Intrauterine devices appear to be safe and effective for women who ordinarily might not be considered good candidates for this form of contraceptive because of factors such as a history of sexually transmitted infections, multiple partners or prior pelvic inflammatory disease, according to a new report.
IUDs are T-shaped devices made of flexible plastic that are placed in the uterus to prevent the sperm from joining with the egg. By altering the lining of the uterus, they are also thought to prevent pregnancy by keeping a fertilized egg from implanting on the wall of the uterus.
Although it protects against pregnancy, it is important to remember that IUDs don’t protect against sexually transmitted infections, including HIV. A latex condom should be used along with the IUD to reduce the risk of infection.
IUDs have a high level of effectiveness, do not have any systemic metabolic effects, and require placement just once to provide long-term protection, Dr. Samuel J. Campbell and colleagues from Virginia Commonwealth University, Richmond, note in the American Journal of Obstetrics and Gynecology.
“Despite these advantages,” the researchers continue, “IUD use is significantly less common in the United States than in other parts of the world, which possibly reflects the widespread concern regarding health risks that are associated with this method.”
The authors point out that product labeling continues to say that women with a history of pelvic inflammatory disease, STDs and high-risk sexual behavior should avoid using the IUD.
The researchers examined the effectiveness and complication rates of the IUD, along with how willing women were to use the device. The study involved 194 women attending an urban university-based obstetrics and gynecology clinic.
Overall, 45 percent of the women were married and 42 percent were never married; 33 percent had a history of an STD and 32 percent had a history of other gynecologic infections prior to IUD use.
Most of the women (79.9 percent), were given the Mirena intrauterine system (Berlax Laboratories) and 20.1 percent were given the ParaGard intrauterine device (Duramed Pharmaceuticals Inc.). The ParaGard IUD was in place for an average of 19.44 months. The Mirena intrauterine system was in place for an average of 12.78 months.
After the IUD was inserted, 5.4 percent of women had a clinically diagnosed STD and 19.4 percent had clinically diagnosed gynecologic infection. Three pregnancies were reported after insertion.
No significant increased risk of pelvic inflammatory disease was seen after IUD insertion compared with before insertion, the researchers report. Neither type of IUD ”appeared to confer an increased risk of upper genital tract infection, despite a high prevalence of STDs in the population that was studied,” they note.
Campbell’s team believes the “data suggest a significantly higher benefit-to-risk ratio for the use of IUDs in a population that typically was classified as poor candidates for this method of contraception.”