JHPIEGO TrainerNews™ |
Contraceptive Technology Update: Use of
Copper-Bearing IUDs for Emergency Contraception
(June 2002)
In the last edition of JHPIEGO TrainerNews, the use of combined and progestin-only oral contraceptives for emergency contraception was discussed. In this article, the use of copper-bearing IUDs--a highly effective but not widely used option--for that same purpose is presented.
How Used
Generally, it is recommended that a copper-bearing IUD be inserted within 5 days of unprotected intercourse. As with emergency contraceptive pills (ECPs), the sooner following unprotected intercourse that the IUD is inserted, the more effective it will be in preventing pregnancy. Studies are also demonstrating that the timeframe for effective use can be much longer depending on when in the menstrual cycle the unprotected intercourse occurs. If, for example, it takes place 3 days before ovulation, the IUD could be effective in preventing pregnancy if inserted up to 10 days after intercourse. The difficulty in determining the day of ovulation, however, has led to the more limited 5-day protocol.
The IUD should be left in place until the woman experiences her next menstrual period, but can provide effective contraception for at least 10 years should the woman want to use it for her ongoing contraceptive needs.
Mechanism of Action
The exact mechanism of action of the IUD remains unclear. It probably functions in the same manner as when used for regular contraception, that is, by interfering with sperm transport and preventing implantation of a fertilized egg, should fertilization occur. For some women, this information may influence their choice of a method for emergency contraception, and should be included in counseling.
Effectiveness
Copper-bearing IUDs are a very effective method of emergency contraception. They are, in fact, significantly more effective as emergency contraception than either combined or progestin-only ECPs. They reduce the risk of pregnancy by more than 99 percent, while combined ECPs reduce the risk by about 75 percent and progestin-only ECPs by 88 percent.
Side Effects
The side effects for emergency contraceptive IUD insertion are the same as those for regular IUD use: pain on insertion, increased menstrual bleeding and/or cramping. These side effects generally subside within 1 to 3 months should the woman choose to continue using the IUD as her method of contraception.
Limitations
- There are a number of reasons why copper-bearing IUDs are not as widely used as ECPs, including:
- The IUD must be inserted by a trained provider, which may delay insertion, thereby decreasing effectiveness
- Recommended infection prevention practices must be followed during the insertion procedure
- The woman must be carefully screened for risk factors for IUD use, such as an increased risk of sexually transmitted diseases (STDs), multiple partners, etc.
- It is not a cost-effective method unless the woman is interested in continuing to use the IUD as her form of contraception
- This stressful situation is probably not a good time for counseling a woman about IUD use and risk factors
Next month we'll discuss barriers to widespread use of any form of emergency contraception. We will also discuss improving access to emergency contraception.
For additional information on any of these topics, contact Lois Schaefer at lschaefer@jhpiego.net.