Intrauterine devices: learning from the past and looking to the future

Although there are 100 million current IUD users on a global level unwarranted apprehension about the devices safety persists on the part of both service providers and potential acceptors. Much of this concern is based on experiences with IUDs such as the Dalkon Shield that are no longer in use and unsubstantiated assertions emerging from past IUD research (e.g. the existence of an IUD-pelvic inflammatory disease link). The development of medicated copper IUDs has renewed confidence about the effectiveness and safety of this form of contraception. The Copper T 380A Multiload Copper-375 Nova-T and levonorgestrel-releasing IUD are expected to be the pillars of IUD contraception for the 1990s and beyond although high production and distribution costs are jeopardizing widespread use in developing countries. Current research is focused on reducing expulsions and medical removal rates through innovative design modifications. At this point there is sufficient data from prospective multicenter clinical trials to enable evaluation of rare side effects. There is a need however to widen the scope of research activities to focus on users needs and expectations and the impact of sociocultural context. Educational campaigns directed both at the public and the medical community would help to dispel remnants of misinformation.