Perpetuating negative attitudes about the intrauterine device: textbooks lag behind the evidence

This study examined current textbooks and manuals to discern whether their presentations of the Copper T380A intrauterine device are accurate, current, and objective. Thirteen medical student obstetrics and gynecology texts used in the US and five from the UK were evaluated for information presented about the Copper T-380A intrauterine device. A scoring system was developed to record the presence or absence of characteristics of intrauterine device usage. The two authors independently reviewed the texts and completed code sheets. In general, advantages of the device were under-reported while disadvantages were exaggerated. Review of US texts identified inaccuracies regarding the device's mechanism of action; 5 of 13 did not include its prefertilization action. Despite evidence to the contrary, 9 of 13 texts reported an increased risk of pelvic inflammatory disease associated with intrauterine device use; 6 of 13 reported an increased risk of ectopic pregnancy; and 4 of 13 reported an increased risk of infertility. Review of UK texts yielded similar results regarding advantages and disadvantages, as well as mechanism of action. The UK texts presented fewer inaccuracies regarding intrauterine device risks. Most texts from both countries implied that the intrauterine device is a method of last resort. Texts commonly used by medical students on women's health rotations may not be evidence-based in the information presented about the intrauterine device.