Intrauterine devices: 22 years of experience

I. Mattos, C. Navas, M. Gallego, J. Corredera, O. Nieto, G. Lopez, JM. Hernández

Hospital 12 de Octubre, Madrid, Spain

Objective To evaluate the efficacy, safety and adverse effects of the copper intrauterine device (IUD) and levonorgestrel-releasing intrauterine system (LNG-IUS).

Methods We retrospectively evaluated 8410 women who had received a IUD in a family planning center of Madrid, Spain between 1983 and 2005. We excluded 170 (2,02%) patients who received the IUD for emergency contraception, and 240 (2,85%) women without follow-up. During the 22 years of the study period, different types of copper IUD were used according to the length of uterine cavity, and only one type of LNG-IUS (Mirena). The method was selected following the World Health Organization elegibility criteria.. All IUDs were inserted during menstruation, absent prophylactic antibiotics and, in nulliparous women, using vaginal prostaglandins 6-8 hours before the insertion. Women returned for a follow-up visit at 1, 6 and 12 months during the first year, and then annually until the removal of the IUD. Duration of use for the IUDs was up to five years. However, if the patient was 46 years old, the IUD was only removed at menopause. We studied demographic characteristics, previous contraception, type of IUD, number of IUD inserted per patient, complications during the insertion, duration of use, causes of removal and adverse effects (dysmenorrhea, bleeding disorders, expulsion, gestation, pelvic inflammatory disease, uterine perforation).

Results Mean age at the moment of insertion was 30,5 years. A total of 17,6% women was nulliparous, and 75,5% had at less one child. Insertion was easy in 93,8% of the women, while cervical dilatation before insertion was needed in 6,2%, without uterine perforation in any case. A total of 61,5% used only one IUD, 30,2% used two IUDs, and 8,2% used three IUDs. The mean duration of use of the first IUD was 52 months, and of the second and third IUDs, 36 months and 23 months respectively. During follow-up, 85,4% women had good tolerance, 1,45% had non severe dysmenorrhea, and 4,4% had bleedings disorders. Complications that forced removal of the IUD were: gestation (0,2%), pelvic inflammatory disease (0,3%), severe dysmenorrhea (0,5%) and menorrhea (1,3%). The rate of return to fertility after IUD removal was 74,9% the fist year, and 100% the second year.

Conclusions The IUD is a safe and effective contraception method when it is appropriately selected and inserted. The rate of return to fertility is high. Our Pearl Index during the 22 years for the IUD was 0,2.