Reducing Barriers to the use of the Intrauterine Contraceptive Device as a Long Acting Reversible Contraceptive

Norman D. Goldstuck

Abstract

The intrauterine device (IUD) is the oldest long acting reversible contraceptive (LARC) method. There remain widespread barriers to its general acceptance, although some have been overcome, others remain. These stem from a lack of understanding of uterine anatomy and physiology. Uterine measuring techniques did not become popular, probably because of the extra effort required prior to IUD insertion. Unfortunately the information they provided regarding IUD design was also not heeded. In some countries varying sizes of other IUDs (second generation) are now available. The third generation hormonal carrying IUDs have also reduced barriers by lowering side effects and producing added health benefits. Fourth generation IUDs will provide added health benefits in addition to contraception and should further reduce barriers to IUD use. Most remaining IUD barriers are due to provider perceptions. Most are based on psychological, moral and religious prejudices. These should not be allowed to interfere with the provision of LARC methods of contraception. There are also acceptor barriers which can be modified by providing education about the method. The use of the IUD as a LARC method is increasing in many developed and developing countries. New technology should help propel the IUD into a more mainstream contraceptive. (Afr J Reprod Health 2014; 18[4]: 15-25).

 

Keywords:  IUD, LARC, barriers, improvements

 

Résumé

 

Le dispositif intra-utérin (DIU) est la plus ancienne méthode  contraceptive réversible à longue durée d’action (CRLDA). Il reste encore des obstacles généralisés à son acceptation globale ;  bien que certains aient été surmontés, d'autres restent toujours. Ceuxci découlent d'un manque de compréhension de l'anatomie et de la physiologie de l'utérus. Les techniques pour mesurer les  utérins ne sont pas devenues populaires, probablement en raison de l'effort supplémentaire nécessaire avant l’insertion d'un DIU. Malheureusement, l'information qu'ils ont fournie quant à la conception de DIU n’a pas également  été entendue. Dans certains pays,  des tailles différentes d’autres  DIU (deuxième génération) sont maintenant disponibles. L’hormonal de la a troisième génération qui portent les DIUs a également réduit les obstacles en diminuant  les effets secondaires et la production de bienfaits pour la santé. Les DIUs de la quatrième  génération offriront des avantages supplémentaires pour la santé, en plus de la contraception et devraient encore réduire les obstacles à l'utilisation d'un DIU. La plupart des obstacles de DIU qui subsistent sont dus à des perceptions des fournisseurs. La plupart sont basées sur des préjugés psychologiques, moraux et religieux. Ils ne devraient pas être autorisés à interférer avec la fourniture de méthodes de la conception à la CRLDA. Il y a aussi des obstacles des accepteurs qui peuvent être modifiés par une éducation sur la méthode. L'utilisation du stérilet comme méthode de la CRLDA) est en augmentation dans de nombreux pays développés et en développement. Maintenant, la technologie devrait aider à propulser le DIU en un contraceptif plus populaire. (Afr J Reprod Health 2014; 18[4]: 15-25).


 

Mots clés: DIU, CRLA, barrières,  améliorations

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References

Blumenthal P, Voedisch A, Gemzell - Danielson K. Strategies to prevent unintended pregnancy: increasing use of long-acting reversible contraception. Human Reproduction Update 2011 17 121 37.

Richter R. Ein Mittal zur Verhuetung der Konzeption. Deutsch Med Wschr 1909 35 1525 7 [German]

Pust K. inbreichbarer Frauenschutz. Deutsch Med schr 1923 9 952 3.[German]

Grafenberg E. Silk as Anticoncipient. Geborten regelung - Vortraege und Verhandlung en des Aerztekursus vom 28 - 30 Dezember 1928, Bendix K, editor. Berlin Selbsverlag, 1929.[German]

Halton M, Dickinson RC. Tietze C. Contraception with intrauterine silk coil. Human Fert 1949:10 13.

Oppenheimer W. Prevention of pregnancy by the

Grafenberg ring method a revaluation after 28 years’ experience. Am J. Obstet Gynecol 1959;78:446 54.

Ishihara A. Clinical studies on intrauterine contraception, especially the present state of contraception in Japan and the experience in the use of intrauterine rings. Yokohama Med J 1959;10:89.

Tietze C, Lewit, S. Recommended procedures for the statistical evaluation of intrauterine contraception. Stud Fam Plan 1973;4:35 42.

Margulies L. History of Intrauterine Devices. Bull NY Acad Med 1975,51:662 7.

Thiery M. Pioneers of the intrauterine device. Eur J Cont Reprod Health Care 1997 2 15 23.

Moyer DL, Mishell DR. Reactions of human endometrium to the intrauterine foreign body. 2.Long term effects on the endometrial histology and cytology. Am J Obstet Gynecol 1971;111:66 80.

Mumford SD. Kessel E. Was The Dalkon Shield a safe and effective intrauterine device? The conflict between case control and clinical trial study findings. Fertil Steril 1992;57:1151 76.

Zipper JA, Tatum HJ, Pastene L, Medel M, Riviera M. Metallic copper as an intrauterine adjunct to the “T” device. Am J. Obstet Gynecol 1969;105:1274 8.

ipper A, Tatum, H , Medel M, Pastene L, Rivera M. Contraception through the use of intrauterine metals. 1. Copper as an adjunct to the “T” device. The endouterine copper “T”. Am Obstet Gynecol

109 771

Benacerraf R, hipp TD, Lyons G, romley . idth of the normal uterine cavity in premenopausal women and effect of parity Obstet Gynecol 2010 11 305 10.

World Health Organisation, Special Programme of Research, Development and Research Training in Human Reproduction. The TCu380A, TCu220C, Multiload 250 and Nova T IUDs At 3,5 and 7 years of se - results from three randomized multicentre trials. Contraception 1990;42:141 58.

Dickinson RL. Human sex anatomy. Robert E. Krieger Publishing Co. 1971.

Kurz RH. Cavimeter uterine measurements and IUD clinical correlation. In Zatuchni GI, Goldsmith A, Sciarra JJ, eds. Intrauterine contraception: Advances and future prospects. Philadelphia, Harper and Row, 1984:126 41.

Cleland R, Zhu H, Goldstuck N, Cheng L, Trussell J. The efficacy of intrauterine devices for emergency contraception: a systematic review of 35 Years of experience. Human Reproduction 2012;27:1994 200.

Reynoso L, Zamora G, Gonzalez - Didi M, Aznar R. Uterine metrology in Mexican women. In Hasson HM, Hafez ES, Van Os WA Eds. Biomedical Aspects of IUDS. Hingham, Masss. MTP Press 1985: 119 24.

Hasson HM. Differential uterine measurements recorded in vivo. Obstet Gynecol 1974;43:400 12.

Ismail AAA, Anwar SM,.Keshk SM et al . Uterine geometry by Wing sound and hysteroraphy versus direct measurements. Adv contracept 1987;3:237 43.

ang G. Development of a new method of insertion of IUDs. Contraception 1982 25 05 2 0.

Wildemeersch D, Pett A, Jandi S, Hasskamp T, Rowe P, Vrijens M Precision intrauterine contraception may significantly increase continuation of use: a review of long-term clinical experience with frameless copper- releasing intrauterine contraception devices. Int J Women's Health 2013;5:215–25 DOI: http://dx. doi. org /10.2147/IJWH.S42784.

Goldstuck ND. The relationship of IUD dimensions to event rates. Contracept Deliv Syst 1982;3:103 5 .

Canteiro R. Bahamondes MV, Fernandes, ADS et al. Length of the endometrial cavity as measured by uterine sounding and ultrasonography in women of different parities. Contraception 2010;81:515 9.

Pharriss B, Erichson R, Bashaw J et al. Progestasert: a uterine therapeutic system for long term contraception : 1. Philosophy and clinical efficacy. Fertil Steril 1974;25:915 21.

Inki P. Long term use of the levonorgestrel - releasing intrauterine system. Contraception 2007; 75;S161–S1 66(Suppl).

Wildemeersch D, Andrade A. Review of clinical experience with the frameless LNG-IUS for contraception and treatment of heavy menstrual bleeding Gynecological Endocrinology,2010;26:383–9.

Trussell J. Lalla AM, Doan QV et al. Cost effectiveness of contraception in the United States. Contraception 2009;79:5 14.

Hubacher D, Lara-Picaldi R, Talyor DJ et al. Use of copper intrauterine devices and the risk of tubal infertility among nulligravid women. N Engl Med 2001;345:561 7.

Beining RM , Dennis LK,Smith EM, Dokras A. MetaAnalysis of Intrauterine Device Use and Risk of Endometrial Cancer. Ann Epidemiol 2008;18:492–9.

Castellsagué X, Díaz M, Vaccarella S, de Sanjosé S, Muñoz N, Herrero R, Franceschi S, Meijer CJLM, Bosch FX. Intruterine device use, cervical infection the human papillomavirus, and risk of cervical cancer: a pooled analysis of 26 epidemiological studies. The Lancet Oncology 2011The Lancet Oncology, Early Online Publication, 13 September 2011doi:10.1016/ S1470-2045(11)70223-6.

Ortiz ME, Croxatto HB. Copper-T intrauterine device and levonorgestrel intrauterine system: biological bases of their mechanism of action. Contraception 2007; 75:S16–S30.

White MK, Org HW. Rooks Jb. Rochat RW. Intrauterine device termination rates and the menstrual cycle day of insertion. Obstet Gynecol 1980; 55(2)-220 -224.

Allen RH, artz D, Grimes DA, Hubacher D, O’ rien P. Interventions for pain with intrauterine device insertion. Cochrane Database of Systematic Reviews 2009, Issue 3. Art No. CD007373. DOI: 10. 1002/14651858. CD 007373. pub 2.

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