ABSTRACT
This article reviews the two intrauterine devices (IUDs) available in the United States:
the TCu380A, marketed as ParaGard (Duramed Pharmaceuticals, Inc. Pomona, NY), and
the levonorgestrel-releasing intrauterine system (LNG-IUS), marketed as Mirena (Bayer
HealthCare Pharmaceuticals, Inc., Wayne, NJ). The properties of the two devices are
detailed, as well as noncontraceptive indications and appropriate candidates for use.
Studies consistently demonstrate that the devices are safe, effective, and provide
cost savings when compared with other reversible methods. The TCu380A may be used
as postcoital contraception with close to 100% effectiveness. Menstrual blood loss
is likely to increase with the TCu380A and decrease with the LNG-IUS. Reduction in
menstrual blood loss and endometrial suppression make the LNG-IUS an increasingly
popular treatment for menorrhagia, endometriosis, adenomyosis, and as an adjunct to
estrogen therapy. IUDs may be inserted immediately after a first- or second-trimester
abortion, immediately postpartum, and ≥4 weeks postpartum. Candidacy for IUDs has
expanded, and includes nulliparous women, adolescents, and women with immunocompromised
conditions including HIV.
KEYWORDS
Intrauterine device - intrauterine system - LNG-IUS - ParaGard - Mirena
REFERENCES
- 1 United Nations .World Contraceptive Use 2007. New York, NY; United Nations Publications
2007
- 2 Duramed Pharmaceuticals .Prescribing Information ParaGard T380A. 2006
- 3 Bayer HealthCare Pharmaceuticals .Mirena Physician Prescribing Information. 2008
- 4
Rivera R, Yacobson I, Grimes D.
The mechanism of action of hormonal contraceptives and intrauterine contraceptive
devices.
Am J Obstet Gynecol.
1999;
181(5 Pt 1)
1263-1269
- 5
Stanford J B, Mikolajczyk R T.
Mechanisms of action of intrauterine devices: update and estimation of postfertilization
effects.
Am J Obstet Gynecol.
2002;
187(6)
1699-1708
- 6
Lähteenmäki P, Rauramo I, Backman T.
The levonorgestrel intrauterine system in contraception.
Steroids.
2000;
65(10-11)
693-697
- 7
Barbosa I, Bakos O, Olsson S E, Odlind V, Johansson E D.
Ovarian function during use of a levonorgestrel-releasing IUD.
Contraception.
1990;
42(1)
51-66
- 8
Bahamondes L, Hidalgo M, Petta C A, Diaz J, Espejo-Arce X, Monteiro-Dantas C.
Enlarged ovarian follicles in users of a levonorgestrel-releasing intrauterine system
and contraceptive implant.
J Reprod Med.
2003;
48(8)
637-640
- 9
United Nations Development Programme .
Long-term reversible contraception. Twelve years of experience with the TCu380A and
TCu220C.
Contraception.
1997;
56(6)
341-352
- 10
Backman T, Rauramo I, Huhtala S, Koskenvuo M.
Pregnancy during the use of levonorgestrel intrauterine system.
Am J Obstet Gynecol.
2004;
190(1)
50-54
- 11
Peterson H B, Xia Z, Hughes J M, Wilcox L S, Tylor L R, Trussell J.
The risk of pregnancy after tubal sterilization: findings from the U.S. Collaborative
Review of Sterilization.
Am J Obstet Gynecol.
1996;
174(4)
1161-1168, discussion 1168–1170
- 12
Trussell J, Lalla A M, Doan Q V, Reyes E, Pinto L, Gricar J.
Cost effectiveness of contraceptives in the United States.
Contraception.
2009;
79(1)
5-14
- 13
Ellertson C, Trussell J, Stewart F, Koenig J, Raymond E G, Shochet T.
Emergency contraception.
Semin Reprod Med.
2001;
19(4)
323-330
- 14
Milsom I, Andersson K, Jonasson K, Lindstedt G, Rybo G.
The influence of the Gyne-T 380S IUD on menstrual blood loss and iron status.
Contraception.
1995;
52(3)
175-179
- 15
World Health Organization .
The TCu380A, TCu220C, multiload 250 and nova T IUDs at 3, 5 and 7 years of use—results
from three randomized multicentre trials.
Contraception.
1990;
42(2)
141-158
- 16
Hidalgo M, Bahamondes L, Perrotti M, Diaz J, Dantas-Monteiro C, Petta C.
Bleeding patterns and clinical performance of the levonorgestrel-releasing intrauterine
system (Mirena) up to two years.
Contraception.
2002;
65(2)
129-132
- 17
Zhang J, Feldblum P J, Chi I C, Farr M G.
Risk factors for copper T IUD expulsion: an epidemiologic analysis.
Contraception.
1992;
46(5)
427-433
- 18
Bahamondes L, Díaz J, Marchi N M, Petta C A, Cristofoletti M L, Gomez G.
Performance of copper intrauterine devices when inserted after an expulsion.
Hum Reprod.
1995;
10(11)
2917-2918
- 19
Harrison-Woolrych M, Ashton J, Coulter D.
Uterine perforation on intrauterine device insertion: is the incidence higher than
previously reported?.
Contraception.
2003;
67(1)
53-56
- 20 World Health Organization .Selected Practice Recommendations for Contraceptive
Use [update]. Geneva, Switzerland; World Health Organization 2004
- 21
Farley T MM, Rosenberg M J, Rowe P J, Chen J H, Meirik O.
Intrauterine devices and pelvic inflammatory disease: an international perspective.
Lancet.
1992;
339(8796)
785-788
- 22
Grimes D A, Schulz K F.
Prophylactic antibiotics for intrauterine device insertion: a metaanalysis of the
randomized controlled trials.
Contraception.
1999;
60(2)
57-63
- 23
Andersson K, Odlind V, Rybo G.
Levonorgestrel-releasing and copper-releasing (Nova T) IUDs during five years of use:
a randomized comparative trial.
Contraception.
1994;
49(1)
56-72
- 24
Pakarinen P, Toivonen J, Luukkainen T, Pakarinen P, Toivonen J, Luukkainen T.
Randomized comparison of levonorgestrel- and copper-releasing intrauterine systems
immediately after abortion, with 5 years' follow-up.
Contraception.
2003;
68(1)
31-34
- 25
Anonymous .
IUD insertion following termination of pregnancy: a clinical trial of the TCu 220C,
Lippes loop D, and copper 7.
Stud Fam Plann.
1983;
14(4)
99-108
- 26
Drey E A, Reeves M F, Ogawa D D, Sokoloff A, Darney P D, Steinauer J E.
Insertion of intrauterine contraceptives immediately following first- and second-trimester
abortions.
Contraception.
2009;
79(5)
397-402
- 27
Goodman S, Hendlish S K, Benedict C, Reeves M F, Pera-Floyd M, Foster-Rosales A.
Increasing intrauterine contraception use by reducing barriers to post-abortal and
interval insertion.
Contraception.
2008;
78(2)
136-142
- 28
Grimes D, Schulz K, van Vliet H, Stanwood N.
Immediate post-partum insertion of intrauterine devices: a Cochrane review.
Hum Reprod.
2002;
17(3)
549-554
- 29
Çelen S, Möröy P, Sucak A, Aktulay A, Danişman N.
Clinical outcomes of early postplacental insertion of intrauterine contraceptive devices.
Contraception.
2004;
69(4)
279-282
- 30
Eroğlu K, Akkuzu G, Vural G et al..
Comparison of efficacy and complications of IUD insertion in immediate postplacental/early
postpartum period with interval period: 1 year follow-up.
Contraception.
2006;
74(5)
376-381
- 31
Hayes J L, Cwiak C, Goedken P, Zieman M.
A pilot clinical trial of ultrasound-guided postplacental insertion of a levonorgestrel
intrauterine device.
Contraception.
2007;
76(4)
292-296
- 32
Hubacher D.
Copper intrauterine device use by nulliparous women: review of side effects.
Contraception.
2007;
75(6, suppl)
S8-S11
- 33
Sivin I, Stern J.
Long-acting, more effective copper T IUDs: a summary of U.S. experience, 1970–75.
Stud Fam Plann.
1979;
10(10)
263-281
- 34
Veldhuis H M, Vos A G, Lagro-Janssen A L, Lagro-Janssen A LM.
Complications of the intrauterine device in nulliparous and parous women.
Eur J Gen Pract.
2004;
10(3)
82-87
- 35
Deans E I, Grimes D A.
Intrauterine devices for adolescents: a systematic review.
Contraception.
2009;
79(6)
418-423
- 36
Paterson H, Ashton J, Harrison-Woolrych M, Paterson H, Ashton J, Harrison-Woolrych M.
A nationwide cohort study of the use of the levonorgestrel intrauterine device in
New Zealand adolescents.
Contraception.
2009;
79(6)
433-438
- 37
Morrison C S, Sekadde-Kigondu C, Sinei S K, Weiner D H, Kwok C, Kokonya D.
Is the intrauterine device appropriate contraception for HIV-1-infected women?.
BJOG.
2001;
108(8)
784-790
- 38
Stringer E M, Kaseba C, Levy J et al..
A randomized trial of the intrauterine contraceptive device vs hormonal contraception
in women who are infected with the human immunodeficiency virus.
Am J Obstet Gynecol.
2007;
197(2)
141-148
- 39
Heikinheimo O, Lehtovirta P, Suni J, Paavonen J.
The levonorgestrel-releasing intrauterine system (LNG-IUS) in HIV-infected women—effects
on bleeding patterns, ovarian function and genital shedding of HIV.
Hum Reprod.
2006;
21(11)
2857-2861
- 40
Milsom I, Andersson K, Andersch B, Rybo G.
A comparison of flurbiprofen, tranexamic acid, and a levonorgestrel-releasing intrauterine
contraceptive device in the treatment of idiopathic menorrhagia.
Am J Obstet Gynecol.
1991;
164(3)
879-883
- 41
Irvine G A, Campbell-Brown M B, Lumsden M A, Heikkila A, Walker J J, Cameron I T.
Randomized comparative trial of the levonorgestrel intrauterine system and norethisterone
for treatment of idiopathic menorrhagia.
Br J Obstet Gynaecol.
1998;
105(6)
592-598
- 42
Hurskainen R, Teperi J, Rissanen P et al..
Clinical outcomes and costs with the levonorgestrel-releasing intrauterine system
or hysterectomy for treatment of menorrhagia: randomized trial 5-year follow-up.
JAMA.
2004;
291(12)
1456-1463
- 43
Andersson K, Mattsson L A, Rybo G, Stadberg E.
Intrauterine release of levonorgestrel—a new way of adding progestogen in hormone
replacement therapy.
Obstet Gynecol.
1992;
79(6)
963-967
- 44
Boon J, Scholten P C, Oldenhave A, Heintz A P.
Continuous intrauterine compared with cyclic oral progestin administration in perimenopausal
HRT.
Maturitas.
2003;
46(1)
69-77
- 45
Raudaskoski T, Tapanainen J, Tomás E et al..
Intrauterine 10 microg and 20 microg levonorgestrel systems in postmenopausal women
receiving oral oestrogen replacement therapy: clinical, endometrial and metabolic
response.
BJOG.
2002;
109(2)
136-144
- 46
Petta C A, Ferriani R A, Abrao M S et al..
Randomized clinical trial of a levonorgestrel-releasing intrauterine system and a
depot GnRH analogue for the treatment of chronic pelvic pain in women with endometriosis.
Hum Reprod.
2005;
20(7)
1993-1998
- 47
Vercellini P, Frontino G, De Giorgi O, Aimi G, Zaina B, Crosignani P G.
Comparison of a levonorgestrel-releasing intrauterine device versus expectant management
after conservative surgery for symptomatic endometriosis: a pilot study.
Fertil Steril.
2003;
80(2)
305-309
- 48
Sheng J, Zhang W Y, Zhang J P, Lu D.
The LNG-IUS study on adenomyosis: a 3-year follow-up study on the efficacy and side
effects of the use of levonorgestrel intrauterine system for the treatment of dysmenorrhea
associated with adenomyosis.
Contraception.
2009;
79(3)
189-193
- 49
Lockhat F B, Emembolu J O, Konje J C, Lockhat F B, Emembolu J O, Konje J C.
The efficacy, side-effects and continuation rates in women with symptomatic endometriosis
undergoing treatment with an intra-uterine administered progestogen (levonorgestrel):
a 3 year follow-up.
Hum Reprod.
2005;
20(3)
789-793
Noa'a ShimoniM.D.
Columbia University Medical Center, Department of Obstetrics and Gynecology
622 W. 168th St., New York, NY 10032
eMail: ns2476@columbia.edu
