Viveca Odlind


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    Viveca Odlind MD, Department of Woman and Child Health, Uppsala University, Uppsala,
    and Medical Products Agency, Uppsala, Sweden,

    Reduction of unintended pregnancy and the subsequent need for induced abortion is a
    great challenge to everyone working with contraceptive method development or family
    planning services. Today, a number of effective and safe contraceptive methods are
    available, but consistent and correct use remains a problem and discontinuation rates are
    often high, particularly with barriers and oral pills. Intrauterine devices (IUD) are among
    methods that can provide a high degree of compliance and continuation.
    Modern copper IUDs are highly effective, safe, long–acting, easy to insert, reversible, do
    not interfere with sexual life and are inexpensive and could therefore be expected to be
    highly acceptable to many women. However, use of the IUD varies considerably between
    countries. Whereas IUDs are used by 30-40% of fertile women in China, in the USA, only
    1–2% of women use an IUD. In the Nordic countries it has been estimated that around
    20% of fertile women use IUDs.
    Important issues surrounding IUD use include the risk of PID. Safety concerns and
    litigations regarding the Dalkon Shield IUD and PID, originating in the 1970s, continue to
    taint the reputation of all IUDs, even now, 30 years later. Recent reviews of studies on the
    risk of PID have provided reassuring data about the safety of IUDs in women at low risk for
    STI, suggesting that development of PID is most strongly related to the insertion process
    and to the background risk of STI but not to continued IUD use. According to WHO
    medical eligibility criteria for contraceptive use, IUDs could generally be used also by
    nulliparous women in monogamous relationships.
    The mechanism of action of copper IUDs has been extensively studied and most evidence
    suggests that the main contraceptive effect is exerted through prevention of fertilisation.
    IUD use should, therefore, not be a concern to those who would object to a method which
    only prevented implantation of a fertilized ovum. 

    The levonorgestrel-releasing IUD (LNG-IUD), through its efficacy and non-contraceptive
    benefits on menstrual blood loss, is particularly suitable to women in their later
    reproductive years. The low dose of levonorgestrel results in little interference with the
    ovarian cycle and few systemic effects. Studies of users of the LNG-IUD have not
    suggested an increased risk of breast cancer.
    Whilst intrauterine contraception is one of the most important long–term family planning
    methods, there are common perceptions which can limit method acceptability. Therefore, it
    is important that careful counselling, medical follow–up and removal facilities always
    accompany promotion and use of intrauterine contraceptive methods.