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IPPF Med Bull. 1987 Dec;21(6):3-5.

Statement on intrauterine devices (IUDs).



Topics covered in this statement on IUDs include: mechanism of action; contraindications; efficacy; duration of use; counseling; IUD selection; insertion; the complications of perforation, bleeding and pain, infection, pregnancy, ectopic pregnancies, and expulsion; removal; and follow-up care. The newer copper- and hormone-releasing IUDs have high continuation rates, and the pregnancy rates are low. The removal in February 1986 of the Lippes Loop, the Copper 7, and the Copper T200 from the US market was for commercial reasons and not because of concerns about safety and efficacy. The Food and Drug Administration (FDA) approves these IUDs, and it is likely that the already FDA-approved Copper T380A will be available in the US during 1988. In its December 1986 meeting, the World Health Organization (WHO) scientific group on the mechanism of action, safety, and efficacy of IUDs concluded that all IUDs stimulate a foreign body reaction in the endometrium which is potentiated by the action of copper, and progestagen-releasing IUDs produce endometrial suppression much as that seen when the drug is administered by other routes. Further, the scientific group indicated that it is unlikely that 1 single mechanism of action accounts for the anti-fertility effect of IUDs. Several absolute contraindications to IUDs are recognized, including: acute or chronic pelvic inflammatory disease (PID); known or suspected pregnancy; abnormal uterine bleeding; confirmed or suspected malignancy of the genital tract; and congenital uterine abnormalities or fibroids distorting the cavity in a manner incompatible with proper IUD placement. The newer copper devices (TCu220C, TCu380Ag, TCu380A, and Multiload 375) have the lowest failure rates. Counseling of the IUD user should include telling her about all alternative family planning methods and advising her of the type of IUD to be inserted and the proper time for replacement if it is a medicated device. The available evidence from many countries suggests that properly trained nonphysicians can insert IUDs as well as doctors. The IUD may be inserted at any time convenient to the user if it can reasonably be determined that she is not pregnant. The medical indications for removal are pregnancy, acute inflammatory disease, endometrial or cervical malignancy, perforation and partial expulsion of the IUD, and abnormal or excessive bleeding. Whenever possible, it is useful to examine IUD users 3 months after IUD insertion, and annual checks are useful to ensure the IUD is in place.

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