Intrauterine Contraception

Abstract

Currently, there are only two basic types of intrauterine devices (IUDs): copper and hormonal. However, other types of IUDs are under development, some of which are in clinical trials around the world. Continued development has focused on increasing efficacy, longer duration of use, and noncontraceptive benefits. This review discusses currently available intrauterine contraceptives, such as the Cu380A IUD and levonorgestrel-releasing intrauterine systems; novel intrauterine contraceptives that are available in select parts of the world including the intrauterine ball, low-dose copper products, frameless devices, and intrauterine delivery systems impregnated with noncontraceptive medication; and novel products currently in development.

Keywords

intrauterine device - levonorgestrel - copper - frameless - indomethacin

• References

• 1 Wessel GM. Of camels, silkworms, and contraception. Mol Reprod Dev 2014; 81 (9) :Fmi
• 2 Guttmacher AF. Intra-uterine contraceptive devices. J Reprod Fertil 1965; 10: 115-128
• 3 Sivin I, Greenslade F, Schmidt F, Waldman SN. The Copper 380 intrauterine device: a summary of scientific data. New York: Population Council, Inc; 1992: 1-50
• 4 Sonfield A. Popularity disparity: attitudes about the IUD in Europe and the United States. Guttmacher Policy Rev 2007; 10 (4) 19-24
• 5 Hubacher D. The checkered history and bright future of intrauterine contraception in the United States. Perspect Sex Reprod Health 2002; 34 (2) 98-103
• 6 World Contraceptive Use 2012 (United Nations publication, POP/DB/CP/Rev2012); 2013 Update for the MDG Database: Contraceptive Prevalence (United Nations publication, POP/DB/CP/A/MDG2013); and 2013 Update for the MDG Database: Unmet Need for Family Planning (United Nations publication, POP/DB/CP/B/MDG2013). Available at: http://www.un.org/en/development/desa/population/publications/pdf/family/worldContraceptivePatternsWallChart2013.pdf
• 7 ESHRE Capri Workshop Group. Intrauterine devices and intrauterine systems. Hum Reprod Update 2008; 14 (3) 197-208
• 8 Cheng D. The intrauterine device: still misunderstood after all these years. South Med J 2000; 93 (9) 859-864
• 9 Hubacher D, Finer LB, Espey E. Renewed interest in intrauterine contraception in the United States: evidence and explanation. Contraception 2011; 83 (4) 291-294
• 10 Finer LB, Jerman J, Kavanaugh ML. Changes in use of long-acting contraceptive methods in the United States, 2007-2009. Fertil Steril 2012; 98 (4) 893-897
• 11 Kavanaugh ML, Jerman J, Finer LB. Changes in use of long-acting reversible contraceptive methods among U.S. women, 2009–2012. Obstet Gynecol 2015; 126 (5) 917-927
• 12 Trussell J. Contraceptive failure in the United States. Contraception 2011; 83 (5) 397-404
• 13 Eisenberg DL, Schreiber CA, Turok DK, Teal SB, Westhoff CL, Creinin MD ; ACCESS IUS Investigators. Three-year efficacy and safety of a new 52-mg levonorgestrel-releasing intrauterine system. Contraception 2015; 92 (1) 10-16
• 14 Bayer Healthcare Pharmaceuticals Inc . Mirena full prescribing information. 2014; Available at: http://labeling.bayerhealthcare.com/html/products/pi/Mirena_PI.pdf
• 15 Bayer Healthcare Pharmaceuticals Inc . Skyla full prescribing information. 2013 ; Available at: http://labeling.bayerhealthcare.com/html/products/pi/Skyla_PI.pdf
• 16 Centers for Disease Control and Prevention. U.S. medical eligibility criteria for contraceptive use, 2010. Adapted from the World Health Organization medical eligibility criteria for contraceptive use, 4th ed. MMWR 2010; 59 (No. RR-4) 11-63
• 17 World Health Organization. Medical Eligibility Criteria for Contraceptive Use, 5th ed. Geneva: World Health Organization; 2015
• 18 Hoover KW, Tao G, Kent CK. Trends in the diagnosis and treatment of ectopic pregnancy in the United States. Obstet Gynecol 2010; 115 (3) 495-502
• 19 Stulberg DB, Cain LR, Dahlquist I, Lauderdale DS. Ectopic pregnancy rates and racial disparities in the Medicaid population, 2004-2008. Fertil Steril 2014; 102 (6) 1671-1676
• 20 Ganacharya S, Bhattoa HP, Batár I. Ectopic pregnancy among non-medicated and copper-containing intrauterine device users: a 10-year follow-up. Eur J Obstet Gynecol Reprod Biol 2003; 111 (1) 78-82
• 21 Backman T, Rauramo I, Huhtala S, Koskenvuo M. Pregnancy during the use of levonorgestrel intrauterine system. Am J Obstet Gynecol 2004; 190 (1) 50-54
• 22 American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 121: Long-acting reversible contraception: implants and intrauterine devices. Obstet Gynecol 2011; 118 (1) 184-196
• 23 UN Development Programme. Long-term reversible contraception. Twelve years of experience with the TCu380A and TCu220C. Contraception 1997; 56 (6) 341-352
• 24 Sivin I. Utility and drawbacks of continuous use of a copper T IUD for 20 years. Contraception 2007; 75 (6, Suppl): S70-S75
• 25 Ortiz ME, Croxatto HB. Copper-T intrauterine device and levonorgestrel intrauterine system: biological bases of their mechanism of action. Contraception 2007; 75 (6, Suppl): S16-S30
• 26 Achilles SL, Creinin MD, Stoner KA, Chen BA, Meyn L, Hillier SL. Changes in genital tract immune cell populations after initiation of intrauterine contraception. Am J Obstet Gynecol 2014; 211 (5) 489.e1-489.e9
• 27 Hubacher D, Reyes V, Lillo S , et al. Preventing copper intrauterine device removals due to side effects among first-time users: randomized trial to study the effect of prophylactic ibuprofen. Hum Reprod 2006; 21 (6) 1467-1472
• 28 Bahamondes L, Brache V, Meirik O, Ali M, Habib N, Landoulsi S ; WHO Study Group on Contraceptive Implants for Women. A 3-year multicentre randomized controlled trial of etonogestrel- and levonorgestrel-releasing contraceptive implants, with non-randomized matched copper-intrauterine device controls. Hum Reprod 2015; 30 (11) 2527-2538
• 29 ACOG. Practice bulletin 152: emergency contraception. Obstet Gynecol 2015; 126 (3) 685-686
• 30 Cleland K, Zhu H, Goldstuck N, Cheng L, Trussell J. The efficacy of intrauterine devices for emergency contraception: a systematic review of 35 years of experience. Hum Reprod 2012; 27 (7) 1994-2000
• 31 Wu JP, Pickle S. Extended use of the intrauterine device: a literature review and recommendations for clinical practice. Contraception 2014; 89 (6) 495-503
• 32 McNicholas C, Maddipati R, Zhao Q, Swor E, Peipert JF. Use of the etonogestrel implant and levonorgestrel intrauterine device beyond the U.S. Food and Drug Administration-approved duration. Obstet Gynecol 2015; 125 (3) 599-604
• 33 Seeber B, Ziehr SC, Gschlieber A , et al. Quantitative levonorgestrel plasma level measurements in patients with regular and prolonged use of the levonorgestrel-releasing intrauterine system. Contraception 2012; 86 (4) 345-349
• 34 Sivin I, Stern J, Coutinho E , et al. Prolonged intrauterine contraception: a seven-year randomized study of the levonorgestrel 20 mcg/day (LNg 20) and the Copper T380 Ag IUDS. Contraception 1991; 44 (5) 473-480
• 35 Lewis RA, Taylor D, Natavio MF, Melamed A, Felix J, Mishell Jr D. Effects of the levonorgestrel-releasing intrauterine system on cervical mucus quality and sperm penetrability. Contraception 2010; 82 (6) 491-496
• 36 Nelson A, Apter D, Hauck B , et al. Two low-dose levonorgestrel intrauterine contraceptive systems: a randomized controlled trial. Obstet Gynecol 2013; 122 (6) 1205-1213
• 37 Kaunitz AM, Bissonnette F, Monteiro I, Lukkari-Lax E, DeSanctis Y, Jensen J. Levonorgestrel-releasing intrauterine system for heavy menstrual bleeding improves hemoglobin and ferritin levels. Contraception 2012; 86 (5) 452-457
• 38 Gupta J, Kai J, Middleton L, Pattison H, Gray R, Daniels J ; ECLIPSE Trial Collaborative Group. Levonorgestrel intrauterine system versus medical therapy for menorrhagia. N Engl J Med 2013; 368 (2) 128-137
• 39 Mawet M, Nollevaux F, Nizet D , et al. Impact of a new levonorgestrel intrauterine system, Levosert(®), on heavy menstrual bleeding: results of a one-year randomised controlled trial. Eur J Contracept Reprod Health Care 2014; 19 (3) 169-179
• 40 Lethaby AE, Cooke I, Rees M. Progesterone or progestogen-releasing intrauterine systems for heavy menstrual bleeding. Cochrane Database Syst Rev 2005; 4 (4) CD002126
• 41 Bahamondes L, Valeria Bahamondes M, Shulman LP. Non-contraceptive benefits of hormonal and intrauterine reversible contraceptive methods. Hum Reprod Update 2015; 21 (5) 640-651
• 42 Hubacher D, Grimes DA. Noncontraceptive health benefits of intrauterine devices: a systematic review. Obstet Gynecol Surv 2002; 57 (2) 120-128
• 43 Kelekci S, Kelekci KH, Yilmaz B. Effects of levonorgestrel-releasing intrauterine system and T380A intrauterine copper device on dysmenorrhea and days of bleeding in women with and without adenomyosis. Contraception 2012; 86 (5) 458-463
• 44 Gardner FJ, Konje JC, Bell SC , et al. Prevention of tamoxifen induced endometrial polyps using a levonorgestrel releasing intrauterine system long-term follow-up of a randomised control trial. Gynecol Oncol 2009; 114 (3) 452-456
• 45 Zhao G, Li M, Zhu P, Xu R, Wang J, Xu R. A preliminary morphometric study on the endometrium from patients treated with indomethacin-releasing copper intrauterine device. Hum Reprod 1997; 12 (7) 1563-1566
• 46 Zhang S, Li Y, Yu P , et al. In vitro release of cupric ion from intrauterine devices: influence of frame, shape, copper surface area and indomethacin. Biomed Microdevices 2015; 17 (1) 19
• 47 Tian K, Xie C, Xia X. Chitosan/alginate multilayer film for controlled release of IDM on Cu/LDPE composite intrauterine devices. Colloids Surf B Biointerfaces 2013; 109: 82-89
• 48 Hu X, Li L, Zou Y, Wu S. A multicenter comparative study of UCu200, TCu380A, and medicated γ-IUD devices inserted immediately after vacuum aspiration. Int J Gynaecol Obstet 2013; 122 (1) 65-69
• 49 Bilian X. Chinese experience with intrauterine devices. Contraception 2007; 75 (6, Suppl): S31-S34
• 50 Baram I, Weinstein A, Trussell J. The IUB, a newly invented IUD: a brief report. Contraception 2014; 89 (2) 139-141
• 51 OCON Medical Ltd . The next generation IUD: intrauterine ball. Available at: http://www.oconmed.com/fileadmin/user_upload/Ocon-IUB-Doctors-Overview-DO_EN_090215_2.pdf . Accessed September 27, 2015
• 52 Wiebe E, Trussell J. Discontinuation rates and acceptability during 1 year of using the intrauterine ball (the SCu380A). Contraception 2015 Dec 8. pii: S0010-7824(15)30125-6. doi:10.1016/j.contraception.2015.12.002. [Epub ahead of print]
• 53 Meirik O, Rowe PJ, Peregoudov A, Piaggio G, Petzold M ; IUD Research Group at the UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction. The frameless copper IUD (GyneFix) and the TCu380A IUD: results of an 8-year multicenter randomized comparative trial. Contraception 2009; 80 (2) 133-141
• 54 Oswal A, Oswal A, Loizides S, Robinson C. Gynefix tales: cervical perforation and repeated late expulsion with the Gynefix device. Eur J Contracept Reprod Health Care 2008; 13 (2) 215-217
• 55 Sajjad Y, Selvan G, Kirwan JM, Kingsland CR. Gynaefix frameless IUD: cause of bowel resection. Eur J Contracept Reprod Health Care 2006; 11 (3) 241-242
• 56 Eskandar OS, Eckford SD. Intravesical migration of a GyneFix intrauterine device. J Fam Plann Reprod Health Care 2003; 29 (4) 237-238
• 57 Aust TR, Kirwan JN, Herod JJ, McVicker JT. Perforation with the GyneFix intrauterine implant: is there a common factor?. J Fam Plann Reprod Health Care 2003; 29 (3) 155-156
• 58 Reuter S, Krishnamurthy S. Intra-uterine implant (GyneFix) lost via intestinal route?. J Fam Plann Reprod Health Care 2001; 27 (3) 159-160
• 59 Gandhi JD, Whitmore J, Iskander MN. Uterine perforation by GyneFix frameless IUD: two case reports. J Fam Plann Reprod Health Care 2001; 27 (3) 153-154
• 60 Mansour D. Perforation with GyneFix IUD. Br J Fam Plann 2000; 26 (3) 179
• 61 al-Kamil RK. Perforation of uterus by the GyneFix intrauterine contraceptive device. Int J Clin Pract 2000; 54 (2) 128-129
• 62 Vekemans M, Verougstraete A. Late uterine perforation with an anchored IUD, the Gynefix: a case report. Contraception 1999; 60 (1) 55-56
• 63 Wildemeersch D, Andrade A. Review of clinical experience with the frameless LNG-IUS for contraception and treatment of heavy menstrual bleeding. Gynecol Endocrinol 2010; 26 (5) 383-389
• 64 Wildemeersch D, Jandi S, Pett A, Nolte K, Hasskamp T, Vrijens M. Use of frameless intrauterine devices and systems in young nulliparous and adolescent women: results of a multicenter study. Int J Womens Health 2014; 6: 727-734
• 65 Andrade A, Wildemeersch D. Menstrual blood loss in women using the frameless FibroPlant LNG-IUS. Contraception 2009; 79 (2) 134-138
• 66 Reeves MF, Hathaway MJ, Canela Oleaga JM, Katz BH, Tal MG. A randomized single-blinded trial of VeraCept, a novel nitinol low-dose copper intrauterine contraceptive compared with a copper T380S intrauterine contraceptive. [Abstract] Obstet Gynecol 2015; 125 (5, Suppl): 5s
• 67 Gemzell-Danielsson K, Apter D, Hauck B , et al. The effect of age, parity and body mass index on the efficacy, safety, placement and user satisfaction associated with two low-dose levonorgestrel intrauterine contraceptive systems: subgroup analyses of data from a phase III trial. PLoS ONE 2015; 10 (9) e0135309