(Published September 2004)

Conclusions

There is an unmet need in the United States for effective contraceptive methods that can be used consistently, correctly, and on an ongoing basis. Intrauterine contraception (IUC) is as effective as sterilization, is not dependent on user motivation for effectiveness, and has high user satisfaction rates. IUC use in the United States has been limited by several factors, including limitations to access and persistent myths about the devices.

Two forms of IUC are available in the United States: the copper-containing ParaGard T 380A intrauterine device (IUD) and the levonorgestrel-releasing intrauterine system (LNG IUS). The two have similar effectiveness rates but differ in side-effect profiles: the copper-T IUD increases menstrual blood flow, whereas the LNG IUS is associated with a reduction in flow that often results in amenorrhea.

The primary mechanism of action of IUC is prevention of fertilization. IUC does not cause or increase rates of pelvic inflammatory disease (PID), infertility, or ectopic pregnancy. The most common side effects associated with IUC use are menstrual changes, heavy bleeding, and cramping. Complications with IUC use are rare but include uterine perforation, expulsion, and missing strings. Providers need to be aware of the recommended management of these side effects and complications, and need to know how to manage sexually transmitted infections, PID, and pregnancy in IUC users.

Candidates for IUC should be selected based on current recommendations; in the past, overly restrictive protocols unnecessarily prevented many women from accessing IUC. Prophylactic antibiotics are not needed at insertion. Providers need to become familiar with issues surrounding the timing of IUC insertion and insertion techniques.

IUC is a safe, highly effective form of contraception, the use of which has been unnecessarily limited in the United States. Providers need to receive accurate information about IUC and become willing to provide insertion, management, and removal services to increase access to this contraceptive method in this country.