The Comeback of the IUD in Twenty-First Century USA.

From 1995 to 2014, intrauterine devices (IUDs) rose from ranking 10th (out of 11) among contraceptive methods to being the fourth most popular, outnumbered only by the pill, sterilization, and condoms. In 1995, the IUD had been largely abandoned by American doctors; two decades later, major medical associations promoted it as a "first line" method for prospective users of all ages. This paper explains the rapid and dramatic increase in intrauterine contraception by exploring three influential factors from the 1970s-1980s - the Dalkon Shield disaster, the lack of innovation in contraceptive research and development, and the moral panic over teen pregnancy in America - that created circumstances by the early 2000s in which health care providers became more receptive to long-acting reversible contraception. Key thought leaders in obstetrics and gynecology took it upon themselves to rehabilitate the IUD in the court of medical opinion and succeeded in securing professional approval of the device as the initial step in its resurrection.

Testing the Gräfenberg Ring in Interwar Britain: Norman Haire, Helena Wright, and the Debate over Statistical Evidence, Side Effects, and Intra-uterine Contraception.

This paper examines the introduction to Britain of the Gräfenberg ring, an early version of what later became known as an intrauterine device (IUD). The struggle during the interwar years to establish the value of the ring provides an opportunity for a case study of the evaluation and acceptance of a new medical device. With the professionalization of the birth control movement and the expansion of birth control clinics in interwar Britain, efforts to develop better scientific means for contraception grew rapidly. At the end of the nineteenth century, methods for controlling fertility ranged from coitus interruptus and abstinence, to diverse substances ingested or placed into the vagina, to barrier methods. The first decades of the twentieth century brought early work on chemical contraceptives as well as a number of new intrauterine devices, among them the Gräfenberg ring. Developing a cheap, reliable, and widely acceptable contraceptive became a pressing goal for activists in the voluntary birth control movement in Britain between the wars. Yet, tensions developed over the best form of contraception to prescribe. By situating the Gräfenberg ring within the context of the debates and competition among British medical and birth control professionals, this paper reveals broader issues of power relationships and expertise in the assessment of a new medical technology.

The efficacy of intrauterine devices for emergency contraception: a systematic review of 35 years of experience.

BACKGROUND: Intrauterine devices (IUDs) have been studied for use for emergency contraception for at least 35 years. IUDs are safe and highly effective for emergency contraception and regular contraception, and are extremely cost-effective as an ongoing method. The objective of this study was to evaluate the existing data to estimate the efficacy of IUDs for emergency contraception. METHODS: The reference list for this study was generated from hand searching the reference lists of relevant articles and our own article archives, and electronic searches of several databases: Medline, Global Health, Clinicaltrials.gov, Popline, Wanfang Data (Chinese) and Weipu Data (Chinese). We included studies published in English or Chinese, with a defined population of women who presented for emergency contraception and were provided with an IUD, and in which the number of pregnancies was ascertained and loss to follow-up was clearly defined. Data from each article were abstracted independently by two reviewers. RESULTS: The 42 studies (of 274 retrieved) that met our inclusion criteria were conducted in six countries between 1979 and 2011 and included eight different types of IUD and 7034 women. The maximum timeframe from intercourse to insertion of the IUD ranged from 2 days to 10 or more days; the majority of insertions (74% of studies) occurred within 5 days of intercourse. The pregnancy rate (excluding one outlier study) was 0.09%. CONCLUSIONS: IUDs are a highly effective method of contraception after unprotected intercourse. Because they are safe for the majority of women, highly effective and cost-effective when left in place as ongoing contraception, whenever clinically feasible IUDs should be included in the range of emergency contraception options offered to patients presenting after unprotected intercourse. This review is limited by the fact that the original studies did not provide sufficient data on the delay between intercourse and insertion of the IUD, parity, cycle day of intercourse or IUD type to allow analysis by any of these variables.

Contraception--past and future.

Modern contraceptive methods have a surprisingly short history and are dominated by the oral contraceptive pill, which came on to the market in 1960. New developments since the advent of the pill have been largely limited to tinkering with the contents and routes of administration of hormonal contraception. The knowledge that would allow a more exciting approach to new contraceptives does exist but the will to proceed is hampered by financial, political and moral factors, and perhaps ironically by the AIDS epidemic.

State-of-the-art of non-hormonal methods of contraception: III. Intrauterine devices.

Since the 1959 revival of the IUD, non-hormonal devices have become the most widely used of all reversible contraceptives. Pregnancy rates of copper-releasing IUDs in current use range from approximately 0.5 to 1.5 per hundred continuing users in the first year, with somewhat lower annual pregnancy rates thereafter. Evidence-based research has been systematically conducted and translated into guidelines for eligibility criteria and problem management. Recent device research, beyond the T, Multiload and frameless devices has centred on improved designs such as U ,Y and Slimline shapes, or enhanced copper release, the latter through electrochemical effects or nanotechnology applications. Other IUD research foci concern devices that decrease bleeding and pain by releasing non-steroidal anti-inflammatory drugs. Yet other research lines indicate noncontraceptive benefits of copper intrauterine devices in protecting against endometrial cancer, and favourable risk-benefit analyses of IUD use by women at risk of or post HIV infection. IUD mechanisms of action and the relation of IUDs to pelvic infection and ectopic pregnancy are briefly reviewed. For our literature search we used Medline, Popline and Cochrane Library data bases, Google search, our personal files, and the references contained in articles in our files.

The intrauterine contraceptive device.

The intrinsic appeal of the convenience and effectiveness of the IUD has increased interest in these devices in the United States in recent years. Understanding the uniqueness of the Dalkon Shield experience and applying the lessons learned about appropriate candidate selection should continue to reduce any lingering liability concerns. One lawsuit has been filed against the copper IUD in the 12 years that it has been available in the United States. If legislation requiring insurance coverage for IUDs and other prescription contraceptive agents continues to be passed by more states, the use of IUDs will continue to grow. The introduction of new IUDs with different side-effect profiles will expand the number of US women who can and will be interested in using this method of birth control.

Intrauterine contraception: from silver ring to intrauterine contraceptive implant.

Gräfenberg introduced his silver ring in 1928 and by his classic paper, published in 1931, provided intrauterine contraception with a scientific basis. For largely non-medical reasons, the Gräfenberg ring vanished from the scene a few years later, and it took almost 30 years before the method was rehabilitated as a result of a change in mental attitude toward birth control, the awareness of world population explosion, and the introduction of improved intrauterine devices (IUDs). The United States became the epicenter of IUD research in the 1960s but, due to adverse publicity and the threat of litigation, the pendulum swung and European investigators took over the job of improving the IUD. Proceeding from Dr Gräfenberg's classic paper, the major steps in the evolution of the intrauterine devices are retraced with focus on the scientists who were innovative in the field.

Dr. Lippes and his loop. Four decades in perspective.

Forty years ago Jack Lippes, M.D., hand made the first models of his "Double-S" intrauterine contraceptive device (IUD). Subsequently the Lippes Loop became the standard against which other IUDs came to be compared. Though millions of loops have been used, they have mostly been supplanted by copper-bearing, T-shaped devices. Due to the implant nature of IUDs, on occasion a patient presents well into menopause still bearing a Lippes Loop or other early IUD. Although there is no established causal evidence linking IUDs retained after menopause and cancer or other significant problems, such retention does confuse the diagnosis of post-menopausal bleeding and makes difficult such procedures as endometrial biopsy and ultrasonic endometrial evaluation. When contraception is no longer an issue, it is prudent to remove IUDs since they may cloud future necessary evaluations.

Historical considerations in the development of modern IUD's: patient and device selection and the importance of insertion techniques.

PIP: The Cooperative Statistical Program was initiated in 1963, the 1st effort to evaluate a method of contraception by using pooled data from several clinics and a systematic statistical method. Progress reports were issued from 1963 through 1970. The reports provided epidemiological evidence that Lippes Loop D has the best overall performance of all the IUDs studied. Expulsion, pregnancy, and removal rates for bleeding and pain were measured. Performance rates for all these indices are better with the duration of the device. Since 1970, numbers of new IUDs have been designed and tested clinically. The aim was to improve efficacy, to make IUDs suitable for women who had never been pregnant, and to reduce the incidence of pain and bleeding. The T-shaped IUD has been found to cause lowered rates of removal for pain and bleeding. To counteract the higher pregnancy rate with this device, an antifertility agent can be added to the IUD for timed release. Steroids and copper have both been used. Clinics differ in their performance rates due to differing patient populations, differing physician experience, and differing clinic attitudes. The insertion technique is important to long-term performance.^ieng

[Contraception in Mexico]. / Anticoncepción en México.

This is an historic review of contraception in Mexico from 1961 to 2002. It includes a description about prescription and investigation on each contraceptive option.

[The Multiload--a modern intrauterine device]. / Multiload--modernata vutrematochna spirala.

In the first part of publication the authors make a profound review of history of development and qualities of Intra Uterine Devices/IUD's/. There are reflected the first steps dated from the ancient times to come to modern IUD's (Multiload, Copper T. Slimline). In Table 1 and 2 (on W.A.A. van Os) are represented single cases (pregnancy, expulsion and extracted IUD's) related to the modern intrauterine devices: MLCu 250 and MLCu 375 for the periods of 1, 3 and 5 years. In the second part the authors represent their scientific and practical results which has been obtained at the Bulgarian Family Planning and Sexual Health Association and the Ob./Gyn. Department of Medical University-Sofia. A retrospective research has been conducted on 406 women who delivered between 18 and 42 years of age and to which MLCu 375 have been inserted. The so analyzed and presented results show very good qualities of MLCu 375 IUD. The cases' frequency corresponds to the one announced by the world leading practice of contraception.