IUDs: An appropriate contraceptive for many women
This discussion of IUDs covers the following: usage shifts to copper IUDs; issues for the 1980s; comparing the Lippes Loop and copper IUDs; life span of copper devices; steroid releasing IUDs; donor agency supplies; types of devices used; insertion and removal (timing of interval insertion, postpartum insertion, postabortion insertion, postcoital insertion, measuring the uterus, removal, and insertion by nurse midwives and paramedicals); bleeding (risk of anemia, limited bleeding); infection (mechanisms of infection, prevention, treatment, actinomyces); pregnancy (uterine pregnancies, ectopic pregnancies, differences among devices, and subsequent fertility); product and packaging issues (manufacture in developing countries, prices, bulk and individual packaging, methods of sterilizing IUDs, and storage). At this time about 60 million women worldwide are using IUDs, including over 40 million in China. In recent years the total number of users has remained relatively stable. The life table event rates per 100 women, by which IUDs are usually evaluated, are approximately as follows after 1 year of use in large, multicenter studies: pregnancy, 0.5-5; expulsion, 5-15; removal for bleeding/pain (5-15); removal for other medical reasons, 3-9; and removel for personal reasons, 1-6. Continuation rates 1 year after insertion tend to range from 50-85%, high rates for a reversible mothed. Some shift in usage occurred in the late 1970s from unmedicated Lippes Loop to copper releasing IUDs and to a lesser extent to IUDs that release progestins into the uterine cavity. Copper devices now have captured much of the market in the US and Western europe and amount to about 2/3 of the supplies provided by donor agencies to many developing countries. During the 1980s attention should probably focus less on the search for an ideal device and more on the need for family planning programs to identify suitable candidates for IUDs, encourage better health service support for IUD insertion and follow-up, and the newer IUDs more widely available to individuals and national programs. In most developing countries the great majority of IUDs are supplied by various national and international donor agencies that purchase large quantities at the lowest possible price and ship them to government and private programs. No data are available on the number of each type of IUD currently in use. Proper insertion of an IUD is important. Insertion can affect all major events that determine success. While there are several different techniques for inserting IUDs, with each the skill of the operator is critical. Recent studies fo about 10,000 women show that there is no one preferable time for insertion.