Future Developments in Intrauterine Contraception

Abstract

The objectives of this paper are to review IUD service delivery practice in East and South East Asia and Oceania and to update practitioners on recent advances in IUDs. The 2 main types of IUD in use are copper-releasing devices and hormone-releasing devices. Pregnancy rate and discontinuation due to bleeding were found to be lower with copper IUDs than with the Lippes Loops. The Nova T and the T Cu 380Ag with a silver core have life spans of 10-15 years. The Multiload Cu 375 lasts for 3-5 years. Pregnancy rates with both were less than 1 per 100 woman-years. The progesterone-releasing Progestasert has an efficacy and continuation rate similar to those of the T Cu 200, Cu 7, Lippes Loop C, and Nova T. The LNG-IUD, a norgestrel-releasing IUD, has a pregnancy rate of .14 and lasts for 7 years. IUDs may be inserted postpartum, postplacental, at time of cesarean section, postabortum, or postcoital. Postpartum insertion earlier than 8 weeks has a higher expulsion rate. Expulsion rates are also higher for postabortion insertion after midtrimester abortion than after 1st trimester abortion. Side effects of IUDs include expulsion, uterine perforation, pelvic inflammatory disease, and menstrual blood loss. Nulliparous and younger women have higher expulsion rates. Pelvic inflammatory disease with an IUD in place increases the risk of ectopic pregnancy by a factor of 7-10. In general, the skill of insertion and fitting of IUDs has more to do with client satisfaction than does the particular type of IUD.