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Intrauterine contraceptives

In the early 20th century, intrauterine devices (IUD) came in the form of metal rings which evolved into plastic one in various shapes. IUDs provide long-term contraception, as long as up to 10 years, once inserted into the uterus. There are two main types of IUD – hormonal (containing progestin) and non-hormonal. The non-hormonal ones contain copper which was discovered to have contraceptive effect back in late 60s. It predominantly works by preventing fertilisation and was found to have 99% efficacy.

In the initial years the uptake of IUD was hampered by reports of serious health problems with Dalkon Shield, a new plastic IUD that had started becoming popular in the US[1]. Despite introduction of newer and better models later, the use of this method did not pick up among American women. IUD insertion and removal requires a trained provider. Amongst other factors at the individual and policy levels, lack of knowledge and training on IUD is one of the barriers to use, especially in the developed world. There are marked regional differences with the highest use in Eastern Asia and the lowest in North America[2]. IUD use is higher in China than in the world overall[3].

Copper IUDs were found to be safe, effective and convenient to use, requiring minimal maintenance by the user and provider. More importantly, it does not have the systematic side effects that hormonal contraceptives produce and is completely reversible. Copper IUDs can be inserted up to 5 days of unprotected intercourse as an emergency contraceptive[4]. A systematic review looking at 35 years of experience concluded that IUD are a highly effective method of emergency contraception2. However, cost, clinical protocols and lack of awareness among both patients and providers are the main barriers to uptake of IUDs for emergency contraception.

[1] Sonfield A. Popularity Disparity: Attitudes about the IUD in Europe and the United States. Guttmacher Policy Review Fall 2007, 10 (4).

[2] d'Arcangues C. Worldwide use of intrauterine devices for contraception. Contraception 2007, 75(6)

[3] Cleland K et al. The efficacy of intrauterine devices for emergency contraception: a systematic review of 35 years of experience. Human Reproduction 2012, 27 (7); 1994–2000.

[4] WHO Model Formulary 2008.


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