Advertisement

Extended use of the intrauterine device: a literature review and recommendations for clinical practice

      Abstract

      There are multiple advantages to “extended use” of the intrauterine device (IUD) use beyond the manufacturer-approved time period, including prolongation of contraceptive and non-contraceptive benefits. We performed a literature review of studies that have reported pregnancy outcomes associated with extended use of IUDs, including copper IUDs and the levonorgestrel intrauterine system (LNG-IUS). Among parous women who are at least 25 years old at the time of IUD insertion, there is good evidence to support extended use of the following devices: the TCu380A and the TCu220 for 12 years, the Multiload Cu-375 for 10 years, the frameless GyneFix® (330 mm2) for 9 years, the levonorgestrel intrauterine system 52 mg (Mirena®) for 7 years and the Multiload Cu-250 for 4 years. Women who are at least 35 years old at the time of insertion of a TCu380A IUD can continue use until menopause with a negligible risk of pregnancy. We found no data to support use of the LNG-IUS 13.5 mg (Skyla®) beyond 3 years. When counseling about extended IUD use, clinicians should consider patient characteristics and preferences, as well as country- and community-specific factors. Future research is necessary to determine the risk of pregnancy associated with extended use of the copper IUD and the LNG-IUS among nulliparous women and women less than 25 years old at the time of IUD insertion. More data are needed on the potential effect of overweight and obesity on the long-term efficacy of the LNG-IUS.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Contraception
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Sonfield A.
        Population disparity: attitudes about The IUD in Europe and the United States.
        Guttmacher Policy Rev. 2007; 10: 19-24
        • Ali M.M.S.R.
        • Cleland J.
        • Ngo T.D.
        • Shah I.H.
        Long-term contraception protection, discontinuation and switching behavior: intrauterine device (IUD) use dynamics in 14 developing countries. World Health Organization and Marie Stopes International, London2011
        • Trussell J.
        Update on and correction to the cost-effectiveness of contraceptives in the United States.
        Contraception. 2012; 85: 611
        • Farley T.M.
        • Rosenberg M.J.
        • Rowe P.J.
        • et al.
        Intrauterine devices and pelvic inflammatory disease: an international perspective.
        Lancet. 1992; 339: 785-788
      1. Mechanism of action, safety and efficacy of intrauterine devices. Report of a WHO Scientific Group. World Health Technical Report Series, 1987:1–91.

        • O'Brien P.A.
        • Kulier R.
        • Helmerhorst F.M.
        • et al.
        Copper-containing, framed intrauterine devices for contraception: a systematic review of randomized controlled trials.
        Contraception. 2008; 77: 318-327
        • 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: 56-72
        • Sivin I.
        • el Mahgoub S.
        • McCarthy T.
        • et al.
        Long-term contraception with the levonorgestrel 20 mcg/day (LNg 20) and the copper T 380Ag intrauterine devices: a five-year randomized study.
        Contraception. 1990; 42: 361-378
        • Bahamondes L.
        • Faundes A.
        • Sobreira-Lima B.
        • et al.
        TCu 380A IUD: a reversible permanent contraceptive method in women over 35 years of age.
        Contraception. 2005; 72: 337-341
      2. Long-term reversible contraception. Twelve years of experience with the TCu380A and TCu220C.
        Contraception. 1997; 56: 341-352
        • Sivin I.
        Utility and drawbacks of continuous use of a copper T IUD for 20 years.
        Contraception. 2007; 75: S70-S75
      3. Improving the safety and effectiveness of contraception in China: a case-study in promotion and improvement of family planning. UNDP/UNFPA/WHO/WORLD BANK Special Programme of Research, Development and Research Training in Human Reproduction (HRP). Geneva, Switzerland, 2008:20–24.

      4. GyneFix® Prescribing information. Acessed January 25, 2014 at: http://contrel.be/GYNEFIX%20SPECIALISTS/prescribing_information.htm.

        • Meirik O.
        • Rowe P.J.
        • Peregoudov A.
        • et al.
        The frameless copper IUD (GyneFix) and the TCu380A IUD: results of an 8-year multicenter randomized comparative trial.
        Contraception. 2009; 80: 133-141
        • Cao X.
        • Zhang W.
        • Gao G.
        • et al.
        Randomized comparative trial in parous women of the frameless GyneFix and the TCu380A intrauterine devices: long-term experience in a Chinese family planning clinic.
        Eur J Contracept Reprod Health Care. 2000; 5: 135-140
        • Chi I.C.
        The multiload IUD — a U.S. researcher's evaluation of a European device.
        Contraception. 1992; 46: 407-425
      5. Multiload® Cu250/ Cu375. Consumer Medicine Information. Accessed January 25, 2014 at: http://www.mydr.com.au/webroot/cmis/OutXHTML/CM07006.htm.

      6. Reproduction annual technical report: World Health Organization. Department of Reproductive Health and Research, including UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction. 2003:59–60.

      7. A randomized multicentre trial of the Multiload 375 and TCu380A IUDs in parous women: three-year results. UNDP/UNFPA/WHO/World Bank, Special Programme of Research, Development and Research Training in Human Reproduction: IUD Research Group.
        Contraception. 1994; 49: 543-549
        • McCarthy T.
        • Ramachandran L.
        • Ratnam S.S.
        Interim 4-year results of a comparative study between the Nova T and the Multiload 250.
        Adv Contracept. 1987; 3: 323-326
        • Soeprono R.
        Extended use of the Multiload Cu-250.
        Adv Contracept. 1988; 4: 109-113
        • Diaz J.
        • Faundes A.
        • Diaz M.
        • et al.
        Evaluation of the clinical performance of a levonorgestrel releasing IUD, up to seven years of use, in Campinas.
        Braz Contracept. 1993; 47: 169-175
        • Hidalgo M.M.
        • Hidalgo-Regina C.
        • Bahamondes M.V.
        • et al.
        Serum levonorgestrel levels and endometrial thickness during extended use of the levonorgestrel-releasing intrauterine system.
        Contraception. 2009; 80: 84-89
        • Sivin I.
        • Stern J.
        • Coutinho E.
        • et al.
        Prolonged intrauterine contraception: a seven-year randomized study of the levonorgestrel 20 mcg/day (LNg 20) and the Copper T380 Ag IUDS.
        Contraception. 1991; 44: 473-480
        • Ronnerdag M.
        • Odlind V.
        Health effects of long-term use of the intrauterine levonorgestrel releasing system. A follow-up study over 12 years of continuous use.
        Acta Obstet Gynecol Scand. 1999; 78: 716-721
        • Bastidas J.
        • Cano E.
        • Mora N.
        Copper corrosion-simulated uterine solutions.
        Contraception. 2000; 61: 395-399
        • Edelman D.
        • van Os W.
        Duration of use of copper releasing IUD and the incidence of copper wire breakage.
        Eur J Gynecol Reprod Biol. 1990; 34: 267-272
        • Kaneshiro B.
        • Aeby T.
        Long-term safety, efficacy, and patient acceptaibility of the intrauterine Copper T-380A contraceptive device.
        Int J Womens Health. 2010; 2: 211-220
        • Ortiz M.
        • Croxatto H.
        Copper-T intrauterine device and levonorgestrel intrauterine system: biological bases of their mechanism of action.
        Contraception. 2007; 75: S16-S30
        • Timonen H.
        Copper release from copper-T intrauterine devices.
        Contraception. 1976; 14: 25-38
        • Gao J.
        • Li Y.
        • Liu J.-p.
        • et al.
        Releasing of cupric ion of three types of copper-bearing intrauterine contraceptive device in simulated uterine fluid.
        J Reprod Contracept. 2007; 18: 33-40
        • Hagenfeldt K.
        Influence on protein and copper concentrations and enzyme activities in uterine washings.
        Contraception. 1972; 6: 219-230
        • Zhou X.
        • Li Y.
        • Jiang X.
        • et al.
        Release of copper and indomethacin from intrauterine devices immersed in simulated uterine fluid.
        Eur J Contracep Repr. 2010; 15: 205-212
        • Cao B.
        • Xi T.
        • Zheng Y.
        Release behavior of cupric ions for TCu380A and TCu220C IUDs.
        Biomed Mater. 2008; 3: 044114
        • Alvarez F.
        • Schilardi P.L.
        • de Mele M.F.
        Reduction of the “burst release” of copper ions from copper-based intrauterine devices by organic inhibitors.
        Contraception. 2012; 85: 91-98
        • Zhang C.X.N.
        • Yang B.
        The corrosion behaviour of copper in simulated uterine fluid.
        Corros Sci. 1996; 38: 635-641
        • Arancibia V.
        • Peñab C.
        • Allenc H.
        • et al.
        Characterization of copper in uterine fluids of patients who use the copper T-380A intrauterine device.
        Clin Chim Acta. 2003; 332: 69-78
        • Sedlis A.
        • Kandemire E.
        • Stone M.
        Intrauterine pH of women using stainless steel contraceptive device.
        Obstet Gynecol. 1967; 30: 114-117
        • Mora N.
        • Cano E.
        • Mora E.M.
        • et al.
        Influence of pH and oxygen on copper corrosion in simulated uterine fluid.
        Biomaterials. 2002; 23: 667-671
        • Wildemeersch D.
        New frameless and framed intrauterine devices and systems — an overview.
        Contraception. 2007; 75: S82-S92
        • Kjaer A.
        • Laursen K.
        • Thormann L.
        • et al.
        Copper release from copper intrauterine devices removed after up to 8 years of use.
        Contraception. 1993; 47: 349-358
      8. Mirena [package insert]. Bayer HealthCare Pharmaceuticals, Wayne, NJ2013
        • Nilsson C.G.
        • Lahteenmaki P.L.
        • Luukkainen T.
        • et al.
        Sustained intrauterine release of levonorgestrel over five years.
        Fertil Steril. 1986; 45: 805-807
        • Xiao B.L.
        • Zhou L.Y.
        • Zhang X.L.
        • et al.
        Pharmacokinetic and pharmacodynamic studies of levonorgestrel-releasing intrauterine device.
        Contraception. 1990; 41: 353-362
        • Natavio M.F.
        • Taylor D.
        • Lewis R.A.
        • et al.
        Temporal changes in cervical mucus after insertion of the levonorgestrel-releasing intrauterine system.
        Contraception. 2013; 87: 426-431
        • Nilsson C.G.
        • Haukkamaa M.
        • Vierola H.
        • et al.
        Tissue concentrations of levonorgestrel in women using a levonorgestrel-releasing IUD.
        Clin Endocrinol. 1982; 17: 529-536
        • Seeber B.
        • Ziehr S.C.
        • Gschliesser A.
        • et al.
        Quantitative levonorgestrel plasma level measurements in patients with regular and prolonged use of the levonorgestrel-releasing intrauterine system.
        Contraception. 2012; 86: 345-349
        • Farr G.
        • Amatya R.
        • Acosta M.
        • et al.
        Clinical performance of the TCu 380A and Lippes Loop IUDs in three developing countries.
        Contraception. 1995; 52: 17-22
        • Dafni L.
        • Tamir A.
        • Spenser T.
        • et al.
        Long term use of inert intrauterine contraceptive devices in 94 women in Israel.
        Br J Gen Pract. 1992; 42: 423-425
        • Ortiz M.E.
        • Croxatto H.B.
        • Bardin C.W.
        Mechanisms of action of intrauterine devices.
        Obstet Gynecol Survey. 1996; 51: S42-S51
      9. United States Census Bureau. International Database. Fertility Rates, 2012. Accessed on February 14, 2013 at: http://www.census.gov/population/international/data/idb/region.php?N=%20Results%20&T=9 A=aggregate&RT=0&Y=2012&R=101,102&C.

        • Behringer T.
        • Reeves M.F.
        • Rossiter B.
        • et al.
        Duration of use of a levonorgestrel IUS amongst nulliparous and adolescent women.
        Contraception. 2011; 84: e5-e10
        • Sivin I.
        • Stern J.
        Long-acting, more effective copper T IUDs: a summary of U.S. experience, 1970–75.
        Stud Fam Plann. 1979; 10: 263-281
        • Dehlendorf C.
        • Levy K.
        • Kelley A.
        • et al.
        Women's preferences for contraceptive counseling and decision making.
        Contraception. 2013; 88: 250-256
        • Ebell M.H.
        • Siwek J.
        • Weiss B.D.
        • Woolf S.H.
        • Susman J.
        • Ewigman B.
        • et al.
        Strength of recommendation taxonomy (SORT): a patient-centered approach to grading evidence in the medical literature.
        Am Fam Physiciaion. 2004; 69: 548-556