Intrauterine devices are safe, effective choices

January 25, 2000 —

The intrauterine device (IUD) is the second most popular form of contraception worldwide, after female sterilization, with approximately 128 million couples depending on this safe and highly effective family planning method.

Nevertheless, IUDs are rarely used in some places. While IUDs are frequent choices in several Asian, Latin American and Arabic countries, they are ignored in many places due largely to a lack of accurate information about the method and unfounded fears about safety. A lack of adequate supplies or training for physicians and nurses who insert the device is also a problem, experts say in the current issue of Network, the quarterly health bulletin of Family Health International.

"The IUD is quite an effective method and has a lower rate of complications than hormonal methods," such as the pill (oral contraceptives), Dr. Carlos Huezo, medical director of the London-based International Planned Parenthood Federation, said in the bulletin. "Therefore, it is regrettable that its use is low in many countries."

This reversible form of contraception requires little effort on the couple's part after it is inserted. The Copper T 380 IUD, one of the most popular IUDs in use, is approved in the United States for 10 years of prevention against unwanted pregnancy, and scientific studies indicate it actually provides at least 12 years of safe and effective contraception. Because it can provide years of protection, the IUD is a good alternative for couples considering sterilization.

For some women, fear of side effects may discourage them from considering an IUD. While IUD users generally report fewer side effects than users of hormonal methods, such as the pill, unexpected side effects have prompted some women to have their IUDs removed. Giving women accurate information about what to expect can help overcome these problems.

Intermenstrual bleeding and cramping are the most common complaints during the first months of IUD use. These side effects are normal and usually diminish over time, experts say. It is not medically necessary to remove the IUD unless the woman also complains of fever, abdominal tenderness or unusual discharge, which could be signs of a more serious condition, such as pelvic inflammatory disease.

In addition to IUDs that use copper, a new device developed in Europe releases small amounts of a hormone called levonorgestrel. This system is not only a highly effective contraceptive, but reduces side effects and has other benefits.

Like the Copper T IUD, the levonorgestrel-releasing system is a T-shaped device that is placed in the uterus. Studies show that women who use the hormone-releasing device experience a substantial decrease in menstrual blood loss and pain. The method also protects against certain noncancerous growths of uterine muscle, which are common but can be painful.

This hormonal device has recently been approved for use in China and Brazil, and is currently used by 1 million women in more than a dozen countries, according to the manufacturer, Schering AG of Germany.

It is available in most European countries including Russia, and in Singapore, New Zealand and several French territories, such as Martinique, Guadeloupe, New Caledonia and Guyana. It is marketed under the brand name Mirena, except in Nordic countries, where the brand name is Levonova.

However, the hormonal system is relatively expensive. Some observers believe its use in developing countries will be limited, even if foreign assistance programs can supply them, since they would still be relatively expensive compared with other contraceptive options.