Two displaced intrauterine contraceptive devices (copper-T).

Worldwide approximately 13% of all women of reproductive age use the intrauterine contraceptive device (IUCD) making it the second most popular contraceptive while 19% use female sterilization the leading method. Most IUCD users are in a few countries especially China where a fifth of the worlds population lives. Inspite of studies showing that the copper-T IUCD is nearly as effective as male or female sterilization the IUCD is often ignored or overlooked. The Lippes loop and Margulies spiral made of biologically inert polypropylene appeared in the early 1960s. The Lippes loop is still being used throughout the world. These are inert (unmedicated) IUCDs not approved for use in the United States. Another inert device flexible stainless steel rings visible on X-ray but with no string are widely used in China. Later the efficacy was improved and the side effects reduced with the addition of copper. The early copper IUCDs Cu 7 and T Cu 200 were superseded by a second generation of long lasting more effective devices including the Multiload Nova T and copper T 380A which is now regarded as the "gold standard". The IUCDs work primarily by inhibition of conception and implantation rather than by interfering with an implanted conceptus. It does not act as an abortificient. It also interferes in the sperm transport (thus reducing the number and viability of sperms) and the ovum development or transport. The copper-T is initially expensive but the costs decrease with each subsequent year after the first year. Within five years it is the most cost-effective method of contraception available. It can also be inserted within five days after unprotected intercourse as an emergency contraception. The commonest side effects of IUCD are increased menstrual bleeding and dysmenorrhoea. These are the most frequent reasons for copper-T removal in the first year. Perforation of uterus can occur at the time of insertion but is often unnoticed Expulsion of IUCD is usually in the first 3 months of use. The displacement or migration of IUCD is not common. A national study on IUCD conducted in 1992 revealed its incidence of 0.8%. The presence of two migrated copper-T devices in a single patient is even rarer. (excerpt)