[Intrauterine contraception. Risks, indications, trends]

Intrauterine contraception is used by approximately 1 million fertile women in Germany. IUDs work through various factors, i.e. impaired activity of spermatozoa, defects in the lining surface epithelium of the endometrium, and inhibitory effects towards the blastocyst itself. The main risks of intrauterine contraception are perforation of the uterus at the time of insertion, irregular bleedings, ascending infections and ectopic pregnancies. If intrauterine pregnancy occurs despite the presence of an IUD (2-4%), the rate of abortion is considerably high. In few those cases septic sequelae may complicate the spontaneous abortion. After the removal of the IUD of any type fertility immediately returns to normal with the exception of cases suffering from inflammatory complications in association with an IUD in situ. The indication for the application of an IUD should be seriously considered, the use of a formal sheet for informed consent is advisable.