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Family Plan World. 1993 Jul-Aug;3(4):5, 26.

The IUD: will its future always be crippled by its past?



IUD use among American women has been and will continue to be in a decline as long as the new IUDs are linked with the adverse publicity on the Dalkon Shield, there is a fear of litigation, and there are misconceptions among client and physician about its safety. The evidence from studies published in the last 10 years has confirmed that IUDs are the most effective and safest forms of contraception available to women. But most American women who would be eligible for the IUD are unaware of its safety. Current IUD users generally are satisfied, but many physicians will not prescribe the IUD and medical schools offer little in the way of training in proper insertion techniques. Potential side effects are increased menstrual bleeding, pain, intermenstrual spotting, and lack of protection from sexually transmitted diseases or pelvic inflammatory disease. Potential complications for the new copper releasing IUDs are lower than for the old ones and their use has not been shown to have long lasting systemic effects. Breast feeding mothers may safely use the IUD without effects on quality or quantity of breast milk. The copper releasing IUDs also have the lowest failure rates. The TCu 380A has a US Food and Drug Administration approval rating of 8 years, which makes it the most cost-effective, long-lasting contraceptive option. Expanding IUD use will depend on how well IUD companies are able to increase awareness of the results of recent research and whether IUD insertion will be approved for nurse, nurse practitioners, and physician assistants as IUD service providers. A disincentive for women wanting IUDs is the lengthy information booklet (11 pages for the Paragard T 380A), which must be initialed on every page. Other competitive contraceptives, such as the diaphragm or sponge do not require informed consent. Potential IUD users are now screened carefully for those who might be at risk for pelvic diseases; nonparous women are still discouraged from using IUDs because of the risk of perforation.

[Indexed for MEDLINE]

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