Paragard
   HOME

TheInfoList



OR:

A copper intrauterine device (IUD), also known as an intrauterine coil, copper coil, or non-hormonal IUD, is a form of
long-acting reversible contraception Long-acting reversible contraceptives (LARC) are methods of birth control that provide effective contraception for an extended period without requiring user action. They include hormonal and non-hormonal intrauterine devices (IUDs) and subdermal ...
and one of the most effective forms of birth control available. It can also be used for
emergency contraception Emergency contraception (EC) is a birth control measure, used after sexual intercourse to prevent pregnancy. There are different forms of EC. Emergency contraceptive pills (ECPs), sometimes simply referred to as emergency contraceptives (ECs), ...
within five days of unprotected sex. The device is placed in the
uterus The uterus (from Latin ''uterus'', : uteri or uteruses) or womb () is the hollow organ, organ in the reproductive system of most female mammals, including humans, that accommodates the embryonic development, embryonic and prenatal development, f ...
and lasts up to twelve years, depending on the amount of copper present in the device. It may be used for contraception regardless of age or previous pregnancy, and may be placed immediately after a vaginal delivery, cesarean delivery, or surgical abortion. Following its removal,
fertility Fertility in colloquial terms refers the ability to have offspring. In demographic contexts, fertility refers to the actual production of offspring, rather than the physical capability to reproduce, which is termed fecundity. The fertility rate ...
quickly returns. Common side effects include heavy menstrual periods and increased menstrual cramps (dysmenorrhea). Rarely, the device may come out or perforate the uterine wall. The copper IUD was initially developed in Germany in the early 1900s, but came into widespread medical use in the 1970s. It is on the
World Health Organization's List of Essential Medicines The WHO Model List of Essential Medicines (aka Essential Medicines List or EML), published by the World Health Organization (WHO), contains the medications considered to be most effective and safe to meet the most important needs in a health s ...
.


Medical uses

Copper IUDs are a form of
long-acting reversible contraception Long-acting reversible contraceptives (LARC) are methods of birth control that provide effective contraception for an extended period without requiring user action. They include hormonal and non-hormonal intrauterine devices (IUDs) and subdermal ...
and are one of the most effective forms of birth control available. The type of frame and amount of copper in the device can affect the effectiveness of different copper IUD models. The copper IUD is effective as contraception as soon as it is inserted, and loses efficacy when removed or if it becomes malpositioned. The effectiveness of the copper IUD (failure rate of 0.8%) is comparable to tubal sterilization (failure rate of 0.5%) for the first year. The failure rates for different models vary between 0.1 and 2.2% after one year of use. The T-shaped models with a surface area of 380 mm2 of copper have the lowest failure rates. The TCu380A (Paragard) has a one-year failure rate of 0.8% and a cumulative 12-year failure rate of 2.2%. Over 12 years of use, the models with less surface area of copper have higher failure rates. The TCu220A has a 12-year failure rate of 5.8%. The frameless GyneFix has a failure rate of less than 1% per year. A 2008 review of the available T-shaped copper IUDs recommended that the TCu380A and the TCu280S be used as the first choice for copper IUDs because those two models have the lowest failure rates and the longest lifespans. Worldwide, older IUD models with lower effectiveness rates are no longer produced. Though only approved by regulatory agencies for a maximum of 12 years, some devices may be effective with continuous use for up to 20 years. Because it does not contain hormones, the copper IUD does not disrupt the timing of an individual's menstrual cycle, nor does it prevent ovulation.


Emergency contraception

It was first discovered in 1976 that the copper IUD could be used as a form of
emergency contraception Emergency contraception (EC) is a birth control measure, used after sexual intercourse to prevent pregnancy. There are different forms of EC. Emergency contraceptive pills (ECPs), sometimes simply referred to as emergency contraceptives (ECs), ...
(EC). The copper IUD is the most effective form of emergency contraception, more effective than oral hormonal emergency contraception, including
mifepristone Mifepristone, and also known by its developmental code name RU-486, is a drug typically used in combination with misoprostol to bring about a medical abortion during pregnancy. This combination is 97% effective during the first 63 days (9 wee ...
,
ulipristal acetate Ulipristal acetate, sold under the brand name Ella among others, is a medication used for emergency contraception (birth control) and uterine fibroids. As emergency contraception it should be used within 120 hours of vaginally penetrating inte ...
, and
levonorgestrel Levonorgestrel is a hormonal medication used in a number of birth control methods. It is combined with an estrogen to make combination birth control pills. As an emergency birth control, sold under the brand names Plan B One-Step and Julie, ...
. Efficacy is not affected by user weight. The pregnancy rate among those using the copper IUD for emergency contraception is 0.09%. It can be used for emergency contraception up to five days after unprotected sex, and does not decrease in effectiveness during the five days. An additional advantage of using the copper IUD for emergency contraception is that it can then be used as a form of birth control for 10–12 years after insertion.


Removal and return to fertility

Removal of the copper IUD should be performed by a qualified medical practitioner. Fertility has been shown to return to previous levels quickly after removal of the device.


Side effects and complications


Complications

The most common complications related to the copper IUD are expulsion, perforation, and infection.
Infertility In biology, infertility is the inability of a male and female organism to Sexual reproduction, reproduce. It is usually not the natural state of a healthy organism that has reached sexual maturity, so children who have not undergone puberty, whi ...
after discontinuation and difficulty breastfeeding during use are not associated with the copper IUD. Expulsion rates can range from 2.2% to 11.4% of users from the first year to the 10th year. The TCu380A may have lower rates of expulsion than other models, and the frameless copper IUD has a similar rate of expulsion to models with frames. Expulsion is more likely with immediate or early postpartum or post-abortal placement. In the postpartum period, expulsion is less likely when the device is placed less than tenminutes after the placenta is delivered, or when inserted after a cesarean delivery. Unusual vaginal discharge, cramping or pain, spotting between periods, postcoital (after sex) spotting, pain during intercourse (dyspareunia), or the absence or lengthening of the strings can be signs of a possible expulsion. As with intentional removal, the device is immediately ineffective after expulsion. If an IUD with copper is inserted after an expulsion has occurred, the risk of re-expulsion has been estimated in one study to be approximately one third of cases after one year.
Magnetic resonance imaging Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to generate pictures of the anatomy and the physiological processes inside the body. MRI scanners use strong magnetic fields, magnetic field gradients, and ...
(MRI) may cause dislocation of a copper IUD, and it is therefore recommended to check the location of the IUD both before and after MRI. Perforation of the device through the uterine wall typically occurs at the time of placement, though it may occur spontaneously during the period of use. Estimates of the rate of perforation vary from 1.1 per 1000 to 1 per 3000 copper IUD insertions. Perforation may be slightly more common in people using the copper IUD while breastfeeding. Due to its inflammatory mechanism of action, a copper IUD that has completely perforated typically requires surgical removal due to the formation of dense adhesions around the device. A device embedded in the uterine wall may be removed hysteroscopically or surgically. The insertion of a copper IUD poses a transient risk of
pelvic inflammatory disease Pelvic inflammatory disease (PID), also known as pelvic inflammatory disorder, is an infection of the upper part of the female reproductive system, mainly the uterus, fallopian tubes, and ovaries, and inside of the pelvis. Often, there may be no ...
(PID) for 21days, though this is almost always in the setting of undiagnosed
gonorrhea Gonorrhoea or gonorrhea, colloquially known as the clap, is a sexually transmitted infection (STI) caused by the bacterium ''Neisseria gonorrhoeae''. Infection may involve the genitals, mouth, or rectum. Gonorrhea is spread through sexual c ...
or
chlamydia Chlamydia, or more specifically a chlamydia infection, is a sexually transmitted infection caused by the bacterium ''Chlamydia trachomatis''. Most people who are infected have no symptoms. When symptoms do appear, they may occur only several w ...
infection at the time of insertion. This occurs in less than 1 in 100 insertions. Beyond this time frame there is no increased risk of PID associated with copper IUD use. By the United States Agency for International Development (USAID). Retrieved on February 14, 2010 Postpartum insertion of a copper IUD is not associated with increased risk of infection, provided that the delivery was not complicated by an infection such as
chorioamnionitis Chorioamnionitis, also known as amnionitis and intra-amniotic infection (IAI), is inflammation of the fetal membranes (amnion and chorion), usually due to bacterial infection. In 2015, a National Institute of Child Health and Human Development W ...
.


Side effects

The most common side effects reported with use of the copper IUD are increased menstrual bleeding and menstrual cramps, both of which may remit after 3–6 months of use. Less frequently, intermenstrual bleeding may occur, especially in the first 3–6 months of use. The increase in menstrual blood volume varies in different studies but is reported to be as low as 20% and as high as 55%; however, there is no evidence for a concomitant change in
ferritin Ferritin is a universal intracellular and extracellular protein that stores iron and releases it in a controlled fashion. The protein is produced by almost all living organisms, including archaea, bacteria, algae, higher plants, and animals. ...
,
hemoglobin Hemoglobin (haemoglobin, Hb or Hgb) is a protein containing iron that facilitates the transportation of oxygen in red blood cells. Almost all vertebrates contain hemoglobin, with the sole exception of the fish family Channichthyidae. Hemoglobin ...
, or
hematocrit The hematocrit () (Ht or HCT), also known by several other names, is the volume percentage (vol%) of red blood cells (RBCs) in blood, measured as part of a blood test. The measurement depends on the number and size of red blood cells. It is nor ...
.
Menorrhagia Heavy menstrual bleeding (HMB), previously known as menorrhagia or hematomunia, is a menstrual period with excessively heavy flow. It is a type of abnormal uterine bleeding (AUB). Abnormal uterine bleeding can be caused by structural abnorm ...
(increased menstrual bleeding) and
dysmenorrhea Dysmenorrhea, also known as period pain, painful periods or menstrual cramps, is pain during menstruation. Its usual onset occurs around the time that menstruation begins. Symptoms typically last less than three days. The pain is usually in th ...
(painful menstrual bleeding) are typically treated with NSAID medications including
naproxen Naproxen, sold under the brand name Aleve among others, is a nonsteroidal anti-inflammatory drug (NSAID) used to treat pain, menstrual cramps, and inflammatory diseases such as rheumatoid arthritis, gout and fever. It is taken orally. It ...
,
ibuprofen Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that is used to relieve pain, fever, and inflammation. This includes dysmenorrhea, painful menstrual periods, migraines, and rheumatoid arthritis. It can be taken oral administration, ...
, and
mefenamic acid Mefenamic acid is a member of the Nonsteroidal anti-inflammatory drug#Anthranilic acid derivatives .28fenamates.29, anthranilic acid derivatives (or fenamate) class of nonsteroidal anti-inflammatory drugs (NSAIDs), and is used to treat mild to m ...
.


Contraceptive failure

The absolute risk of
ectopic pregnancy Ectopic pregnancy is a complication of pregnancy in which the embryo attaches outside the uterus. Signs and symptoms classically include abdominal pain and vaginal bleeding, but fewer than 50 percent of affected women have both of these sympto ...
with IUD use is lower than with no contraception due to the dramatically decreased rate of pregnancy overall. However, when pregnancy does occur with a copper IUD in place, a higher percentage of those pregnancies are ectopic, from 3% to 6%, a two to sixfold increase. This corresponds to an absolute rate of ectopic pregnancy in copper IUD users of 0.2–0.4 per 1000 person-years, compared to 3 per 1000 person-years in the population using no contraception. If a pregnancy continues with the IUD in place, there is an increased risk of complications including preterm delivery,
chorioamnionitis Chorioamnionitis, also known as amnionitis and intra-amniotic infection (IAI), is inflammation of the fetal membranes (amnion and chorion), usually due to bacterial infection. In 2015, a National Institute of Child Health and Human Development W ...
, and spontaneous abortion. If the IUD is removed, these risks are lower, especially the risks of bleeding and miscarriage; the rate of miscarriage approaches that of the general population depending on study population. Overall failure rates with the copper IUD are low, and are mainly dependent on the surface area of copper in the device. After 12 years of continuous use, the TCu380A device has a cumulative pregnancy rate of 1.7%. The TCu 380A is more effective than the MLCu375, MLCu350, TCu220, and TCu200. The TCu 380S is more effective than the TCu 380A. The frameless device has similar failure rates to conventional devices.


Contraindications

The copper IUD is considered safe and effective during lactation and in those who have never been pregnant. In the
World Health Organization The World Health Organization (WHO) is a list of specialized agencies of the United Nations, specialized agency of the United Nations which coordinates responses to international public health issues and emergencies. It is headquartered in Gen ...
(WHO) ''Medical Eligibility Criteria for Contraceptive Use'', category 3 contraindications (risk typically outweighs benefit) and category 4 contraindications (unacceptable health risk) are listed for the copper IUD. Category 3 contraindications include untreated
HIV/AIDS The HIV, human immunodeficiency virus (HIV) is a retrovirus that attacks the immune system. Without treatment, it can lead to a spectrum of conditions including acquired immunodeficiency syndrome (AIDS). It is a Preventive healthcare, pr ...
, recent and recurrent exposure to gonorrhea or chlamydia without adequate treatment, benign gestational trophoblastic disease, and
ovarian cancer Ovarian cancer is a cancerous tumor of an ovary. It may originate from the ovary itself or more commonly from communicating nearby structures such as fallopian tubes or the inner lining of the abdomen. The ovary is made up of three different ...
. Category 4 contraindications besides pregnancy and active genital tract infections (e.g. pelvic tuberculosis, sexually transmitted infections,
endometritis Endometritis is inflammation of the inner lining of the uterus (endometrium). Symptoms may include fever, lower abdominal pain, and abnormal vaginal bleeding or discharge. It is the most common cause of infection after childbirth. It is also p ...
) include malignant gestational trophoblastic disease,
abnormal uterine bleeding Abnormal uterine bleeding is vaginal bleeding from the uterus that is abnormally frequent, lasts excessively long, is heavier than normal, or is irregular. The term "dysfunctional uterine bleeding" was used when no underlying cause was presen ...
, active
cervical cancer Cervical cancer is a cancer arising from the cervix or in any layer of the wall of the cervix. It is due to the abnormal growth of cells that can invade or spread to other parts of the body. Early on, typically no symptoms are seen. Later sympt ...
,
Wilson's disease Wilson's disease (also called hepatolenticular degeneration) is a genetic disorder characterized by the excess build-up of copper in the body. Symptoms are typically related to the brain and liver. Liver-related symptoms include vomiting, wea ...
, and active
endometrial cancer Endometrial cancer is a cancer that arises from the endometrium (the epithelium, lining of the uterus or womb). It is the result of the abnormal growth of cells (biology), cells that can invade or spread to other parts of the body. The first s ...
. HIV infection is not itself a contraindication, as long as it is treated. There are no known drug interactions between the copper IUD and anti-retroviral medications.


Device description

There are various of models of copper IUDs available around the world. Most copper devices consist of a plastic (
polyethylene Polyethylene or polythene (abbreviated PE; IUPAC name polyethene or poly(methylene)) is the most commonly produced plastic. It is a polymer, primarily used for packaging (plastic bags, plastic films, geomembranes and containers including bott ...
) core that is wrapped in a copper wire. Many of the devices have a T-shape similar to the hormonal IUD. However, there are "frameless" copper IUDs available as well, the most popular of which is marketed as GyneFix. Early copper IUDs had copper around only the vertical stem, but more recent models have copper sleeves wrapped around the horizontal arms as well, increasing copper surface area and thereby effectiveness.


Insertion

A copper IUD can be inserted at any phase of the
menstrual cycle The menstrual cycle is a series of natural changes in hormone production and the structures of the uterus and ovaries of the female reproductive system that makes pregnancy possible. The ovarian cycle controls the production and release of eg ...
, as long as pregnancy can be reliably excluded. It may be inserted in the immediate
postpartum period The postpartum (or postnatal) period begins after childbirth and is typically considered to last for six to eight weeks. There are three distinct phases of the postnatal period; the acute phase, lasting for six to twelve hours after birth; the ...
(shortly after delivery of the
placenta The placenta (: placentas or placentae) is a temporary embryonic and later fetal organ that begins developing from the blastocyst shortly after implantation. It plays critical roles in facilitating nutrient, gas, and waste exchange between ...
), and after an induced
medical Medicine is the science and Praxis (process), practice of caring for patients, managing the Medical diagnosis, diagnosis, prognosis, Preventive medicine, prevention, therapy, treatment, Palliative care, palliation of their injury or disease, ...
,
surgical Surgery is a medical specialty that uses manual and instrumental techniques to diagnose or treat pathological conditions (e.g., trauma, disease, injury, malignancy), to alter bodily functions (e.g., malabsorption created by bariatric surgery ...
, or spontaneous abortion provided a genital tract infection can be reliably excluded. NSAIDs taken prior to the procedure and use of local anesthesia are recommended to reduce pain at the time of insertion.


Types

Many different types of copper IUDs are currently manufactured worldwide, but availability varies by country.


Frameless IUDs

The frameless IUD eliminates the use of the frame that gives conventional IUDs their signature T-shape. This change in design was made to reduce discomfort and expulsion risk associated with prior IUDs; without a solid frame, the frameless IUD should mold to the shape of the uterus. It may reduce expulsion and discontinuation rates compared to framed copper IUDs. Gynefix is the only frameless IUD brand currently available. It consists of hollow copper tubes on a
polypropylene Polypropylene (PP), also known as polypropene, is a thermoplastic polymer used in a wide variety of applications. It is produced via chain-growth polymerization from the monomer Propene, propylene. Polypropylene belongs to the group of polyolefin ...
thread. It is inserted through the
cervix The cervix (: cervices) or cervix uteri is a dynamic fibromuscular sexual organ of the female reproductive system that connects the vagina with the uterine cavity. The human female cervix has been documented anatomically since at least the time ...
with a special applicator that anchors the thread to the fundus (top) of the
uterus The uterus (from Latin ''uterus'', : uteri or uteruses) or womb () is the hollow organ, organ in the reproductive system of most female mammals, including humans, that accommodates the embryonic development, embryonic and prenatal development, f ...
; the thread is then cut with a tail hanging outside of the cervix, similar to framed IUDs, or looped back into the cervical canal for patient comfort. When this tail is pulled, the anchor is released and the device can be removed. This requires more force than removing a T-shaped IUD, but results in comparable discomfort at the time of removal.


Mechanism of action

The copper IUD's primary mechanism of action is to prevent fertilization. p. S28: p. 246: p. 259: Copper causes a localized inflammatory response, which is spermicidal and causes the endometrium to be inhospitable.
Spermatozoa A spermatozoon (; also spelled spermatozoön; : spermatozoa; ) is a motile sperm cell (biology), cell produced by male animals relying on internal fertilization. A spermatozoon is a moving form of the ploidy, haploid cell (biology), cell that is ...
entering the uterine cavity and
cervical mucus The cervix (: cervices) or cervix uteri is a dynamic fibromuscular sexual organ of the female reproductive system that connects the vagina with the uterine cavity. The human female cervix has been documented anatomically since at least the tim ...
are consumed by local
phagocytes Phagocytes are cell (biology), cells that protect the body by ingesting harmful foreign particles, bacteria, and dead or Apoptosis, dying cells. Their name comes from the Greek language, Greek ', "to eat" or "devour", and "-cyte", the suffix in ...
, and are also directly killed by copper ions and
lysosome A lysosome () is a membrane-bound organelle that is found in all mammalian cells, with the exception of red blood cells (erythrocytes). There are normally hundreds of lysosomes in the cytosol, where they function as the cell’s degradation cent ...
contents. Presence of copper ions disrupts sperm motility, rendering fertilization improbable. Although not a primary mechanism of action, copper may disrupt embryonic implantation, p. 199: especially when used for
emergency contraception Emergency contraception (EC) is a birth control measure, used after sexual intercourse to prevent pregnancy. There are different forms of EC. Emergency contraceptive pills (ECPs), sometimes simply referred to as emergency contraceptives (ECs), ...
. p. 157: However, if implantation occurs, there is no evidence that copper affects subsequent development of a pregnancy or causes embryonic failure. Therefore, the copper IUD is considered to be a true contraceptive and not an
abortifacient An abortifacient ("that which will cause a miscarriage" from Latin: '' abortus'' "miscarriage" and '' faciens'' "making") is a substance that induces abortion. This is a nonspecific term which may refer to any number of substances or medications, ...
.


Usage

Globally, the IUD is the most widely used method of reversible birth control. , 161million people used IUDs worldwide (including both non-hormonal and hormonal IUDs). , IUDs were the most popular method of contraception in fourteen countries, mostly in Central and East Asia. In Europe, , copper IUD prevalence ranged from under 5% in the United Kingdom, Germany, and Austria to over 10% in Denmark and the Baltic States.


History

Precursors to IUDs were first reported in the early 1900s. Developed from stem or wishbone
pessaries A pessary is a prosthetic device inserted into the vagina for structural and pharmaceutical purposes. It is most commonly used to treat stress urinary incontinence to stop urinary leakage and to treat pelvic organ prolapse to maintain the locati ...
, which were made of firm rubber or metal and had an anchor in the cervix, the stem on these devices extended into the uterine cavity. They were associated with high rates of genital tract infection, especially
gonorrhea Gonorrhoea or gonorrhea, colloquially known as the clap, is a sexually transmitted infection (STI) caused by the bacterium ''Neisseria gonorrhoeae''. Infection may involve the genitals, mouth, or rectum. Gonorrhea is spread through sexual c ...
, and were not widely adopted. The first intrauterine device to be contained entirely within the uterus was described in a
German German(s) may refer to: * Germany, the country of the Germans and German things **Germania (Roman era) * Germans, citizens of Germany, people of German ancestry, or native speakers of the German language ** For citizenship in Germany, see also Ge ...
publication in 1909 by Richard Richter, who reported a ring-shaped device made of silk sutures with two ends protruding from the external os of the cervix for removal. A similar design was reported by Karl Pust, who wound the free ends of the suture tightly and attached them to a glass disc, which covered the external os. Ersatz versions were made using silk suture wrapped into a ring and embedded in a gelatin capsule, which was inserted into the uterus, where the gelatin dissolved. In 1929,
Ernst Gräfenberg Ernst Gräfenberg (26 September 1881 – 28 October 1957) was a German-born physician and scientist. He developed the intrauterine device (IUD), and studied the role of the woman's urethra in orgasm. The G-spot is named after him. Career Gräfe ...
of Germany published a report on an IUD made of silk sutures (
Gräfenberg's ring Gräfenberg's ring is a flexible ring of silk suture, later versions of which were wrapped in silver wire. It was an early IUD, a birth control device. Gräfenberg's ring was the first IUD used by a significant number of women. The ring was int ...
), initially with a small amount of silver wire attached for visualization on x-ray, and then completely covered in silver wire. Because the silver was absorbed systemically and deposited in other tissues, causing a discoloration known as
argyria Argyria or argyrosis is a condition caused by excessive exposure to chemical compounds of the element silver, or silver dust. The most dramatic symptom of argyria is that the skin turns blue or blue-gray, and is usually most prominent in sun-ex ...
, the device was then recreated with an
alloy An alloy is a mixture of chemical elements of which in most cases at least one is a metal, metallic element, although it is also sometimes used for mixtures of elements; herein only metallic alloys are described. Metallic alloys often have prop ...
of copper, nickel, and zinc (then called
German silver Nickel silver, maillechort, German silver, argentan, new silver, nickel brass, albata, or alpacca is a cupronickel (copper with nickel) alloy with the addition of zinc. The usual formulation is 60% copper, 20% nickel and 20% zinc. Nickel silver ...
, also known as nickel silver). It was widely used in the UK and the
Commonwealth A commonwealth is a traditional English term for a political community founded for the common good. The noun "commonwealth", meaning "public welfare, general good or advantage", dates from the 15th century. Originally a phrase (the common-wealth ...
, but discouraged from use in the US and Europe due to the perceived risk of infection, cancer, and inefficacy. In 1934, Japanese physician
Tenrei Ōta Tenrei Ōta ( Japanese: ''Ōta Tenrei''), born Takeo Ōta (太田 武夫 ''Ōta Takeo'', 1900–1985) was a Japanese obstetrician-gynaecologist and politician. He invented the Ōta ring, an early intrauterine device (IUD). Throughout his life ...
developed a variation of Gräfenberg's ring that contained a supportive structure in the center. The addition of this central disc lowered the IUD's expulsion rate and increased the surface area. Though his research was hampered by the fascist government's stance against contraception and his need to spend time in hiding, after World War II he returned to the development of IUDs. Gold and silver, which had been used by Gräfenberg, were in very short supply in post-war Japan, which led Ōta to other metals, silk, and nylon. By the end of the 1950s, there were 32 different frame shapes used in Japan, and larger studies showed no connection between these devices and development of
endometrial cancer Endometrial cancer is a cancer that arises from the endometrium (the epithelium, lining of the uterus or womb). It is the result of the abnormal growth of cells (biology), cells that can invade or spread to other parts of the body. The first s ...
, which had been a theoretical concern due to the inflammatory properties of metals in the uterus. Ōta's devices were used in Japan until the 1980s. The first plastic device was developed by Lazar Margulies and first trialed in 1959; it was made of a polyethylene ring filled with a radiopaque solution. The appearance gave rise to the colloquial term "coil", which persists despite the change in appearance of modern IUDs. Due to its size (6 mm), the cervix had to be dilated prior to insertion, it was poorly tolerated, and the device was prone to expulsion. Margulies modified it to add a beaded tail in 1962. The Lippes Loop, a slightly smaller plastic device with a monofilament tail, was introduced in 1962 and gained in popularity over the Margulies device. Stainless steel was introduced as an alternative to the copper-nickel-zinc alloy in the 1960s and 70s, and was subsequently widely used in China because of low manufacturing costs. The Chinese government banned production of steel IUDs in 1993 due to high failure rates (up to 10% per year). American obstetrician
Howard Tatum Howard J. Tatum (1915 – 2002) was an American obstetrician. Along with Chilean physician Jaime Zipper, he invented the copper intrauterine device (IUD). The Tatum-T intrauterine device was the first T-shaped copper-bearing IUD to be sold in ...
conceived the plastic T-shaped IUD in 1967, but its high failure rate (approximately 18%) made it nonviable. Shortly thereafter Jaime Zipper, a Chilean doctor, discovered that the nickel silver alloy had spermicidal properties due to its copper percentage, and added a copper sheath to the plastic T, bringing the failure rate to approximately 1%. (Has pictures of many IUD designs, both historic and modern.) It was found that copper-containing devices could be made in smaller sizes without compromising effectiveness, resulting in fewer side effects such as pain and bleeding. T-shaped devices had lower rates of expulsion due to their greater similarity to the shape of the uterus. Tatum developed many different models of the copper IUD. He created the TCu220C, which had copper collars as opposed to a copper filament, which prevented metal loss and increased the lifespan of the device. Second generation copper-T IUDs were also introduced in the 1970s. These devices had higher surface areas of copper, and for the first time consistently achieved effectiveness rates of greater than 99%. The final model developed by Tatum, the TCu380A, was approved by the US FDA in 1984 and is the most recommended model today.


References

{{DEFAULTSORT:Intrauterine Device Wikipedia medicine articles ready to translate World Health Organization essential medicines