Intrauterine devices. The optimal long-term contraceptive method?

Area of Science:

• Reproductive Health
• Contraception
• Public Health

Background:

• Long-acting reversible contraceptives (LARCs) are crucial for family planning.
• Intrauterine devices (IUDs), Norplant, and surgical sterilization are established long-term contraceptive methods.
• Comparative data on effectiveness, safety, and cost is essential for informed decision-making.

Purpose of the Study:

• To compare the effectiveness, safety, cost, and ease of use of intrauterine devices (IUDs) against Norplant and surgical sterilization.
• To evaluate IUDs as a viable alternative to other long-term contraceptive methods.

Main Methods:

• A literature review was conducted.
• Selected data on IUDs, Norplant, and surgical sterilization were analyzed.

Main Results:

• IUDs are highly effective, safe, and cost-effective, offering pregnancy prevention comparable to sterilization and potentially exceeding Norplant's efficacy.
• The copper T 380A (TCu380A) IUD is effective for at least 10 years, and the levonorgestrel (LNg) IUD for at least 7 years, outlasting Norplant's 5-year effectiveness.
• While IUDs can alter menstrual bleeding (copper IUDs increase loss, LNg IUDs decrease it), risks like pelvic inflammatory disease can be minimized with proper insertion; LNg IUDs may not increase this risk.
• IUDs, sterilization, and Norplant do not protect against sexually transmitted infections.
• The TCu380A IUD is highly cost-effective, and the LNg IUD could be a valuable addition to contraceptive options in developing countries if made accessible.

Conclusions:

• Intrauterine devices (IUDs) should be considered by providers, consumers, and program managers as effective substitutes for surgical sterilization and Norplant.
• IUDs represent a significant advancement in long-term reversible contraception.