. The general medical consensus is that spermicidal and ovicidal mechanisms are the only way in which IUDs work. Some physicians and medical texts have suggested they may have a secondary effect of interfering with the development of pre-implanted embryos; this secondary effect is considered more plausible when the IUD is used as
emergency contraceptionEmergency contraception , or emergency postcoital contraception, refers to birth control measures that, if taken after sexual intercourse, may prevent pregnancy.Forms of EC include:...
.
Second-generation copper-T IUDs have failure rates of less than 1% per year, and cumulative 10-year failure rates of 2-6%. A copper IUD may also be used as emergency contraception. If an IUD is inserted within five days of unprotected intercourse, a woman's chance of pregnancy is reduced to that of ongoing IUD users. A large
World Health OrganizationThe World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
trial reported a cumulative 12-year failure rate of 2.2% for the T 380A (
ParaGardThe ParaGard T-380A is an IUD with copper, manufactured and marketed in the United States by Duramed Pharmaceuticals. It is the only copper-containing intrauterine device approved for use in the U.S....
) (an average failure rate of 0.18% per year over 12 years), equivalent to a cumulative 10-year failure rate of 1.8% following
tubal ligationTubal ligation or tubectomy is a surgical procedure for sterilization in which a woman's fallopian tubes are clamped and blocked, or severed and sealed, either method of which prevents eggs from reaching the uterus for fertilization...
. The frameless GyneFix also has a failure rate of less than 1% per year. Worldwide, older IUD models with lower effectiveness rates are no longer produced.
Insertion
Both insertion and removal is performed by a medical professional, and
informed consentInformed consent is a phrase often used in law to indicate that the consent a person gives meets certain minimum standards. As a literal matter, in the absence of fraud, it is redundant. An informed consent can be said to have been given based upon a clear appreciation and understanding of the...
may be required. Before placement of an IUD, a
medical historyThe medical history or anamnesis of a patient is information gained by a physician by asking specific questions, either of the patient or of other people who know the person and can give suitable information , with the aim of obtaining information useful in formulating a diagnosis and providing...
and
physical examinationPhysical examination or clinical examination is the process by which a doctor investigates the body of a patient for signs of disease. It generally follows the taking of the medical history — an account of the symptoms as experienced by the patient...
by a medical professional is useful to check for any contraindications or concerns.
A copper IUD can be inserted at any phase of the menstrual cycle, but the optimal time is right after the menstrual period, when the cervix is softest and the woman is least likely to be pregnant. Uterine sounding may be used to measure the length and direction of the cervical canal and uterus in order to decrease the risk of
uterine perforationUterine perforation is a potential complication of any intrauterine procedure. It may be associated with injury to surrounding blood vessels or viscera such as the bladder or intestine. If not diagnosed at the time of the procedure it can result in massive hemorrhage or sepsis...
. A
speculumA speculum is a medical tool for investigating body cavities, with a form dependent on the body cavity for which it is designed. In old texts, the speculum may also be referred to as a diopter or dioptra...
is used to hold the vagina open, a
tenaculumA tenaculum is a surgical instrument, usually classified as a type of forceps. It consists of a slender sharp-pointed hook attached to a handle and is used mainly in surgery for seizing and holding parts, such as blood vessels.Uses include:...
is used to steady the cervix and uterus, and a tube is used to place the IUD.
After the insertion is finished, normal activities such as sex, exercise, and swimming can be performed as soon as it feels comfortable. Strenuous physical activity does not affect the position of the IUD.
Contraindications
The
WHOThe World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
Medical Eligibility Criteria for Contraceptive Use and
RCOGThe Royal College of Obstetricians and Gynaecologists is a professional association based in the UK. Its members, including people with and without medical degrees, work in the field of obstetrics and gynaecology, that is, pregnancy, childbirth, and female sexual and reproductive health...
Faculty of Family Planning &
Reproductive HealthWithin the framework of the World Health Organization's definition of health as a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity, reproductive health, or sexual health/hygiene, addresses the reproductive processes, functions and system...
Care (FFPRHC)
UK Medical Eligibility Criteria for Contraceptive Use list the following as conditions where insertion of a copper IUD is not usually recommended (category 3) or conditions where a copper IUD should not be inserted (category 4):
Category 3. Conditions where the theoretical or proven risks usually outweigh the advantages of inserting a copper IUD:
- Postpartum between 48 hours and 4 weeks (increased IUD expulsion rate with delayed postpartum insertion)
- Benign
A benign tumor is a tumor that lacks the ability to metastasize. Common examples of benign tumors include moles and uterine fibroids.The term "benign" implies a mild and nonprogressive disease. Indeed, many kinds of benign tumors are harmless to human health...
gestational trophoblastic diseaseGestational trophoblastic disease is a term used for a group of pregnancy-related tumours. These tumours are rare, and they appear when cells in the womb start to grow out of control. The cells that form gestational trophoblastic tumours are called trophoblasts and come from tissue that grows to...
- Ovarian cancer
Ovarian cancer is a cancerous growth arising from the ovary. Symptoms are frequently very subtle early on and may include: bloating, pelvic pain, difficulty eating and frequent urination, and are easily confused with other illnesses....
- Very high individual likelihood of exposure to gonorrhea
Gonorrhea is a common sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae. The usual symptoms in men are burning with urination and penile discharge. Women, on the other hand, are asymptomatic half the time or have vaginal discharge and pelvic pain...
or chlamydial STIs
- AIDS
Acquired immune deficiency syndrome or acquired immunodeficiency syndrome is a disease of the human immune system caused by the human immunodeficiency virus...
(unless clinically well on anti-retroviral therapyAntiretroviral drugs are medications for the treatment of infection by retroviruses, primarily HIV. When several such drugs, typically three or four, are taken in combination, the approach is known as Highly Active Antiretroviral Therapy, or HAART...
)
Category 4. Conditions which represent an unacceptable health risk if a copper IUD is inserted:
- Pregnancy
Pregnancy refers to the fertilization and development of one or more offspring, known as a fetus or embryo, in a woman's uterus. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets...
- Postpartum puerperal sepsis
- Immediately after a septic abortion
A septic abortion or septic miscarriage is a form of miscarriage that is associated with a serious uterine infection. The infection carries risk of spreading infection to other parts of the body and cause septicaemia, a grave risk to the life of the woman.-Causes:A septic abortion can occur when...
- Before evaluation of unexplained vaginal bleeding
Vaginal bleeding refers to bleeding in females that is either a physiologic response during the non-conceptional menstrual cycle or caused by hormonal or organic problems of the reproductive system. Vaginal bleeding may occur at any age, but always needs investigation when encountered in female...
suspected of being a serious condition
- Malignant
Malignancy is the tendency of a medical condition, especially tumors, to become progressively worse and to potentially result in death. Malignancy in cancers is characterized by anaplasia, invasiveness, and metastasis...
gestational trophoblastic diseaseGestational trophoblastic disease is a term used for a group of pregnancy-related tumours. These tumours are rare, and they appear when cells in the womb start to grow out of control. The cells that form gestational trophoblastic tumours are called trophoblasts and come from tissue that grows to...
- Cervical cancer
Cervical cancer is malignant neoplasm of the cervix uteri or cervical area. One of the most common symptoms is abnormal vaginal bleeding, but in some cases there may be no obvious symptoms until the cancer is in its advanced stages...
(awaiting treatment)
- Endometrial cancer
Endometrial cancer refers to several types of malignancies that arise from the endometrium, or lining, of the uterus. Endometrial cancers are the most common gynecologic cancers in the United States, with over 35,000 women diagnosed each year. The incidence is on a slow rise secondary to the...
- Distortions of the uterine cavity by uterine fibroids
A uterine fibroid is a benign tumor that originates from the smooth muscle layer and the accompanying connective tissue of the uterus.Fibroids are the most common benign tumors in...
or anatomical abnormalities
- Current pelvic inflammatory disease
Pelvic inflammatory disease is a generic term for inflammation of the uterus, fallopian tubes, and/or ovaries as it progresses to scar formation with adhesions to nearby tissues and organs. This may lead to infections. PID is a vague term and can refer to viral, fungal, parasitic, though most...
- Current purulent cervicitis
Cervicitis is inflammation of the uterine cervix. Cervicitis in women has many features in common with urethritis in men and many cases are caused by sexually transmitted infections...
, chlamydial infection, or gonorrheal STIs
- Known pelvic tuberculosis
Tuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...
Some concern has been expressed that women with metal sensitivities to copper or nickel may experience adverse reactions from an IUD. The metal used in IUDs is 99.99% copper, with one study finding a maximum nickel content of 0.001%. Because nickel has a relatively high
sensitizingAn Allergy is a hypersensitivity disorder of the immune system. Allergic reactions occur when a person's immune system reacts to normally harmless substances in the environment. A substance that causes a reaction is called an allergen. These reactions are acquired, predictable, and rapid...
potential, a few researchers suggested even this tiny amount might be problematic. A few
case reportIn medicine, a case report is a detailed report of the symptoms, signs, diagnosis, treatment, and follow-up of an individual patient. Case reports may contain a demographic profile of the patient, but usually describe an unusual or novel occurrence....
s have attributed
eczemaEczema is a form of dermatitis, or inflammation of the epidermis . In England, an estimated 5.7 million or about one in every nine people have been diagnosed with the disease by a clinician at some point in their lives.The term eczema is broadly applied to a range of persistent skin conditions...
tous
dermatitis-Etymology:Dermatitis derives from Greek derma "skin" + -itis "inflammation" and genetic disorder.-Terminology:There are several different types of dermatitis. The different kinds usually have in common an allergic reaction to specific allergens. The term may describe eczema, which is also called...
and
urticariaUrticaria is a kind of skin rash notable for pale red, raised, itchy bumps. Hives is frequently caused by allergic reactions; however, there are many non-allergic causes...
in a handful of users of copper-releasing IUDs to
systemicSystemic refers to something that is spread throughout, system-wide, affecting a group or system such as a body, economy, market or society as a whole. Systemic may also refer to:-In medicine:...
copper or nickel allergic contact dermatitis. However, the daily metal absorption from an IUD is only a fraction of the normal daily absorption from food, and many dermatologists are skeptical that the symptoms described in the case reports were actually caused by metal sensitivity.
While
nulliparousIn biology, parity is a technical term that refers to the number of times a female has given birth to a fetus.It can lead to some ambiguity for events occurring between 20 and 24 weeks, and for multiple pregnancies.-Enumeration:...
women (women who have never given birth) are somewhat more likely to have side effects, this is not a contraindication for IUD use. Overall, IUDs are safe and acceptable also in young nulliparous women. The same is likely the case for virgin women, unless there is a microperforate hymen that obstructs any insertion of the IUD.
Some doctors prefer to insert the IUD during menstruation to verify that the woman is not pregnant at the time of insertion. However, IUDs may safely be inserted at any time during the menstrual cycle as long as it is reasonably certain the woman is not pregnant. Insertion may be more comfortable if done midcycle, when the cervix is naturally dilated.
During insertion
Insertion of the IUD may introduce bacteria into the
uterusThe uterus or womb is a major female hormone-responsive reproductive sex organ of most mammals including humans. One end, the cervix, opens into the vagina, while the other is connected to one or both fallopian tubes, depending on the species...
. The insertion process carries an increased risk of
pelvic inflammatory diseasePelvic inflammatory disease is a generic term for inflammation of the uterus, fallopian tubes, and/or ovaries as it progresses to scar formation with adhesions to nearby tissues and organs. This may lead to infections. PID is a vague term and can refer to viral, fungal, parasitic, though most...
in the first 20 days following insertion, but the risk is still low, and is attributable to preexisting
gonorrheaGonorrhea is a common sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae. The usual symptoms in men are burning with urination and penile discharge. Women, on the other hand, are asymptomatic half the time or have vaginal discharge and pelvic pain...
or chlamydia infection present in the cervix at the time of insertion, and not to the IUD itself. Proper infection prevention procedures have little or no effect on the course of gonorrhea or chlamydia infections, but is important in helping protect both clients and providers from infection in general. Such infection prevention practices include washing hands and then putting on gloves, cleaning the cervix and vagina, making minimal contact with non-sterile surfaces (using a "no touch insertion technique") and, after the procedure, washing hands again and then processing instruments. Antibiotics should be given before insertion to women at high risk for
endocarditisEndocarditis is an inflammation of the inner layer of the heart, the endocardium. It usually involves the heart valves . Other structures that may be involved include the interventricular septum, the chordae tendineae, the mural endocardium, or even on intracardiac devices...
(infection of the valves within the heart), but should not be used routinely.
The
cervixThe cervix is the lower, narrow portion of the uterus where it joins with the top end of the vagina. It is cylindrical or conical in shape and protrudes through the upper anterior vaginal wall...
is dilated in order to sound (measure) the uterus and insert the IUD. Cervix dilation can be uncomfortable and, for some women, painful. Taking
NSAIDSNonsteroidal anti-inflammatory drugs, usually abbreviated to NSAIDs or NAIDs, but also referred to as nonsteroidal anti-inflammatory agents/analgesics or nonsteroidal Anti-inflammatory medicines , are drugs with analgesic and antipyretic effects and which have, in higher doses, anti-inflammatory...
before the procedure can reduce discomfort, as can the use of a
local anaestheticA local anesthetic is a drug that causes reversible local anesthesia, generally for the aim of having local analgesic effect, that is, inducing absence of pain sensation, although other local senses are often affected as well...
.
MisoprostolMisoprostol is a drug that is used for the prevention of non steroidal anti inflammatory drug induced gastric ulcers, for early abortion, to treat missed miscarriage, and to induce labor. The latter use is controversial in the United States. Misoprostol was invented and marketed by G.D...
6 to 12 hrs before insertion can help with cervical dilatation.
Uterine sounding is performed in order to measure the length and direction of the cervical canal and uterus. This reduces the risk of perforating the uterus with the IUD. This may occur when the IUD is inserted too deeply or at the wrong angle. Uterine perforation is generally caused by an inexperienced provider and is very rare.
After insertion
After IUD insertion,
menstrual periodsThe menstrual cycle is the scientific term for the physiological changes that can occur in fertile women for the purpose of sexual reproduction. This article focuses on the human menstrual cycle....
are often heavier, more painful, or both - especially for the first few months after they are inserted. On average, menstrual
blood lossBleeding, technically known as hemorrhaging or haemorrhaging is the loss of blood or blood escape from the circulatory system...
increases by 20–50% after insertion of a copper-T IUD; increased menstrual discomfort is the most common medical reason for IUD removal.
Expulsion is more common in younger women, women who have not had children, and when an IUD is inserted immediately after childbirth or abortion. Women should check the string of the IUD at least once per menstrual cycle to verify that it is still in place.
The string(s) may be felt by some men during
intercourseSexual intercourse, also known as copulation or coitus, commonly refers to the act in which a male's penis enters a female's vagina for the purposes of sexual pleasure or reproduction. The entities may be of opposite sexes, or they may be hermaphroditic, as is the case with snails...
. If this is problematic, the provider may cut the strings even down to the cervix, so they cannot be felt. Shortening the strings does prevent the woman from checking for expulsion, however.
The risk of
ectopic pregnancyAn ectopic pregnancy, or eccysis , is a complication of pregnancy in which the embryo implants outside the uterine cavity. With rare exceptions, ectopic pregnancies are not viable. Furthermore, they are dangerous for the parent, since internal haemorrhage is a life threatening complication...
to a woman using an IUD is lower than the risk of ectopic pregnancy to a woman using no form of birth control. However, of pregnancies that do occur during IUD use, a higher than expected percentage (3–4%) are ectopic.
The pregnancy rate during IUD use is very low (less than 1% per year). If pregnancy does occur, the IUD should be removed. Although IUDs are not teratogenic, presence of the IUD increases the risk of
miscarriageMiscarriage or spontaneous abortion is the spontaneous end of a pregnancy at a stage where the embryo or fetus is incapable of surviving independently, generally defined in humans at prior to 20 weeks of gestation...
, particularly during the second trimester. It also increases the risk of
premature deliveryIn humans preterm birth refers to the birth of a baby of less than 37 weeks gestational age. The cause for preterm birth is in many situations elusive and unknown; many factors appear to be associated with the development of preterm birth, making the reduction of preterm birth a challenging...
. Although the
Dalkon ShieldThe Dalkon Shield was a contraceptive intrauterine device developed by the Dalkon Corporation and marketed by the A.H. Robins Company. The Dalkon Shield was found to cause severe injury to a disproportionately large percentage of its users, which eventually led to numerous lawsuits in which...
IUD was associated with septic abortions (infections associated with miscarriage), other brands of IUD are not. IUDs are also
not associated with
birth defectsA congenital disorder, or congenital disease, is a condition existing at birth and often before birth, or that develops during the first month of life , regardless of causation...
.
Non-hormonal (copper) IUDs are considered safe to use while breastfeeding.
Some
barrier contraceptivesBarrier contraception methods prevent pregnancy by physically preventing sperm from entering the uterus.-History:The earliest recorded barrier methods are those of stem pessaries, found in Egypt. The diaphragm and reusable condoms became common after the invention of rubber vulcanization in the...
protect against
STDsSexually transmitted disease , also known as a sexually transmitted infection or venereal disease , is an illness that has a significant probability of transmission between humans by means of human sexual behavior, including vaginal intercourse, oral sex, and anal sex...
. Hormonal contraceptives reduce the risk of developing
pelvic inflammatory diseasePelvic inflammatory disease is a generic term for inflammation of the uterus, fallopian tubes, and/or ovaries as it progresses to scar formation with adhesions to nearby tissues and organs. This may lead to infections. PID is a vague term and can refer to viral, fungal, parasitic, though most...
(PID), a serious complication of certain STDs. IUDs, by contrast, do
not protect against STDs or PID.
Use as emergency contraception
Intrauterine devices can be used as
emergency contraceptionEmergency contraception , or emergency postcoital contraception, refers to birth control measures that, if taken after sexual intercourse, may prevent pregnancy.Forms of EC include:...
to prevent pregnancy up to 5 days after unprotected
sexual intercourseSexual intercourse, also known as copulation or coitus, commonly refers to the act in which a male's penis enters a female's vagina for the purposes of sexual pleasure or reproduction. The entities may be of opposite sexes, or they may be hermaphroditic, as is the case with snails...
, or sexual intercourse during which the primary contraception is believed to have failed (e.g. a
condomA condom is a barrier device most commonly used during sexual intercourse to reduce the probability of pregnancy and spreading sexually transmitted diseases . It is put on a man's erect penis and physically blocks ejaculated semen from entering the body of a sexual partner...
was used, but it broke). Insertion of a copper-T IUD as emergency contraception is more than 99% effective, making it more effective than emergency contraceptive pills (ECP or 'morning-after pill').
Prevalence
The IUD is the world's most widely used method of reversible birth control,
currently used by nearly 160 million women (just over two-thirds of whom are in China where it is the most widely used birth control method, surpassing sterilization). Usage in many countries has been measured by surveys of married women of reproductive age. In this population in the 1990s, IUD use ranged from 1.5% in North America, to 18% in Scandinavia, 33% in Russia and China, and 40% in Kazakhstan. Use in China increased to 45% of married women by 2002.
Among women who recently had sex and are not trying to become pregnant, 1.9% use IUDs in the United States, 6% in the United Kingdom and 20% in France.
In the U.S., the
ParaGardThe ParaGard T-380A is an IUD with copper, manufactured and marketed in the United States by Duramed Pharmaceuticals. It is the only copper-containing intrauterine device approved for use in the U.S....
T 380A was approved by the
FDAThe Food and Drug Administration is an agency of the United States Department of Health and Human Services, one of the United States federal executive departments...
in 1984 and became available for use in 1988. and was used by 1.3% of women of reproductive age in a 2002 U.S. survey.
Types of IUDs available
Many different types of copper IUDs are currently manufactured worldwide, but availability varies widely by country. For example, in the United States, only one type of copper IUD is approved for use, while in the United Kingdom, over ten varieties are available. One company, Mona Lisa N.V. offers generic versions of many existing IUDs.
| IUD | Type | Copper (mg2) | Life (years) | Manufacturer | Distinguishing characteristics |
| Multiload Cu375 |
U-shaped |
375 |
5 |
Multilan |
|
| Multiload Cu250 |
U-shaped |
250 |
3 |
Multilan |
|
| Multi-Safe 375 |
U-shaped |
375 |
5 |
Williams Medical Supplies |
|
| Multi-Safe 375 Short Loop |
U-shaped |
375 |
5 |
Williams Medical Supplies |
|
| Load 375 |
U-shaped |
375 |
5 |
7-MED Industrie |
|
| Nova-T 380 |
T-shaped (plain) |
380 |
5 |
Bayer |
|
| Neo-Safe T 380 |
T-shaped (plain) |
380 |
5 |
Durbin |
|
| UT 380 |
T-shaped (plain) |
380 |
5 |
7-MED Industrie |
|
| UT 380 Short |
T-shaped (plain) |
380 |
5 |
7-MED Industrie |
|
| Flexi-T 300 |
T-shaped (plain) |
300 |
5 |
Prosan |
|
| Flexi-T + 300 |
T-shaped (plain) |
300 |
5 |
Prosan |
Wider arms than Flexi-T 300 |
| T-safe CU 380A |
T-shaped (banded) |
380 |
8 |
Durbin |
|
| Flexi-T + 380 |
T-shaped (banded) |
380 |
5 |
Prosan |
|
| TT 380 Slimline |
T-shaped (banded) |
380 |
10 |
7-MED Industrie |
|
ParagardThe ParaGard T-380A is an IUD with copper, manufactured and marketed in the United States by Duramed Pharmaceuticals. It is the only copper-containing intrauterine device approved for use in the U.S....
|
T-shaped (banded) |
380 |
10 |
Duramed |
|
| Gynefix 330 (standard) |
Frameless |
330 |
5 |
Contrel |
Only frameless IUD brand available |
| Gynefix 200 (mini) |
Frameless |
200 |
3 |
Contrel |
Only frameless IUD brand available |
| IUD | Type | Copper (mg2) | Life (years) | Manufacturer | Distinguishing characteristics |
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