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.