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Dialogues Contracept. 1997 Spring;5(2):1-4.

The IUD: dispelling the myths and assessing the potential.

Abstract

PIP:

While the IUD is the most widely used method of reversible contraception throughout the rest of the world, it is used by only 1% of women in the US. Misperceptions that inhibit use of the IUD in the US include 1) the belief that the device works as an abortifacient when, in fact, the mechanism of action of copper releasing IUDs is contraceptive; 2) the belief that all IUDs increase risk of pelvic infection when, in fact, the Dalkon shield is the only IUD associated with increased risk because its multifilament tail allowed bacteria to ascend into the uterine cavity; 3) the association of IUD usage with increased risk of ectopic pregnancy despite the evidence that copper-bearing IUDs actually reduce risk of ectopic pregnancy; and 4) fears that IUD prescribers increase their legal liability although these fears can be allayed by reviewing product information with users, obtaining their informed consent to IUD use, and documenting the provision of detailed postinsertion instructions. Both the copper-releasing and the progesterone-containing IUDs provide effective contraception associated with very low pregnancy rates. Complications of use include expulsions, which occur most frequently in the first 3 months of use and are associated with young age of the women, immediate postpartum insertion, nulliparity, and the skill of the clinician. Uterine perforation upon insertion is extremely rare, and risk depends upon clinician skill. Risk of spontaneous abortion increases if IUDs are left in place during pregnancy. The main reason for discontinuation are increased menstrual bleeding and pain in users, although the progesterone IUD is associated with reduced blood loss. Discontinuation is accompanied by a rapid return to fertility. After screening IUD candidates for risk factors, insertion can occur at any time as long as pregnancy is ruled out (with postpartum insertion recommended after 4 weeks). Users should receive detailed instructions about how to check for expulsion. IUDs provide a good longterm alternative to sterilization.

PMID:
12292543
[Indexed for MEDLINE]
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