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intrauterine device

 
Dictionary: intrauterine device
 
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n. (Abbr. IUD)

A birth control device, such as a plastic or metallic loop, ring, or spiral, that is inserted into the uterus to prevent implantation.


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World of the Body: intrauterine device
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Intrauterine device (IUD) Intrauterine devices have a long and controversial history, with their widespread acceptance being delayed until the later part of the twentieth century. Hippocrates has been credited with using a hollow lead tube to insert pessaries or other objects into the uterus over 2500 years ago, and Arabs and Turks are known to have placed stones in the uteri of their camels to prevent pregnancy while on long journeys. It was not until 1909 that Richter, a German physician, developed a looped aluminum-bronze wire spiral that could be placed in the human uterus. However, his results did not include details of pregnancy rates because of strict laws against birth control measures in place at the time. Twenty years later Grafenburg reported the use of an intrauterine silk suture, and then modified his technique by using a ring wrapped in wire that contained 26% copper. Early IUDs were associated with high rates of pelvic infection, septic abortion, and haemorrhage, particularly as they were also used by some to terminate pregnancies. A number of maternal deaths were attributed to their use and this led them into disrepute amongst both the medical profession and the general population. It was not until the first international conference on IUDs in New York in 1962 that they gained widespread acceptance. They are now the second most commonly used form of reversible contraception worldwide, mainly because they are so popular in China.

Intrauterine devices work primarily as a foreign body stimulating the immune system into producing an excess of leukocytes and prostaglandins. This creates a hostile environment in the uterus and fallopian tubes, making it difficult for fertilization to occur. In addition, the IUD creates a barrier to implantation of an embryo into the endometrium. Because the contraceptive effect may occur after fertilization some women find this form of family planning unacceptable. Most IUDs are now made of a plastic frame, with copper wrapped around them to increase their contraceptive action and therefore reduce the failure rate. Threads are usually attached to the lower end to facilitate removal. They are extremely reliable, with pregnancy rates of less than 1 per 100 women using them for a year. However, they are not very effective at preventing ectopic pregnancies which develop outside the uterine cavity. IUDs can also be used as ‘emergency’ contraception up to 5 days following the calculated date of ovulation.

Coils, as they are commonly known, are not usually recommended for women who have never been pregnant, as they are more difficult to insert and the slightly increased risk of pelvic inflammatory disease (PID) may impair future fertility. They are also unsuitable for women with a recent history of sexually transmitted disease or multiple sexual partners. Women with an abnormally shaped uterus, possibly caused by fibroids, should use a different contraceptive technique as the risks of failure are much higher in this situation.

The recent development of progestogen-releasing IUDs has been an exciting new contraceptive advance. Difficulties associated with older generation coils, such as heavy and sometimes painful periods, promise to be overcome. They have also provided a new treatment option for women with heavy periods who no longer need contraception, perhaps because they have already been sterilized. This type of IUD can be used to oppose the unwanted effects of oestrogen on the endometrium in women receiving hormone replacement therapy (HRT).

— Andrew Hextall, Linda Cardozo

See also contraception.

 
Columbia Encyclopedia: intrauterine device
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intrauterine device (IUD), variously shaped birth control device, usually of plastic, which is inserted into the uterus by a physician. The IUD may contain copper or levonorgestrel, a progestin (a hormone with progesteronelike effects; see progesterone). Apparently the IUD creates a hostile environment for the fertilized egg.

 
Health Dictionary: intrauterine device
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(in-truh-yooh-tuh-ruhn, in-truh-yooh-tuh-reyen)

A metal or plastic device inserted into the uterus and used to prevent pregnancy.

 
Wikipedia: Intrauterine device
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This article is about non-hormonally-based intrauterine contraceptives. For hormonally-based intrauterine contraceptives such as Mirena, see Intrauterine system.
Intrauterine device
Photo of a common IUD (Paragard T 380A)
Background
B.C. type Intra-uterine
First use 1909–1929
Failure rates (first year)
Perfect use 0.6%
Typical use 0.8%
Usage
Duration effect 5–12+ years
Reversibility Immediate
User reminders Check thread position after each period. Have removed shortly after menopause, if not before.
Clinic review Annually
Advantages and Disadvantages
STD protection No
Periods May be heavier and more painful
Benefits Unnecessary to take any daily action.
Emergency contraception if inserted within 5 days
Risks Small transient risk of PID in first 20 days following insertion.
Rarely, uterine perforation.

An intrauterine device (ATC G02BA) is a long acting reversible contraceptive birth control device placed in the uterus, also known as an IUD or a coil (this colloquialism is based on the coil-shaped design of early IUDs). Dr. Ernst Gräfenberg of Germany invented an early IUD and was the first person to market these devices. The IUD is the world's most widely used method of reversible birth control,[1] currently used by nearly 160 million women (just over two-thirds of whom are in China where it is the most widely used birth control method, surpassing sterilization).[2] The device has to be fitted inside and removed from the uterus by a doctor or qualified medical practitioner. It remains in place the entire time pregnancy is not desired. Depending on the type, a single IUD is approved for 5 to 10 years, and trials have demonstrated the copper T 380A to be effective for at least 12 years.[3]

Contents

History

According to popular legend, Arab traders inserted small stones into the uteruses of their camels to prevent pregnancy during long desert treks. The story was originally a tall tale to entertain delegates at a scientific conference on family planning; although it was later repeated as truth, it has no known historical basis.[4]

Precursors to IUDs were first marketed in 1902. Developed from stem pessaries (where the stem held the pessary in place over the cervix), the 'stem' on these devices actually extended into the uterus itself. Also known as interuterine devices (because they occupied both the vagina and the uterus), they had high rates of infection and were condemned by the medical community.[5]

The first intrauterine device (contained entirely in the uterus) was described in a German publication in 1909, although the author appears to have never marketed his product.[6]

In 1929, Dr. Ernst Gräfenberg of Germany published a report on an IUD made of silk suture. He had found a 3% pregnancy rate among 1,100 women using his ring. In 1930, Dr. Gräfenberg reported a lower pregnancy rate of 1.6% among 600 women using an improved ring wrapped in silver wire. Unbeknownst to Dr. Gräfenberg, the silver wire was contaminated with 26% copper. Copper's role in increasing IUD efficacy would not be recognized until nearly 40 years later.

In 1934, Japanese physician Tenrei Ota developed a variation of the Gräfenberg ring that contained a supportive structure in the center. The addition of this central disc lowered the IUD's expulsion rate. These devices still had high rates of infection, and their use and development was further stifled by World War II politics: contraception was forbidden in both Nazi Germany and Axis-allied Japan. The Western world did not learn of the work by Gräfenberg and Ota until well after the war ended.[6]

The first plastic IUD, the Margulies Coil or Margulies Spiral, was introduced in 1958. This device was somewhat large, causing discomfort to a large proportion of women users, and had a hard plastic tail, causing discomfort to their male partners. The Lippes Loop, a slightly smaller device with a monofilament tail, was introduced in 1962 and gained in popularity over the Margulies device.[5]

The stainless steel single-ring IUD was developed in the 1970s[7] and widely used in China because of low manufacturing costs. The Chinese government banned production of steel IUDs in 1993 due to high failure rates (up to 10% per year).[8][9]

Dr. Howard Tatum, in the USA, conceived the plastic T-shaped IUD in 1968. Shortly thereafter Dr. Jaime Zipper, in Chile, introduced the idea of adding copper to the devices to improve their contraceptive effectiveness.[5][10] It was found that copper-containing devices could be made in smaller sizes without compromising effectiveness, resulting in fewer side effects such as pain and bleeding.[11] T-shaped devices had lower rates of expulsion due to their greater similarity to the shape of the uterus.[6]

The poorly designed Dalkon Shield plastic IUD (which had a multifilament tail) was manufactured by the A. H. Robins Company and sold by Robins in the United States for three and a half years from January 1971 through June 1974, before sales were suspended by Robins on June 28, 1974 at the request of the FDA because of safety concerns following reports of 110 septic spontaneous abortions in women with the Dalkon Shield in place, seven of whom had died.[12][13] Robins stopped international sales of the Dalkon Shield in April 1975.[14]

Second-generation copper-T IUDs were also introduced in the 1970s. These devices had higher surface areas of copper, and for the first time consistently achieved effectiveness rates of greater than 99%. Worldwide today, with the exception of the new GyneFix, this is the only type of non-hormonal IUD available.[11]

Types of IUDs

There are two broad categories of intrauterine contraceptive devices: inert and copper-based devices, and hormonally-based devices that work by releasing a progestogen.

In the United States, there are two types of intrauterine contraceptive available: the copper Paragard and the hormonal Mirena. Both of these contraceptives are referred to as IUDs.[15]

In the United Kingdom, where ten types of copper-containing IUDs are available, the term IUD only refers to inert or copper-containing devices. Hormonal intra-uterine contraceptives are considered a different form of contraception from copper IUDs, and they are distinguished with the term IntraUterine System or IUS.[16][17]

Inert and copper-based devices

Most non-hormonal IUDs have a plastic T-shaped frame that is wound around with pure electrolytic copper wire and/or has copper collars (sleeves). The Paragard T 380a is 32 mm (1.26") in the horizontal direction (top of the T), and 36 mm (1.42") in the vertical direction (leg of the T). In some IUDs, such as the Nova T 380, the pure copper wire has a silver core which has been shown to prevent breaking of the wire.[16][18] The arms of the frame hold the IUD in place near the top of the uterus. The GyneFix does not have a T-shape, but rather is a loop that holds several copper tubes. The GyneFix is held in place by a suture to the fundus of the uterus. All copper-containing IUDs have a number as part of their name. This is the surface area of copper (in square millimeters) the IUD provides.

Hormonal intra-uterine devices

Main article: Intrauterine system

Hormonal uterine devices do not increase bleeding as inert and copper-containing IUDs do. Rather, they reduce menstrual bleeding or prevent menstruation altogether, and can be used as a treatment for menorrhagia (heavy periods).

Although use of IntraUterine Systems results in much lower systemic progestogen levels than other very-low-dose progestogen-only hormonal contraceptives, they might possibly have some of the same side effects.

Progestasert was the first hormonal uterine device, developed in 1976[19] and manufactured until 2001.[20] It released progesterone, was replaced annually, and had a failure rate of 2% per year.[21]

As of 2007, the LNG-20 IUS - marketed as Mirena by Bayer - is the only IntraUterine System available. First introduced in 1990, it releases levonorgestrel (a progestogen) and may be used for five years.

A lower-dose T-shaped IntraUterine System named Femilis is being developed by Contrel, a Belgian company. Contrel also manufactures the FibroPlant-LNG, a frameless IUS. FibroPlant is anchored to the fundus of the uterus as the GyneFix IUD is. Although a number of trials have shown positive results, FibroPlant is not yet commercially available.[22]

Contraindications

The WHO Medical Eligibility Criteria for Contraceptive Use and RCOG Faculty of Family Planning & Reproductive Health Care (FFPRHC) UK Medical Eligibility Criteria for Contraceptive Use list the following as conditions where insertion of a copper IUD is not usually recommended (category 3) or conditions where a copper IUD should not be inserted (category 4):[23][24]

Category 3. Conditions where the theoretical or proven risks usually outweigh the advantages of inserting a copper IUD:

Category 4. Conditions which represent an unacceptable health risk if a copper IUD is inserted:

Some concern has been expressed that women with metal sensitivities to copper or nickel may experience adverse reactions from an IUD. The metal used in IUDs is 99.99% copper, with one study finding a maximum nickel content of 0.001%. Because nickel has a relatively high sensitizing potential, a few researchers suggested even this tiny amount might be problematic. A few case reports have attributed eczematous dermatitis and urticaria in a handful of users of copper-releasing IUDs to systemic copper or nickel allergic contact dermatitis. However, the daily metal absorption from an IUD is only a fraction of the normal daily absorption from food, and many dermatologists are skeptical that the symptoms described in the case reports were actually caused by metal sensitivity.[25][26][27]

While nulliparous women (women who have never given birth) are somewhat more likely to have side effects, this is not a contraindication for IUD use.

Some doctors prefer to insert the IUD during menstruation to verify that the woman is not pregnant at the time of insertion. However, IUDs may safely be inserted at any time during the menstrual cycle as long as it is reasonably certain the woman is not pregnant.[28] Insertion may be more comfortable if done midcycle, when the cervix is naturally dilated.[29]

Side effects and complications

Insertion of the IUD may introduce bacteria into the uterus. The insertion process carries a small, transient increased risk of pelvic inflammatory disease in the first 20 days following insertion.[30] It is very important that the provider use proper infection-prevention techniques during insertion.[31] Antibiotics should be given before insertion to women at high risk for endocarditis (infection of the valves within the heart), but should not be used routinely.[32]

During the placement appointment, the cervix is dilated in order to sound (measure) the uterus and insert the IUD. Cervix dilation can be uncomfortable and, for some women, painful. Taking NSAIDS before the procedure can reduce discomfort[33], as can the use of a local anaesthetic. Misoprostol 6 to 12 hrs before insertion can help with cervical dilatation.[33]

After IUD insertion, menstrual periods are often heavier, more painful, or both - especially for the first few months after they are inserted. On average, menstrual blood loss increases by 20–50% after insertion of a copper-T IUD; increased menstrual discomfort is the most common medical reason for IUD removal.[34]

Complications include expulsion and uterine perforation. Uterine perforation is generally caused by an inexperienced provider and is very rare. Expulsion is more common in younger women, women who have not had children, and when an IUD is inserted immediately after childbirth or abortion. Women should check the string of the IUD at least once per menstrual cycle to verify that it is still in place.

The string(s) may be felt by some men during intercourse. If this is problematic, the provider may cut the strings even down to the cervix, so they cannot be felt. Shortening the strings does prevent the woman from checking for expulsion, however.

The risk of ectopic pregnancy to a woman using an IUD is lower than the risk of ectopic pregnancy to a woman using no form of birth control. However, of pregnancies that do occur during IUD use, a higher than expected percentage (3–4%) are ectopic.[35]

The pregnancy rate during IUD use is very low (less than 1% per year). If pregnancy does occur, the IUD should be removed. Although IUDs are not teratogenic,[36] presence of the IUD increases the risk of miscarriage, particularly during the second trimester. It also increases the risk of premature delivery. Although the Dalkon Shield IUD was associated with septic abortions (infections associated with miscarriage), other brands of IUD are not. IUDs are also not associated with birth defects or other pregnancy complications.[37]

Non-hormonal (copper) IUDs are considered safe to use while breastfeeding.[38]

Effectiveness and mechanism of contraception

A diagram showing a copper IUD in place in uterus.

All second-generation copper-T IUDs have failure rates of less than 1% per year, and cumulative 10-year failure rates of 2-6%.[9] A copper IUD may also be used as emergency contraception. If an IUD is inserted within five days of unprotected intercourse, a woman's chance of pregnancy is reduced to that of ongoing IUD users.[39]

A large World Health Organization trial reported a cumulative 12-year failure rate of 2.2% for the T 380A (ParaGard) (an average failure rate of 0.18% per year over 12 years), equivalent to a cumulative 10-year failure rate of 1.8% following tubal ligation.[3] The frameless GyneFix also has a failure rate of less than 1% per year.[40] Worldwide, older IUD models with lower effectiveness rates are no longer produced.[11]

The presence of a device in the uterus prompts the release of leukocytes and prostaglandins by the endometrium. These substances are hostile to both sperm and eggs; the presence of copper increases this spermicidal effect.[41][42] The current medical consensus is that spermicidal and ovicidal mechanisms are the only way in which IUDs work.[36] Still, a few physicians have suggested they may have a secondary effect of interfering with the development of pre-implanted embryos;[43] this secondary effect is considered more plausible when the IUD is used as emergency contraception.[44] Controversially, the possibility of this secondary effect has led some to consider the IUD an abortifacient.

Some barrier contraceptives protect against STDs. Hormonal contraceptives reduce the risk of developing pelvic inflammatory disease (PID), a serious complication of certain STDs. IUDs, by contrast, do not protect against STDs or PID.[30]

Use as emergency contraception

Intrauterine devices can be used as emergency contraception to prevent pregnancy up to 5 days after unprotected sexual intercourse, or sexual intercourse during which the primary contraception is believed to have failed (e.g. a condom was used, but it broke). Insertion of a copper-T IUD as emergency contraception is more than 99% effective, making it more effective than emergency contraceptive pills (ECP or 'morning-after pill').[39]

Prevalence

A sign in Futu, Hubei, suggests getting an IUD after the first childbirth, and a tubal ligation after the second

The IUD is the world's most widely used method of reversible birth control,[1] currently used by nearly 160 million women (just over two-thirds of whom are in China where it is the most widely used birth control method, surpassing sterilization).[2] Usage in many countries has been measured by surveys of married women of reproductive age. In this population in the early 1990s, IUD use ranged from 1.5% in North America, to 18% in Scandinavia, 33% in Russia and China, and 40% in Kazakhstan.[45] Use in China increased to 45% of married women by 2002.[2]

Among women who recently had sex and are not trying to become pregnant, 1.9% use IUDs in the United States, 6% in the United Kingdom and 20% in France.[46]

In the U.S., the ParaGard T 380A was approved by the FDA in 1984 and became available for use in 1988. It is still the only copper IUD approved for use in the U.S., and was used by 1.3% of women of reproductive age in a 2002 U.S. survey.[47] A wider variety of IUDs are available outside of the U.S. As of 2008 in the U.K., for example, ten brands are available: Flexi-T 300, Flexi-T +380, Load 375, Multi-Load Cu 375, Nova T 380, T-Safe Cu 380A, TT 380 Slimline, UT 380 Short, UT 380 Standard, and GyneFix - also called FlexiGard 330 or CuFix PP330.[16]

See also

References

  1. ^ a b "What are the most widely used contraceptive methods across the world?". Births / Birth control. Institut national d'études démographiques (INED). 2006. http://www.ined.fr/en/everything_about_population/faq/naissances_natalite/bdd/q_text/what_are_the_most_widely_used_contraceptive_methods_across_the_world_/question/80/. Retrieved on 2006-11-16. 
  2. ^ a b c World Health Organization (2002). "The intrauterine device (IUD)-worth singing about". Progress in Reproductive Health Research (60): 1–8. http://www.who.int/reproductive-health/hrp/progress/60/news60.html. 
  3. ^ a b World Health Organization (1997). "Long-term reversible contraception. Twelve years of experience with the TCu380A and TCu220C". Contraception 56 (6): 341–52. PMID 9494767. 
  4. ^ "A History of Birth Control Methods". Planned Parenthood. June 2002. http://www.plannedparenthood.org/resources/research-papers/bc-history-6547.htm. Retrieved on 2007-10-14. , which cites:
    • Thomas, Patricia (1988-03-14). "Contraceptives". Medical World News 29 (5): 48. 
    • Bullough, Vern L.; Bullough, Bonnie (1990). Contraception: A Guide to Birth Control Methods. Buffalo, NY: Prometheus Books. 
  5. ^ a b c Lynch, Catherine M.. "History of the IUD". Contraception Online. Baylor College of Medicine. http://www.contraceptiononline.org/meetings/IUD/lynch/presentation_text.cfm?cme_activityid=47&showmenu=1. Retrieved on 2006-07-09. 
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  7. ^ Bradley, Jeff (August 1998). "Ultrasound Interactive Case Study: Ring IUD". OBGYN.net. http://www.obgyn.net/us/us.asp?page=/us/present/9808/bradley. Retrieved on 2006-07-09.  (Has pictures of various IUD designs.)
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  9. ^ a b IUDs-An Update. Chapter 2.3: Effectiveness.
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  11. ^ a b c IUDs—An Update. Chapter 1: Background.
  12. ^ Sivin I (1993). "Another look at the Dalkon Shield: meta-analysis underscores its problems". Contraception 48 (1): 1–12. doi:10.1016/0010-7824(93)90060-K. PMID 8403900. 
  13. ^ Mintz, Morton (January 15, 1986). "A Crime Against Women. A. H. Robins and the Dalkon Shield". Multinational Monitor 7 (1). http://multinationalmonitor.org/hyper/issues/1986/0115/index.html. 
  14. ^ Salem R (February 2006). "New Attention to the IUD: Expanding Women’s Contraceptive Options To Meet Their Needs". Popul Rep B (7). http://www.infoforhealth.org/pr/b7/chap1.shtml#outdated. 
  15. ^ Treiman K, Liskin L, Kols A, Rinehart W (1995). "IUDs—an update" (PDF). Popul Rep B (6): 1–35. PMID 8724322. http://www.infoforhealth.org/pr/b6/b6.pdf. Retrieved on 2006-01-01. 
  16. ^ a b c "Contraceptive coils (IUDs)". NetDoctor.co.uk. 2006. http://www.netdoctor.co.uk/sex_relationships/facts/contraceptivecoil.htm. Retrieved on 2006-07-05. 
  17. ^ French, R; Van Vliet H, Cowan F, et al. (2004). "Hormonally impregnated intrauterine systems (IUSs) versus other forms of reversible contraceptives as effective methods of preventing pregnancy". Cochrane Database of Systematic Reviews (3). doi:10.1002/14651858.CD001776.pub2. PMID 15266453. 
  18. ^ Schering (May 13, 2003). "Nova T380 Patient information leaflet (PIL)". http://emc.medicines.org.uk/emc/assets/c/html/displaydoc.asp?documentid=3641. Retrieved on 2007-04-27. 
  19. ^ IUDs—An Update. Chapter 2: Types of IUDs.
  20. ^ Smith (pseudonym), Sydney (March 8, 2003). "Contraceptive Concerns". medpundit: Commentary on medical news by a practicing physician.. http://www.medpundit.blogspot.com/2003_03_02_medpundit_archive.html. Retrieved on 2006-07-16. 
  21. ^ "Birth Control Options: The Progestasert Intrauterine Device (IUD)". Wyoming Health Council. 2004. http://wyhc.org/birth_control_options/Progestasert-IUD.php. Retrieved on 2006-07-16. 
  22. ^ "New Contraceptive Choices". Population Reports, INFO Project, Center for Communication Programs (The Johns Hopkins School of Public Health) M (19). April 2005. http://www.infoforhealth.org/pr/m19/. Retrieved on 2006-07-14.  Chapter 9: Intrauterine Devices.
  23. ^ WHO (2004). "Intrauterine devices (IUDs)". Medical Eligibility Criteria for Contraceptive Use (3rd ed.). Geneva: Reproductive Health and Research, WHO. ISBN 92-4-156266-8. 
  24. ^ FFPRHC (2006). "The UK Medical Eligibility Criteria for Contraceptive Use (2005/2006)" (PDF). http://www.ffprhc.org.uk/admin/uploads/UKMEC200506.pdf. Retrieved on 2007-01-11. 
  25. ^ Jouppila P, Niinimäki A, Mikkonen M (1979). "Copper allergy and copper IUD". Contraception 19 (6): 631–7. doi:10.1016/0010-7824(79)90009-X. PMID 487812. 
  26. ^ Frentz G, Teilum D (1980). "Cutaneous eruptions and intrauterine contraceptive copper device". Acta Derm Venereol 60 (1): 69–71. PMID 6153839. 
  27. ^ Wohrl S, Hemmer W, Focke M, Gotz M, Jarisch R (2001). "Copper allergy revisited". J Am Acad Dermatol 45 (6): 863–70. doi:10.1067/mjd.2001.117729. PMID 11712031. 
  28. ^ IUDs-An Update. Chapter 3: Insertion.
  29. ^ "control methods/pub-contraception-iud.xml#1103415754536::8998200633989168060 Understanding IUDs". Planned Parenthood Federation of America. July 2005. http://www.plannedparenthood.org/pp2/portal/files/portal/medicalinfo/Birth control methods/pub-contraception-iud.xml#1103415754536::8998200633989168060. Retrieved on 2006-07-22. 
  30. ^ a b Farley TM, Rosenberg MJ, Rowe PJ, Chen JH, Meirik O (1992). "Intrauterine devices and pelvic inflammatory disease: an international perspective". Lancet 339 (8796): 785–8. doi:10.1016/0140-6736(92)91904-M. PMID 1347812. 
    Grimes DA (2000). "Intrauterine device and upper-genital-tract infection". Lancet 356 (9234): 1013–9. doi:10.1016/S0140-6736(00)02699-4. PMID 11041414. 
    Mishell Jr., Daniel R. (2004). "Contraception". in in Strauss III, Jerome F.; Barbieri, Robert L. (eds.). Yen and Jaffe's Reproductive Endocrinology (5th ed.). Philadelphia: Elsevier Saunders. pp. 899–938. ISBN 0-7216-9546-9. 
    Grimes, David A. (2004). "Intrauterine Devices (IUDs)". in in Hatcher, Robert A.; Trussell, James; Stewart, Felicia H.; Nelson, Anita L.; Cates Jr., Willard; Guest, Felicia; Kowal, Deborah (eds.). Contraceptive Technology (18th rev. ed.). New York: Ardent Media. pp. 495–530. ISBN 0-9664902-5-8. 
    Speroff, Leon; Darney, Philip D. (2005). "Intauterine Contraception: The IUD". A Clinical Guide for Contraception (4th ed.). Philadelphia: Lippincott Williams & Wilkins. pp. 221–257. ISBN 0-7817-6488-2. 
    Hall, Janet E. (2005). "Infertility and Fertility Control". in in Kasper Dennis L.; Braunwald, Eugene; Fauci, Anthony S.; Hauser, Stephen L.; Longo, Dan L.; Jameson, J. Larry (eds.). Harrison's Principles of Internal Medicine (16th ed.). New York: McGraw-Hill. pp. 279–83. ISBN 0-07-139140-1. 
    Soper, David E.; Mead, Philip B. (2005). "Infections of the Female Pelvis". in in Mandell, Gerald L.; Bennett, John E.; Dolin, Raphael (eds.). Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases (6th ed.). Philadelphia: Elsevier Chuchill Livingston. pp. 1372–81. ISBN 0-443-06643-4. 
    Glasier, Anna (2006). "Contraception". in in DeGroot, Leslie J.; Jameson, J. Larry (eds.). Endocrinology (5th ed.). Philadelphia: Elsevier Saunders. pp. 2993–3003. ISBN 0-7216-0376-9. Stubblefield, Phillip G.; Carr-Ellis, Sacheen; Kapp, Nathalie (2007). "Family Planning". in in Berek, Jonathan A. (ed.). Berek & Novak's Gynecology (14th ed.). Philadelphia: Lippincott Williams & Wilkins. pp. 247–311. ISBN 0-7817-6805-5. 
  31. ^ IUDs—An Update. Sidebar: Infection Prevention for IUD Insertion and Removal.
  32. ^ IUDs—An Update. Sidebar: Procedures for Providing IUDs.
  33. ^ a b Hutten-Czapski P, Goertzen J (2008). "The occasional intrauterine contraceptive device insertion". Can J Rural Med 13 (1): 31–5. PMID 18208650. http://www.cma.ca/multimedia/staticContent/HTML/N0/l2/cjrm/vol-13/issue-1/pdf/pg31.pdf. 
  34. ^ IUDs-An Update. Chapter 2.5: Bleeding and Pain.
  35. ^ IUDs-An Update. Chapter 2.9:Ectopic Pregnancies.
  36. ^ a b Grimes, David (2007). "Intrauterine Devices (IUDs)". in Hatcher, Robert A., et al.. Contraceptive Technology (19th rev. ed.). New York: Ardent Media. pp. 120. ISBN 0-9664902-0-7. 
  37. ^ IUDs-An Update. Chapter 2.8: Intrauterine Pregnancy.
  38. ^ Can I use the copper IUD while nursing?
  39. ^ a b Gottardi G, Spreafico A, de Orchi L (1986). "The postcoital IUD as an effective continuing contraceptive method.". Contraception 34 (6): 549–58. doi:10.1016/S0010-7824(86)80011-7. PMID 3549140. 
  40. ^ O'Brien, PA; Marfleet C (January 25, 2005). "Frameless versus classical intrauterine device for contraception". Cochrane Database of Systematic Reviews (1). 
  41. ^ "Mechanisms of the Contraceptive Action of Hormonal Methods and Intrauterine Devices (IUDs)". Family Health International. 2006. http://www.fhi.org/en/RH/Pubs/booksReports/methodaction.htm. Retrieved on 2006-07-05. 
  42. ^ Keller, Sarah (Winter 1996, Vol. 16, No. 2). "IUDs Block Fertilization". Network. Family Health International. http://www.fhi.org/en/RH/Pubs/Network/v16_2/nt1623.htm. Retrieved on 2006-07-05. 
  43. ^ Stanford J, Mikolajczyk R (2002). "Mechanisms of action of intrauterine devices: update and estimation of postfertilization effects". Am J Obstet Gynecol 187 (6): 1699–708. doi:10.1067/mob.2002.128091. PMID 12501086. , which cites:
    Smart Y, Fraser I, Clancy R, Roberts T, Cripps A (1982). "Early pregnancy factor as a monitor for fertilization in women wearing intrauterine devices". Fertil Steril 37 (2): 201–4. PMID 6174375. 
  44. ^ Trussell, James; Elizabeth G. Raymond (April 2008) (PDF). Emergency Contraception: A Last Chance to Prevent Unintended Pregnancy. The Office of Population Research at Princeton University and the Association of Reproductive Health Professionals. http://ec.princeton.edu/questions/ec-review.pdf. Retrieved on 2008-05--08. 
  45. ^ IUDs—An Update. Worldwide Use - Developed Countries. Table 2: Worldwide Use of IUDs.
  46. ^ "Reducing unintended pregnancy in the United States". Contraception. January 2008. http://www.arhp.org/editorials/january2008.cfm. 
  47. ^ Chandra, A; Martinez GM, Mosher WD, Abma JC, Jones J. (2005). "Fertility, Family Planning, and Reproductive Health of U.S. Women: Data From the 2002 National Survey of Family Growth" (PDF). Vital Health Stat (National Center for Health Statistics) 23 (25). http://www.cdc.gov/nchs/data/series/sr_23/sr23_025.pdf. Retrieved on 2007-05-20.  See Table 56.

External links

v • d • e
Birth control methods (G02B)
Comparison
Behavioral
Barrier or
spermicidal
Hormonal
Anti-estrogen
Ormeloxifene (Centchroman)
Post-intercourse
Emergency contraception (pills or copper IUD)
Intrauterine
IUD (copper or progestogen), IUS (progestogen)
Abortion
Surgical, Medical (RU-486/abortion pill)
Sterilization

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