of Intrauterine Contraception
History of Intrauterine Contraception
Intrauterine contraception is the most cost-effective reversible method of contraception today.
history of intrauterine contraception is remarkably short. Many IUD designs and shapes are a direct
result of clinicians efforts to
improve the performance of IUDs and reduce the overall level of their side
effects. However only a few of these have ever been commercialised.
illustration shows a number of intrauterine devices dating from the
beginning of the development of intrauterine contraception and including
currently available IUDs.
two most successful copper IUDs currently on the market are the TCu380A IUD
(Gravigard®) and Multiload® (ML) Cu375 IUD.
Dr Tatum, USA, conceived the plastic T-IUD and Dr Zipper, Chile, invented the use of copper to optimise the contraceptive effectiveness.
The Multiload® (ML) IUD, invented by the Dutch gynecologist Dr Willem van Os in 1974, is still used by many women.
— the difference between “typical” and “perfect” use
contraception is the most cost-effective reversible method of contraception
today. Modern high-load copper IUDs are very effective (i.e., efficacy is
now close to 100%, see table below) when compared with other birth control
Table. Percentage of women experiencing an unintended pregnancy during the first
year of typical use* and the first year of perfect use** of contraception and
the percentage continuing use at the end of the first year (US).
*Failure rates during typical use show how effective the different methods are during actual use (including inconsistent or incorrect use)
**Failure rates during perfect use show how effective methods can be, where perfect use is defined as following the directions of use
of women experiencing an unintended pregnancy within the first year of use
|% of women continuing use at one year|
|Method||Typical use||Perfect use|
- Progestin only
|- Copper T380A||0.8||
|- LNg 20**||0.1||0.1||81|
*Failure rates with the ‘frameless’ GyneFix IUD (not included in the table) are lower than with the TCu380A IUD. The ectopic pregnancy rates are much lower
**Include the Mirena® and Femilis™ intrauterine systems. The latter is not yet available
Reducing health risks with intrauterine contraceptives
health risks related to oral contraceptives raises the question whether locally
applied (intrauterine) contraceptives can offer a valuable alternative with
respect to efficiency and safety. Arguments against the use of IUDs (problems and complications with IUD
insertion, the risk of pelvic inflammatory disease, ectopic pregnancy and
infertility as well as side effects such as menorrhagia, pelvic cramps and IUD
expulsion) generally appear to be based on a lack of awareness with respect to
recent developments and other misunderstandings derived from bad experiences
during the 1980s and earlier.
Dr. Malcolm Potts (quoted by H. Van Kets, Prof. Em. University Ghent, See ref. below) once developed a very original approach to the problem of health safety considering varous events in women’s life. He calculated how long a woman would live if she had to die from only one isolated cause. The risks of being hit by lightning or a falling airplane are so small that she could live several million years. Using oral contraceptives as sole risk gives her 63,000 years to live but, using an IUD, she would reach the blessed age of 200,000 years.
Risks associated with oral contraceptives
According to Folia Pharmacotherapeutica 2002;29:100-104 (an information brochure published by the Belgian Centre for Pharmacotherapeutic Information officially recognized by the FOD (Division of the Ministry of Health), the following conclusions as to the safety of oral contraceptives were formulated based on studies conducted in 2001 and 2002 (Click here for references):
Breastcancer : In a recently conducted observational study in current or past users of oral contraceptives between 35 and 64 years of age, no increased risk was found when compared with non-users of oral contraceptives. These results are reassuring. However, the results have to be interpreted with respect to a meta-analysis of 54 observational studies published in 1996 which found a slight increased risk of breast cancer in oral contraceptive users, especially in those less than 35 years of age.
Cervical cancer : There is increasing clinical evidence that women with a positive human papillomavirus (HPV) test have a higher risk for cervical cancer.
Myocardial infarction : There is increasing clinical evidence that the risk of myocardial infarction is increased in women using oral contraceptives, especially in smokers.
Venous thromboembolism : A meta-analysis shows evidence of the slightly increased risk of deep venous thrombosis in women using third-generation oral contraceptive in comparison to second-generation contraceptives.
Use and underuse of intrauterine devices
a worldwide scale there are nearly 160 million IUD users, most of them (over 100
million) in China. The popularity of intrauterine devices stems for their
effectiveness, combined with their long duration of action. Because of
their long lifespan, IUDs require fewer visits to doctors, which means high
cost-effectiveness. IUDs are implanted and, therefore, cannot be
“forgotten”, an asset much appreciated by many women.
IUD use in developed countries, however, varies from as low as 1% in the Netherlands and the USA to about 30% in Scandinavia.
The limited IUD use, particularly in developed countries, can be ascribed to various causes:
Pharmaceutical industry : The pill market is of great economic importance. This is the single drug that is taken by the greatest number of healthy women in the world.
Medical profession : prescribing oral contraceptives is less time-and energy consuming than insertion an IUD. Moreover not all practitioners have acquired the skills to perform a correct insertion which guarantees the best possible results.
Women themselves are often very poorly informed, and fear that inserting an IUD in their uterus has to be painful and may bring an unknown infection and even cancer.
The media have never been kind to IUDs and have often neglected their many advantages, but are still repeating the old stories of the ill-fated Dalkon Shield (which has been refuted in post-marketing studies conducted in the UK, See M. Cox J Fam Plann Reprod Health Care 2003;29:8).
conclude that it is due time for the medical profession to realize that
contraception does not equal oral contraception. The correctly inserted IUD in correctly evaluated recipients has come of
age, has eliminated a great deal of its previous disadvantages, has received a
clean bill of health and offers an economically and medically justified choice.
PA et al.
contraceptives and the risk of breast cancer. New Engl J Med
NE and Helzlsouer KJ (editorial).
news about oral contraceptives. New Engl J Med 2002;346:2078-2079.
V et al.
of oral contraceptives in risk of cervical cancer in women witrh human
papilloma virus infection: the IARC multicenric case-control study. Lancet
N et al.
of parity and human papillomavirus in cervical cancer.
contraceptives, parity and cervical cancer. Lancet
BA et al.
contraceptives and the risk of myocardial infarction. New Engl J Med
L and M Stampfer (editorial):
contraceptives and myocardial infarction – The search for the smoking gun.
New Engl J Med 2001;345:1841-1842.
JM et al.
generation oral contraceptives and the risk of venous thrombosis:
meta-analysis. Brit Med J 2001;323:119-120.
JO (editorial). The
third generation pill controversy (“continued”). The risks are still small compared with pregnancy.
Brit Med J 2001;323:119-120.
Vasilakis-Scaramozza C and Jick H. Risk of venous thrombo-embolism with cyproterone or levonorgestrel contraceptives. Lancet 2001;358:1429-1429.