JHPIEGO TrainerNews™ |
Contraceptive Update
(November 2001)
Contraceptive Pearl: Are copper IUDs unrelated to infertility and therefore safer than previously thought?
Question: I understand that a recent study found copper IUDs to be unrelated to infertility and thus safer than was previously thought. Is that so?
Answer: Yes. A Family Health International study recently published in the New England Journal of Medicine, found no increased risk of infertility among nulligravid women (women never previously pregnant) who used copper IUDs. Older studies had mixed results related to copper IUDs and infertility. The new study was particularly strong because of its relatively large size and because it used two types of controls. It is especially notable because many providers appear to shy away from the IUD because of concerns about infertility and withhold IUDs from women who have never been pregnant.
Moreover, it is already known that the relatively small increase in risk of pelvic inflammatory disease (PID), is associated with the IUD only for women at risk of STIs. Accordingly the article concludes: "This study suggests that the use of copper IUDs is much safer than was previously thought. Nulligravid women who are not at risk for a sexually transmitted disease are candidates for the copper IUD. Contemporary copper IUDs may be among the safest, most effective and least expensive reversible contraceptives available."
Reference: Hubacher D et al. Use of copper intrauterine devices and the risk of tubal infertility among nulligravid women. NEJM 2001;345:561?7.
Contraceptive Pearl: Has a new contraceptive "patch" been approved?
Question: I understand a new contraceptive "patch" has been approved by the USFDA. Can you tell me more?
Answer: Yes, the new patch developed by Ortho-McNeil, called Ortho Evra is designed to deliver continuous levels of progestin and estrogen for seven days through the skin. Thus it is similar to OCs, and appears similar in effectiveness and probably safety. After 3 seven-day patches, the fourth week is "patch free," which allows for withdrawal bleeding like OCs.
One potential disadvantage is that for heavier women (over 198 lbs) the data suggest the patch may be less effective. However, one potential benefit is that applying such a patch may be easier to remember than daily OCs and one study found that "compliance" with the patch was indeed somewhat better than with the pill. Since most OC failures are related to imperfect pill?taking, this advantage could be important.
These "Pearls" were prepared by Dr. James D. Shelton, Senior Medical Scientist, Office of Population, United States Agency for International Development (USAID).