Intrauterine Devices: Copper IUDs-performance to date
The current status of research and development with copper IUDs is reviewed in this report. A copper IUD resembles other IUDs except that a copper wire is twisted around the plastic device. The 3 configurations tested with copper have been the T, the 7, and the Lippes loop. Zipper demonstrated the antifertility effects of copper in 1969. Although early reports were very encouraging, 2-year cumulative gross event rates showed that although removals for bleeding and pain were slightly lower with the copper IUD in the shape of the T or 7, pregnancies and expulsions were in the same range for the copper IUDs and the Lippes loop D. For young nulliparas, the copper T and 7 may offer some advantage over the Lippes loop. Some 1-year studies show rates of pregnancy, expulsion, and removal for bleeding and pain in nulliparas using the copper IUD that are at least comparable to the rates in multiparas with inert devices. The copper devices may also be easier to insert and produce less bleeding than the loop. In order to retain contraceptive efficacy, the copper IUD needs to be replaced when the copper is exhausted, usually after about 2 years. This may preclude its use for women who are not able to have a medical follow-up. Age and parity remain major determinants of IUD effectiveness. The copper IUDs have not eliminated the continuing IUD problem of accidental pregnancy, expulsion, or removal for bleeding and pain. Although the copper IUDs are useful especially for younger nulliparous women, for general family planning program use with parous women, the Lippes loop remains the standard.