Misconceptions around intrauterine contraceptive devices (IUDs) mean that they are underused in developed countries, despite being a safe and effective form of contraception, says a women's health expert in this week's BMJ.
IUDs are suitable for most women, are cost effective when continued long term, and can have health benefits beyond contraception, writes Sally Rose, Research Fellow at the University of Otago, New Zealand.
Fertility is restored on their removal, and unlike other forms of contraception their efficacy does not depend on the user's behaviour. Consequently, such devices are an excellent alternative to female sterilisation (which women may later regret) and are a long term alternative to other methods of birth control prone to misuse or failure.
Side effects such as pain and heavy bleeding are common reasons for discontinuing use of an IUD within the first year, but can usually be managed with appropriate pain relief.
Despite this, data shows these devices are underused in developed countries, says the author.
Nearly half of all users are in China, while only 6% of women of reproductive age in the United Kingdom, 4.6% in Australia and New Zealand, and fewer than 1% in the United States use this method of contraception.
Reluctance to offer or use intrauterine devices seems to stem largely from the experience with the Dalkon Shield in the 1970s, she says, which caused pelvic infections that had serious health consequences for many thousands of women.