ABSTRACT
The worldwide popularity and usage of intrauterine devices (IUDs) plummeted in the 1970s, when grim reports of septic abortions and pelvic inflammatory disease were published. Although the Dalkon Shield ultimately was determined to be the culprit for these problems, the reputation of all IUDs was damaged, and their popularity spiraled downward. The stigma continues, despite the proven safety and efficacy of newer IUDs, particularly the ParaGard T 380A and the Progestasert, which are now the only two IUDs approved for use in the United States. This article will review how the IUD works and will focus on dispelling the misconceptions surrounding its use. Rigid patient-selection guidelines and strict aseptic insertion techniques can provide safe, long-term, cost-effective, and highly efficacious contraception for monogamous women. Practitioners who follow these guidelines should not fear prescribing IUDs as a contraceptive device in the appropriate female population.
PIP: Reports of Dalkon Shield-related pelvic inflammatory disease during the 1970s severely damaged public acceptance of all IUDs. This stigma persists, despite the proven safety and efficacy of newer IUDs, especially the ParaGard T 380A and the Progestasert--the only two IUDs approved for use in the US. The ParaGard may be advantageous for older women in whom hormonal contraception is contraindicated, while the Progestasert is a good choice for women who experienced heavy bleeding with copper IUDs. This article was prepared to improve the understanding of nurse practitioners in the US of the mechanism of action of the IUD and to correct misinformation about its side effects. A special section outlines insertion techniques for the ParaGard T 380A. Given rigid patient selection guidelines and strict aseptic insertion techniques, the IUD represents a safe, long-term, cost-effective, and highly efficacious contraceptive method for monogamous women. Current theory holds that the IUD can be inserted at any time during the menstrual cycle, as long as pregnancy can be reliably excluded.
