Long-acting Reversible Contraceptives - IUDS/IUS and Implants: A Review (2025)

Advances in Contraception: IUDs from a Managed Care Perspective

Journal of Women's Health, 2008

Contraceptive use in the United States is virtually universal among women of reproductive age. However, unplanned pregnancies continue to occur and can be largely attributed to the nonuse and misuse of contraception. Reducing unintended pregnancies constitutes a critical goal for managed care and the public. This can be achieved in part with intrauterine devices (IUDs), which are an effective method of contraception that require a one-time insertion and stay in place for 5-10 years. Therefore, compliance issues are largely mitigated, and actual use efficacy is the same as perfect use efficacy. The IUD is also reversible, unlike tubal ligation, and could potentially be the contraceptive of choice in today's environment. Unfortunately, safety concerns surrounding the use of older IUDs have precluded many women from recognizing the benefits of their use. Currently, the only approved IUDs in the United States are ParaGard ® , the copper IUD, and Mirena ® , the levonorgestrel-releasing intrauterine system (LNG-IUS). These devices offer superior safety profiles compared with those products that were withdrawn from the market in the 1970s. In addition to a favorable safety and tolerability profile, the LNG-IUS offers an advantage over copper IUDs, demonstrating improved efficacy in preventing intrauterine and ectopic pregnancies. Successful communication between patients and providers regarding the improved safety and efficacy of newer IUDs will ensure an appropriate place in therapy. Thus, greater numbers of women will recognize the IUD as a safe, cost-effective means to contraception, thereby reducing the economic and social burdens associated with unplanned pregnancies.

Intrauterine Device-A Long-term Effective Contraceptive Method

Revista de Chimie

The Intrauterine Device (IUD) is a modern method of intrauterine contraception, with high efficiency and long lasting uninterrupted use. The study of IUD dropout rate in first year of use and the frequency of unexpected pregnancies A prospective study was conducted within the Buna Vestire Galati Obstetrics and Gynecology Hospital during 2014 - 2015, which tracked women who had requested the installation of an IUD via the Family Planning Practice in the hospital ambulatory and who observed the recommended control visits. Various types of IUDs, most of them T-Cooper 380 and with progestagen (LNG-IUD), less with Gold were fitted. Of the total number of IDUs in that period, 67.6% returned to the indicated annual check or when some issues were reported. As a complaint to the method, there was only one case of intrauterine pregnancy and two IUDs lost. Three women gave up the IUD to have a pregnancy, and two requested extraction of an LNG-IUD due to repeated bleeding. One case had a PID th...

Efficacy and Safety of Long-Acting Reversible Contraception

Drugs, 2011

Long-acting reversible contraception (LARC) includes intrauterine devices (IUDs) and the subdermal implant. These methods are the most effective reversible methods of contraception, and have the additional advantages of being long-lasting, convenient, well liked by users and cost effective. Compared with other user-dependent methods that increase the risk of noncompliancerelated method failure, LARC methods can bring 'typical use' failure rates more in line with 'perfect use' failure rates. LARC methods are 'forgettable'; they are not dependent on compliance with a pill-taking regimen, remembering to change a patch or ring, or coming back to the clinician for an injection. LARC method failure rates rival that of tubal sterilization at <1% for IUDs and the subdermal implant. For these reasons, we believe that IUDs and implants should be offered as first-line contraception for most women. This article provides a review of the LARC methods that are currently available in the US, including their effectiveness, advantages, disadvantages and contraindications. Additionally, we dispel myths and misconceptions regarding IUDs, and address the barriers to LARC use. Recent years have seen an expansion in the type of contraceptive options available to women. Long-acting reversible contraception (LARC: intrauterine contraception and subdermal implants) are highly effective and have the additional advantages of being longlasting, convenient, well liked by users and cost effective. [1] Compared with shorter-term, user-dependent methods, which increase the risk of noncompliance-related method failure, LARC methods can bring 'typical use' failure rates more in line with 'perfect use' failure rates. In fact, IUDs and implants are the most effective methods of contraception available today (figure 1 and figure 2). LARC methods are 'forgettable'; they are not dependent on compliance with a pill-taking regimen, remembering to change a patch or ring, or coming back to the clinician for an injection. An additional unifying characteristic among LARC methods is that they are all estrogen free. Estrogen is the primary hormone associated with thromboembolic events. Oral contraceptive pills and male condoms are the most commonly used reversible methods of contraception in the US. [3] However, typical male condom failure rate is approximately 15-18% and oral contraceptive failure rate is 8-9%. At <1%, LARC method failure rates rival that of tubal sterilization. [1] Prior to initiating a new contraceptive method, it is important to consider the characteristics of each method, including effectiveness, adverse effects and patient acceptability. Clinicians must also consider a patient's medical co-morbidities and conditions or behaviours that may

Contraceptive efficacy of intrauterine devices

American Journal of Obstetrics and Gynecology, 2008

To compare the contraceptive efficacy of various types of intrauterine devices (IUD; copper devices, Nova-T, intrauterine contraceptive systems, levonorgestrel-releasing devices), we reviewed all relevant publications on this subject that have been published over the last 2 decades. The first point to be highlighted by this review is the excellent effectiveness of IUDs, with a global cumulative pregnancy rate Ͻ2% at 5 years, whatever the type of device used. We observed a large variation in efficacy rate according to the type of IUD and also according to study design. Nevertheless, of all the types of IUDs, the levonorgestrel-releasing IUD and to a lesser extent the TCu380A IUD seem to be the most effective, with a cumulative pregnancy rate at 5 years of Ͻ0.5% for the levonorgestrel-releasing IUD and between 0.3% and 0.6% for the TCu380A IUD.

IUD expulsion solved with implant technology

Contraception, 1995

In an attempt to minimize the problem of IUD explusion, implantation technology has been developed and tested. The trials have extended from 1985 until the present time for interval as well as for immediate postabortal and postplacental insertion and fixation of the CuFix IUD (Gyne-FixVM). The present article reports on an ongoing study with GyneFix'" interval insertion, with an improved inserter, in 820 women, observed up to 3 years, of whom 213 (25.9%) are nulligravid/nulliparous. The cumulative expulsion rate is 0.6 per 100 women-years at 3 years and is not significantly higher in the nuZZigravid/nulliparous group. The cumulative pregnancy rate is 0.6 and the cumulative removal rate for medical reasons 3.2 at 3 years. The total experience in this multicenter study covers approximately 14,000 woman-months. It is concluded that the design characteristics of the GyneFix'" (fixed, frameless, and flexible) explain the low expulsion, high efficacy and high acceptability rates. The implantation technology is very effective and the improved inserter allows easy insertion and optimal anchoring. CONTRACEPTION

Safety and Benefits of Contraceptives Implants: A Systematic Review

Pharmaceuticals, 2021

Progestin-only contraceptive implants provide long-acting, highly effective reversible contraception. We searched the medical publications in PubMed, CENTRAL, and EMBASE for relevant articles on hormonal implants published in English between 1990 and 2021. Levonorgestrel (LNG) 6-capsule subdermal implants represented the first effective system approved for reversible contraception. The etonogestrel (ENG) single rod dispositive has been widely employed in clinical practice, since it is a highly effective and safe contraceptive method. Abnormal menstrual bleeding is a common ENG side effect, representing the main reason for its premature discontinuation. Emerging evidence demonstrated that it is possible to extend the use of the ENG implant beyond the three-year period for which it is approved. The ENG implant could be an effective and discrete alternative to the IUD in young girls, such as post-partum/post-abortion. Implants should be inserted by trained skilled clinicians who previo...

Risk factors for IUD failure: results of a large multicentre case-control study

Human Reproduction, 2006

BACKGROUND: This study was conducted to identify the risk factors for intrauterine device (IUD) failure. METHODS: A retrospective case-control study was carried out between 1999 and 2002. Cases (women with an IUD and a confirmed pregnancy) and controls (women with an IUD and who were not pregnant) were recruited by gynaecologists. An anonymous questionnaire was filled in during the consultation, with specific items regarding any type of drugs used before the predicted fertile period for cases and within the cycle that ended in menses for controls. RESULTS: Two hundred and sixteen cases were compared with 657 controls. Age was associated with IUD failure, with a significantly lower failure risk in women >35 years. A significant relationship was observed between a history of IUD expulsion and IUD failure risk (age-adjusted odds ratio 3.31, 95% CI 1.40-7.81). No relationship was observed between the risk of IUD failure and gynaecological background (fibroma, polyps and miscarriage), nor with any type of medicine taken by the woman. CONCLUSION: This study is clearly reassuring, as we found that anti-inflammatory drugs and any other medicines taken by the woman were not implicated in IUD failure. Only a history of previous IUD expulsion was found to be a risk factor for failure, indicating that these women should have regular medical and echographical follow-up. Comparing the efficacy rate of various types of IUDs, we found a clear advantage for levonorgestrel-releasing devices.

Intrauterine device quo vadis? Why intrauterine device use should be revisited particularly in nulliparous women?

Open Access Journal of Contraception, 2015

Background: Long-acting reversible contraceptive (LARC) methods, including intrauterine devices (IUDs) and the contraceptive implant, are considered the best methods for preventing unintended pregnancies, rapid repeat pregnancy, and abortion in young women. An opinion paper of 2012 by the American College of Obstetricians and Gynecologists recommends Mirena and Paragard for use in nulliparous and adolescent women. However, these IUDs are not designed for young women and are not optimal as they often lead to early discontinuation. Objective: This article was written with the objective to respond to the urgent need to improve intrauterine contraception as it is likely that the objectives of LARC will not be met without significant improvement of IUD design. Anatomical variations in size and shape of the uterus are not sufficiently considered, producing harm and suffering, which often lead to early removal of the IUD. Proposed problem solving: The article describes why IUDs should be revisited to meet the challenge of LARC and proposes how to solve these problems. The opinion statement presented here may be considered provocative but is based on hundreds of women with IUD problems who consult or are referred to the practices of the authors of this article due to the disproportion between the IUD and their small uterine cavity. The solution is simple but requires a revision of the current design of IUDs. One-dimensional (longitudinal) IUDs are likely to be the first option. Framed devices with shortened transverse arm and IUDs which adapt to the width of the given uterus are viewed as second best. Conclusion: One of the reasons of the high unintended pregnancy rate in the USA may be the paucity of suitable IUDs. Also, the legal climate in the USA seems to be a problem for developers as many lawsuits have recently been reported. Clinical studies conducted in young nulliparous and adolescent women suggest that IUDs that fit well in the uterine cavity, like a shoe, result in better tolerance, less side effects, and last but not least, higher use continuation rates.

Effectiveness of Long-Acting Reversible Contraception

New England Journal of Medicine, 2012

The rate of unintended pregnancy in the United States is much higher than in other developed nations. Approximately half of unintended pregnancies are due to contraceptive failure, largely owing to inconsistent or incorrect use.

Use of IUDs for emergency contraception: current perspectives

Open Access Journal of Contraception, 2014

Emergency contraception is an essential intervention for the prevention of unplanned pregnancy worldwide. The copper intrauterine device (IUD) is highly effective at preventing pregnancy after unprotected sex or contraceptive failure. Unfortunately, its usage in this context is low and far exceeded by hormonal forms of emergency contraception. These have higher failure rates and, unlike the IUD, are not effective post-fertilization. This review aims to summarize the literature surrounding IUD use as emergency contraception, contrast it with the hormonal options, and provide suggestions for increased usage.

IRJET- Intrauterine Device (IUD): A Review of Types of IUD Devices

IRJET, 2021

An intrauterine device (IUD) is a small, T-shaped birth control device that is inserted into the uterus of female to prevent pregnancy. IUDs are one form of long-acting reversible birth control and are safe and effective. The types of intrauterine devices commonly available in the market are Nonhormonal IUD and Hormonal IUD. The aim of this paper is to give a brief review about the two types of IUD's, its history, Devices and its composition, Advantages and Disadvantages, Risks, and the upcoming research in IUD's.

The new LNG-releasing IUS: a new opportunity to reduce the burden of unintended pregnancy

European Journal of Obstetrics & Gynecology and Reproductive Biology, 2015

A 3-year multicentre randomized controlled trial of etonogestrel- and levonorgestrel-releasing contraceptive implants, with non-randomized matched copper-intrauterine device controls

Human reproduction (Oxford, England), 2015

Is there any difference in the clinical performance of the 3-year one-rod etonogestrel (ENG)- and the 5-year two-rod levonorgestrel (LNG)-releasing contraceptive implants during 3 years of insertion, and between implant and intrauterine device (IUD) contraception, in particular complaints possibly related to hormonal contraceptives? The cumulative contraceptive effectiveness after 3 years and method continuation through 2.5 years were not significantly different between ENG and LNG implants, but both outcomes were significantly worse in the non-randomized age-matched group of IUD users than in the combined implant group. ENG- and LNG-releasing implants are safe and highly efficacious contraceptives with pregnancy rates reported to be 0.0-0.5 per 100 women-years (W-Y). No head-to-head comparative study of the two implants has been undertaken, and little information is available on comparisons of complaints of side effects of implant and copper IUD users. This was an open parallel gro...

An Article on Common Risks of Intrauterine Devices Experienced by Disparate Age Group of Women

2021

An intrauterine device, or IUD, is a small device that doctors insert in the uterus as a contraceptive. Many women experience IUD side effects, especially in the first few weeks to the several months following insertion. Major concern in disparate age of women depends upon various physiological factors. Indubitably uterine perforation, expulsion and bleeding irregularities are the common one with an IUD. Sometimes the perforation may be partial or sometimes whole device passes to the peritoneal cavity, moreover large randomized trial of parous women aged 18 to 38 observed highest rate of IUD expulsion. Copper containing device mostly causes intermenstrual spotting or heavy or prolonged menstrual bleeding and thus it is main reason for the method discontinuation. All the risks should be explained to patients and should be prevented, if possible, by taking all measures to insert devices safely, and diagnosed and managed appropriately.

Practical Advice for Emergency IUD Contraception in Young Women

Obstetrics and Gynecology International, 2015

Too few women are aware of the very high efficacy of intrauterine copper devices (IUDs) to prevent pregnancy after unprotected intercourse. Women who frequently engage in unprotected intercourse or seek emergency contraception (EC) are at high risk of unplanned pregnancy and possible abortion. It is therefore important that these women receive precise and accurate information about intrauterine devices as they may benefit from using an IUD for EC as continuing contraception. Copper IUDs should be used as first choice options given their rapid onset of action and their long-term contraceptive action which require minimal thought or intervention on the part of the user. In the United States, there is only one copper IUD presently available which limits treatment options. There are numerous copper IUDs available for use in EC, however, their designs and size are not always optimal for use in nulliparous women or women with smaller or narrower uteruses. Utilization of frameless IUDs whi...

Prolonged intrauterine contraception: A seven-year randomized study of the levonorgestrel 20 mcg/day (LNg 20) and the Copper T380 Ag IUDS

Contraception, 1991

A levonorgestrel-releasing IUD and the Copper T 380Ag IUD were in randomized comparison for seven years in five clinics. In two other clinics the randomized study was truncated at five years, but use of the Copper T continued. No pregnancies occurred to users of either device in years 6 and 7. Cumulative pregnancy rates were 1.1 per 100 at seven years for the steroid-releasing and 1.4 per 100 for the copper-releasing RIDS. Cumulative rates of PID did not differ between devices. Infection rates appeared to be lowest during the sixth and seventh years of the study. Termination attributable to amenorrhea was the principal contributor to differences in cumulative continuation rates between devices. At the five clinics that carried the comparative study to seven years, cumulative continuation rates were 24.9 per 100 for LNg20 IUD users and 29.4 per 100 for TCu 380Ag users. Women who used either method for periods of five to seven years experienced, on average, marked to mild increases in hemoglobin as compared with levels at admission. The Copper T380 family and the LNg20 KIDS represent the most effective reversible contraceptive methods yet studied in long-term randomized trials.

Hormonal implants: Contraception for a new century

American Journal of Obstetrics and Gynecology, 1994

Reversible, Long - Action Reproductive Control with Frameless IUD for Intracesarean Insertion

Open Access Journal of Gynecology, 2017

Ease of intrauterine contraceptive device insertion in family planning settings

Australian and New Zealand Journal of Obstetrics and Gynaecology, 2012

STATUS OF INTENT AND FACTORS ASSOCIATED WITH THE USE OF IUDS IN THE PUERPERIUM OF WOMEN ADMITTED TO ``HOSPITAL UNIVERSITÁRIO JUNDIAÍ``-SP (Atena Editora)

STATUS OF INTENT AND FACTORS ASSOCIATED WITH THE USE OF IUDS IN THE PUERPERIUM OF WOMEN ADMITTED TO ``HOSPITAL UNIVERSITÁRIO JUNDIAÍ``-SP (Atena Editora), 2024

Introduction: Currently, unplanned pregnancies impact the lives of thousands of Brazilian women. 95% of postpartum women declare a desire to avoid pregnancy in the next 24 months, although 70% of these do not use contraceptive methods. Thus, the IUD represents a highly effective choice, available in the SUS, with few contraindications, and can be inserted in the immediate postpartum period. Therefore, it guarantees safe contraception, autonomy and family planning. Objective: To evaluate the perception of IUD use among postpartum women hospitalized in the HU ward who declared their intention to use it as a postpartum contraceptive; detail the reasons given for this choice and know the associated factors; compare the status of intention with the effective use of the method. Materials and Methods: Cross-sectional study carried out at the ``Hospital Universitário de Jundiaí`` based on questionnaires applied to postpartum women in the ward. In a prospective and analytical cohort study, questionnaires were administered in two different telephone contacts to characterize the outcome. The data were archived in a database and analyzed using simple descriptive statistics and, subsequently, bivariate analysis. Results: Between May 2021 and July 2023, 146 postpartum women between 14 and 42 years old were evaluated. 76.1% chose the IUD due to its high effectiveness. In the immediate postpartum period, 73.4% declared an unplanned pregnancy; 65.5% reported never having discussed contraception. After 40 days, 92.2% denied using the IUD, citing the waiting time for consultation as the main reason (50.5%). After 180 days, 80.4% denied using the IUD; 25.5% opted for another method. Conclusion: Although evaluated as a method of intention for postpartum use, the IUD was not the contraceptive most used by the postpartum women interviewed. According to this study, this is due to the lack of public policies that guarantee the principles and guidelines of the SUS. The difficulty in accessing gynecological consultations stands out, which reduces access to health information and education.