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Contents 1 Cleopatra, stones as IUD 2 Complication rate 3 Facts? 4 How does it work? 5 commons.wikimedia.org 6 Proposed Infobox for individual birth control method articles 7 Definition? 8 5-July-2006 edits 9 Dalkon Shield comment deletion 10 Controversy? 11 GyneFix 12 Gynefix changes 13 IUD picture and nickel 14 Removal of "duplicate" references 15 PID 15.1 Weight Gain

[edit] Cleopatra, stones as IUD

Cleopatra used small smooth stones to do the same thing. Myth or not? - Omegatron July 8, 2005 03:53 (UTC)

[edit] Complication rate

"Modern IUDs, however, are much safer and complications are very rare."

Numbers, please. - Omegatron July 8, 2005 03:54 (UTC)

[edit] Facts?

Where are the facts refuting the "myths" on this page?

It claims that the IUD does not increase the risk of ectopic pregnancies, but the Planned Parenthood website says the opposite.

"A pregnancy that happens while using an IUD, however, is more likely to be ectopic than one that happens when not using an IUD. "

http://www.plannedparenthood.org/pp2/portal/medicalinfo/birthcontrol/pub-contraception-iud.xml#1103415686264::-7880598834388752785

1. IUDs reduce the overall number of pregnancies
2. Out of the pregnancies that occur, the percentage that are ectopic increases in cases with the IUD
3. The overall number of ectopic pregnancies decreases with IUDs

These statements do not conflict. — Omegatron 19:56, 2 December 2005 (UTC)

[edit] How does it work?

I still don't understand after reading this article how a copper IUD works. I only know how the hormonal one works because I know birth control pills contain hormones and I'm assuming the IUD uses similar ones. --Ntg 04:32, 5 January 2006 (UTC)

My understanding is that it prevents the uterine wall from becoming a viable host for fertilized eggs. I had an IUD inserted 3-weeks ago and now the string is missing and the ultra sound didn't clearly confirm that the IUD was still in my uterus. So now they need xrays.

• Good question, indeed not covered by the article - well spotted :-) I'm not sure that anyone is absolutely sure, probably combination of the plastic IUD itself causing a mild local inflammation that makes local environment hostile to sperm and then the very low levels of copper add to this anti-sperm effect. Anyone care to add to this discussion something a little more scientifically precise, before I try and add a 'Mechanism of Action' section ?
• Secondly really need to split off the IUS stuff to its own article (info & the nice picture)

David Ruben ^Talk 00:19, 6 January 2006 (UTC)

The National Health Service has a reasonably concise explanation here. --Arcadian 03:40, 6 January 2006 (UTC)

Many thanks; I will update the article. --Ntg 04:41, 6 January 2006 (UTC)

I too had seen the NHS explanation - just did not think its simplistic description really qualified, vs some fuller primary source or research papaer. David Ruben ^Talk 18:07, 17 February 2006 (UTC)

[edit] commons.wikimedia.org

can someone make those picture available on "commons.wikimedia.org"?? Thanks, 132.68.246.17 22:47, 11 March 2006 (UTC)

[edit] Proposed Infobox for individual birth control method articles

Let's all work on reaching a consensus for a new infobox to be placed on each individual birth control method's article. I've created one to start with on the Wikipedia Proposed Infoboxes page, so go check it out and get involved in the process. MamaGeek (Talk/Contrib) 12:23, 14 June 2006 (UTC)

[edit] Definition?

I've usually thought of an IUD as any device that resides completely in the uterus (as opposed to the early inter-uterine devices that were both in the uterus and the vagina). This definition would encompass copper-T devices like the Paraguard, copper bead devices like the Gynefix, and also hormonal devices like the IUS.

But some edits have reffered to the (to me) general term 'intrauterine device' as if it were synonomous with only the Paraguard. Is this the definition that Wikipedia should use? Lyrl 12:11, 2 July 2006 (UTC)

I would not generally include the progesterone hormonal Mirena coil (IUS) when generally discussing (the pros/cons of) IUDs. IUDs work by foreign-body reaction/low-concentration copper disolved off them, whilst IUS work probably more by the release of the progesterone. IUDs may increase the heaviness of periods, IUS are used as a treatment for excessively heavy periods (menorrhagia) thus halving the need to resort to hysterectomies for this condition. IUDs may be used as an Emergency contraception, but IUS are ineffective for this. So yes IUS are a device that resides in the uterine cavity, but I would not group it as an IntraUterine Device (note use as a group noun rather than adjective) in the manner that this term is usually applied. I've been considering removing the current discussion of IUS from the IUD article, providing just a 'See also' link to the specific IUS article with a brief explanation of the differences. David Ruben ^Talk 01:52, 3 July 2006 (UTC)

[edit] 5-July-2006 edits

I made too many changes to describe in the editing blurb, so I'm putting my comments here:

The article says they may be used 2-10 years, so I added that to the infobox. The 10 years is for ParaGuard, I believe, while the 2 years is for the Mirena. Because of the de-emphasis on the hormonal version, later editors might want to change that to 3-10 years to reflect only copper devices.

I removed "most inexpensive" as fertility awareness methods could compete for that title.

I tried to broaden the descriptions of different types by listing different brands, and describing T-shape vs. GyneFix, etc.

I combined discussion of effectiveness with discussion of how they work.

I tried to straighten out contraindications, side effects, and history of the device. These were previously all jumbled together (i.e. discussion of the Dalcon Shield and subsequent unpopularity in U.S. was in the "Side effects" section), some side effects were in the "Misconceptions" section, etc. I also expanded the history discussion somewhat (I would like to work on that section more as I have time).

I absorbed the cited information in the "Misconceptions" section into the rest of the article. The section title did not seem very encyclopedic. The uncited information had been tagged for a long time without editor response, so I removed it.

I seperated out the hormonal device into a small section near the end of the article. Lyrl 01:58, 6 July 2006 (UTC)

[edit] Dalkon Shield comment deletion

Not accurate. "negative publicity"--there was no negative publicity. There was public awareness of the damage done by this horrible device. Cindery 03:18, 30 July 2006 (UTC)

[edit] Controversy?

A paper from 1967 is referenced and then the statement "The debate has continued essentially unchanged for decades"?

I suppose the studies done in 1987, 1988, 1996, and the review published in 2002 are complete irrelevent to this 'debate'?

I would support some expansion of the "Mechanism of action" section, explaining that some people have moral problems with the back-up mechanism of preventing embryo implantation and a wikilink to the Beginning of pregnancy controversy article.

But the current "Controversy" section seems, well, outdated. Experimental evidence from the 80s has quite clearly demonstrated that the primary mechanism of action is anti-fertilization. The 2002 review states that there is evidence for secondary anti-pre-implanted embryo mechanisms - having that published in the American Journal of Obstetrics and Gynecology seems pretty mainstream. I question that there is any remaining controversy over the mechanism of action, and so I'm questioning the existence of the "Controversy" section. Lyrl ^Talk _Contribs 02:38, 26 August 2006 (UTC)

Well debated, your suggested modifications seem very sensible David Ruben ^Talk 03:07, 26 August 2006 (UTC)

Well. ya got me I guess. I've no doubt I could find solid peer-reviewed work showing that nearly half of all pregnancies prevented by IUDs are of the implantation-prevention variety, but my access to materials is not good at present and I am very ill. You may have noticed on another Talk page on related topics my statement that although I am pro-choice, I'm even more pro-truth. The research I've seen that supports anti-fertilization as the main IUD mode of action or, even more frequently, research and summaries of research that claim the mode is unknown, has been truly shoddy (yes, one of them was in the American Journal of Obstetrics and Gynecology). There certainly is remaining controversy among serious researchers and I'm afraid your own predilections have led you to see a wipeout where there is none. But all I can do at present is say oh well and hope someone with ready access to online journals comes along someday, reads this Talk page and gets cracking on the truth. JDG 22:54, 27 August 2006 (UTC)

To me, the studies that washed the uterine cavities of volunteers seems fairly decent. In volunteers without IUDs, the researchers found lots of live sperm and some embryos. In volunteers with IUDs, the researchers found dead sperm and no embryos. The studies were small (I imagine it was difficult to find volunteers), so they do not have statistical significance regarding any secondary mechanisms. But it seemed fairly conclusive, to me, that the most common mechanism was spermicidal/ovicidal.

I would like to think of myself as pro-truth also (I've been involved in editing the emergency contraception article to remove claims it has been "proven to not have postfertilization effects"). As I don't see anything morally wrong with preventing implantation, I am not sure what predilections would distort my opinions of IUD mechanisms.

On that note, now you have me very curious - what issues are in the studies that makes their results questionable? Lyrl ^Talk _Contribs 23:28, 27 August 2006 (UTC)

I would have to review them to jog my memory. It was mostly the tiny number of subjects and the use of the word "appears" in every other sentence that makes the results questionable. Also, I don't dismiss research done in the `60s. Maybe I'm turning into a crotchety old jobber, but I increasingly find that work done by people who were in their prime in the 50s and 60s is consistently better than later generations, whether it's manufactured goods, literary works, space programs or what have you. So if the scientists of that day said the primary mode of action is to prevent implantation, I listen... Honestly, I didn't expect my "Controversy" section to remain in the form I wrote it at all, but I was hoping people would come and work on it rather than blowing it away wholesale. It's enough if a significant minority of all IUD-terminated pregancies are post-fertilization-- say, 25%. People with a sincere belief that life starts at conception would want to know this about IUDs. And they should be allowed to know it. The current state of public education on the matter, which Wikipedia has joined thanks to the efforts of folks like you and Andrew c., would lead these people to believe there is no significant chance that IUDs sometimes work this way. Sorry, but that's shameful to me. Everybody deserves clear information on basic facts so they can apply their own right/wrong valuations. They shouldn't be steered away because functionaries in the health professions (not to mention the IUD manufacturers) want to steer IUDs clear of political storms in that direction. While those storms go on, folks need to make decisions in their own lives... Take a close look at the following from a 1996 study: "Therefore, the common belief that the major mechanism of action of IUDs in women is through destruction of embryos in the uterus (i.e., abortion) is not supported by the available evidence. In Cu-IUD users, it is likely that few spermatozoa reach the distal segment of the fallopian tube, those that encounter an egg may be in poor condition. Thus, the few eggs that are fertilized have little chance for development and their possibility for survival in the altered tubal milieu become worse as they approach the uterine cavity." The key phrase the few eggs that are fertilized have little chance for development is expertly swept under a rug of verbiage assuring the reader that the "major mechanism" is not abortifacient (this is from an abstract that surrounds this excerpt with many more such assurances). But exactly how many eggs were found fertilized in this study? They never seem to give a number or a percentage. But since the number of people in the study is so small, a bit of logic tells us that the number of such eggs cannot have been vanishingly small... This is where the controversy lies and it is alive and well in `06. I really wish you'd restore the section but with wording that seems responsible to you. JDG 03:35, 28 August 2006 (UTC)

It's not that I disagree with presenting information about postfertilization effects, I just don't see it as a complicated enough subject to have a seperate section. Hopefully, too, presenting the information near the top of the article - in the "Effectiveness and mechanism of contraception" section - might get it to more readers than a controversy section all the way at the bottom. Would it be better to strengthen the wording in the effectiveness section? Maybe replace the third sentence with something along the lines of: "Although the spermicidal and ovicidal mechanisms account for a majority of prevented pregnancies, the IUD also prevents the development of pre-implanted embryos". Or add something about it not being known how often the anti-embryonic effects occur?

The whole ethical discussion I moved into the pregnancy controversy article a few months ago, because the topic is relevent to so many different articles. Does that seem like it was a bad idea?

I completely agree about things built in the 60's - my company is looking to replace some 50-year-old just-recently-worn-out hardness testers, and we're being told by current manufacturers we'll be lucky if the new ones last 20 years. On the topic of IUDs, however, my impression was that there wasn't any research done in the 60's on how IUDs worked - that it was purely speculation. From a 1968 publication: "It became apparent at the conference that little was known concerning the mode of action of IUDs in humans or in animals."

One study from 1969 indicates basically the same thing as the studies from the 80s - that the IUD is definitely spermicidal from experimental evidence, and very plausibly ovicidal and embryocidal (pre-implantation) from the same mechanisms. I agree it would be wrong to try to hide the likely embryocidal nature of IUDs, but at the same time it would be inaccurate to say that is the primary method by which they work.

Like JDG, I am also frustrated about researchers blowing off the postfertilization effects of contraceptive methods, and have complained about it on the EC talk page (and been warned against doing original research by drawing different conclusions from studies than the researchers did). But if given the option, I would rather not even give article space to that group of researchers, instead just stating in the article what the studies seem to indicate. Lyrl ^Talk _Contribs 01:01, 29 August 2006 (UTC)

[edit] GyneFix

I looked into GyneFix very thoroughly when researching my IUD, and I think that the information about it in this article is misleading.

GyneFix is very little used, despite having been around for a number of years and promising to revolutionise IUDs. The theory was that the frameless device and small size would be less likely to cause increased cramping and blood loss, thus making it particularly suitable for nulliparous women or those with heavy periods. From what a number of gynaecologists have told me, this did not turn out to be the case in practice: the increase in cramping and blood flow was the same as for other types of copper IUD. There was also a theory that the expulsion rate would be lower, but again this was not borne out in practice.

In addition, the insertion procedure is much more difficult because the device has to be anchored to the uterine wall, which requires very careful placement. It takes far longer to learn how to insert this IUD, and many doctors do not have the additional time, but more importantly, there is a greatly increased risk of uterine perforation during insertion, and many doctors who have learned to insert the GyneFix have stopped because of this.

Since there are no additional benefits but there are several additional risks, it is almost impossible to find a doctor who will insert the GyneFix. Even in Europe, where there is a wider range of copper IUDs than in the US and a larger proportion of women using them, there may be no one offering the GyneFix in an entire country.

So the GyneFix is certainly not recommended for nulliparous women anywhere that I know of (apart from by the manufacturer, whose advice is not being taken by doctors). In the UK a smaller T-shaped copper IUD such as the Nova T380 is usual for nulliparous women.

I researched the Gynefix because I am nulliparous and had expelled my first IUD, and this one sounded less likely to be expelled due to the anchoring method. A number of gynaecologists warned me against it, however. Apparently several doctors at my local Family Planning Clinic (the Edinburgh one, which has a superb reputation for IUD insertion) had trained in Gynefix insertion, but all but one of them had stopped due to several perforations (which I think were the first ever perforations at this clinic). The one gynaecologist who could insert them hadn't done one in years because of their unpopularity for the above reasons. I only know of one other clinic in the UK where Gynefixes may be inserted, but again they strongly prefer not to.

Elettaria 09.09.06

Please be bold and change the information to be accurate. You might also be interested in fixing up the Gynefix article. Lyrl ^Talk _Contribs 23:30, 9 September 2006 (UTC)

[edit] Gynefix changes

Done, mostly by taking out the claims for GyneFix which are unsubstantiated (e.g. that it is recommended for nulliparous women). I've extensively rewritten the GyneFix article, though I've only managed to find one suitable medical article to put in for backup (most of it's on word of mouth, alas, though it's all what doctors have told me, and the evidence that it is almost impossible to find a doctor to insert the GyneFix alone tells you quite a bit), and I still haven't figured out how to put in footnotes.

Elettaria 15:12, 10 September 2006 (UTC)

[edit] IUD picture and nickel

Could I also suggest that you change the IUD picture? It's quite a lot larger than a real-life IUD, which might mislead (not to mention scare) people, and having a colour version would help as well.

You might want to mention that some copper IUDs have a small amount of nickel in them. A woman posted in http://iud-divas.livejournal.com/ about this a while ago, she was allergic to nickel and discovered too late that the IUD that was already in her contained nickel. She confirmed it directly from the manufacturer, I think it was Paragard but you should be able to check through the past entries of that forum.

Elettaria 23:12, 10 September 2006 (UTC)

[edit] Removal of "duplicate" references

From Wikipedia:Citing sources#Full citations: Page numbers are essential whenever possible.

The editor who deleted the page number links and references seems to have been acting in good faith to make the references easier to read, but this action violated Wikipedia policy because it made it more difficult to verify the cited statements. Lyrl ^Talk _C 20:42, 1 January 2007 (UTC)

My reference entry did list the page numbers of the journal article:

Treiman K, Liskin L, Kols A, Rinehart W (1995). "IUDs--an update". Popul Rep B (6):1-35. [PMID 8724322].

The PDF version of the journal article is slower to load and may be somewhat more difficult to navigate around than the HTML version, but the PDF version includes pictures not included in the HTML version and the PDF version tables are easier to read.

This Wikipedia article cites this single journal article 18 times. Why do we need 14 different references for this single journal article, individually citing "chapters" that are: 3, 4, 4, 5, 6, 7 and 8 paragraphs long (some "chapters" sharing the same page), two "sidebars" that are 1 and 1 1/2 pages long, as well as a table that takes up less than a quarter of one page in the journal article?

Providing one full and complete reference to a single journal article--especially one that includes a direct link to a copy of the journal article that is freely available online--should surely be sufficent for those who want to verify the cited statements, instead of cluttering the references section with 14 separate references for the same single journal article.

It may look a little odd in the references section to have 18 citations of a single journal article as a source, but that fairly represents the extent to which this Wikipedia article relies on a single journal article.

It is also not necessary to provide an access date for an online copy of a journal article published in print 11 years ago since the content of the published journal article should not change.

69.208.167.86 23:23, 1 January 2007 (UTC)

This issue also came up in the IntraUterine System article. That was slightly different because one of the documents (from the FDA) was a scanned PDF, so the text could not be searched - I felt specific page number were particularly helpful in that case.

But even when the PDF has searchable text, I find it very helpful to have the exact page number and a url link directly to the relevant paragraph when navigating nearly 30 pages of text.

The resolution in the IUS article was to have a "References" section listing the major references, but to go ahead and list exact page numbers individually in the "Footnotes" section.

My understanding on access date was that it was there to provide information on the last known "live" date in case the link went dead. Johns Hopkins has no particular obligation or commitment to maintaining the online version of the article. The accessdate is only relevant to the name of the url link; obviously the article text is fixed and should be available indefinitely in the normal offline channels.

Lyrl ^Talk _C 00:15, 2 January 2007 (UTC)

[edit] PID

"IUDs do not protect against STDs, and unlike barrier contraceptives and hormonal contraceptives, do not protect against developing pelvic inflammatory disease (PID)"

I may have missed something, but do any contraceptives protect against PID? I appreciate that it can result from some STDs, but other than condoms protecting from most STDs, I wasn't aware that any contraceptive providing protection from PID - the extra bit on the end of the sentence seems a bit redundant. —The preceding unsigned comment was added by 89.243.1.76 (talk • contribs) 02:37, 13 January 2007 (UTC)

I believe that women who have STDs and use hormonal contraception are less likely to develop PID than women who have STDs and do not use hormonal contraception. So hormonal contraception does not protect against STDs, but does protect (somewhat) against PID.

I agree the current sentence is confusing, though. I'll think about how to clean it up. Lyrl ^Talk _C 03:58, 13 January 2007 (UTC)

Hatcher & Nelson (2004). "Combined Hormonal Contraceptive Methods" in Hatcher, Contraceptive Technology, 18th ed., p. 401:

• Advantages and Indications
  • General health benefits
    • 4. Reduced risk of hospitalization for gonorrheal PID.

Hatcher (2004). "Depo-Provera Injections, Implants, Progestin-Only Pills (Minipills)" in Hatcher, Contraceptive Technology, 18th ed., p. 466:

• Advantages and Indications
  • Advantages of All Progestin-Only Methods
    • 2. Noncontraceptive benefits.
      • Decreased risk of endometrial cancer, ovarian cancer, and pelvic inflammatory disease (PID)

Grimes (2004). "Intrauterine Devices (IUDs)" in Hatcher, Contraceptive Technology, 18th ed., p. 501:

• Special Issues
  • Upper-genital-tract Infection
    • Three persistent biases led to the wrong conclusion about the risk of IUD-related infection. First, many studies used an inappropriate comparison group for IUD users: women using other contraceptives. Many of these contraceptives, such as the pill or condom, decrease the risk of salpingitis, thus biasing the comparison against the IUD.

Speroff & Darney (2005). "Oral Contraception" in A Clinical Guide for Contraception, 4th ed., p. 88:

• Infections And Oral Contraception
  • Viral STIs.
    • For women not in a stable, monogamous relationship, a dual approach is recommended, combining the contraceptive efficacy and protection against pelvic inflammatory disease (PID) offered by estrogen-progestin contraception with the use of a barrier method for prevention of viral STIs.
  • Bacterial STIs.
    • Because pelvic infection is the single greatest threat to the reproductive future of a young woman, the now recognized protection offered by oral contraception against PID is highly important. The risk of hospitalization for PID is reduced by approximately 50-60%, but at least 12 months of use are necessary, and the protection is limited to current users. Furthermore, if a patient does get a pelvic infection, the severity of the salpingitis found at laparoscopy is decreased. The mechanism of this protection remains unknown. Speculation includes thickening of the cervical mucus to prevent movement of pathogens and bacteria-laden sperm into the uterus and tubes and decreased menstrual bleeding, reducing movement of pathogens into the tubes as well as a reduction in "culture medium." This protection probably accounts for the greater fertility rate observed in previous users of oral contraception.

Speroff & Darney (2005). "Injectable Contraception" in A Clinical Guide for Contraception, 4th ed., p. 205:

• Advantages
  • Other benefits associated with depot-medroxyprogesterone acetate use include a decreased risk of endometrial cancer comparable with that observed with oral contraceptives and probably the same benefits associated with the progestin impact of oral contraceptives: reduced menstrual flow and anemia, less pelvic inflammatory disease (PID), less endometriosis, fewer uterine fibroids, and fewer ectopic pregnancies.

Mishell (2004). "Contraception", in Strauss & Barbieri, Yen & Jaffe's Reproductive Endocrinology, 5th ed., p. 920:

• Oral Steroid Contraceptives
  • Non-contraceptive Health Benefits
    • Other Benefits
      • Another benefit is protection against salpingitis, commonly referred to as pelvic inflammatory disease (PID). The relative risk of PID among OC users in most studies is about 0.5, a 50% reduction. OCs reduce the development of acute salpingitis in women infected with gonorrhea. Ectopic pregnancy risk is also reduced by more than 90% in current users, and OCs may reduce the incidence in former users by decreasing their risk of salpingitis.

Mishell (2004). "Contraception", in Strauss & Barbieri, Yen & Jaffe's Reproductive Endocrinology, 5th ed. p. 926:

• Long-Acting Contraceptive Steroids
  • Injectable Suspensions
    • Depot Formulation of Medroxyprogesterone Acetate
      • Non-contraceptive Health Benefits
        • In a summarization by Cullins, there is good epidemiologic evidence that use of DMPA reduces the risk of iron deficiency anemia, PID, and endometrial cancer.

69.208.196.181 04:47, 13 January 2007 (UTC)

[edit] Weight Gain

The article lists a disadvantage as no weight gain. I think that lack of weight gain is an advantage, not a disadvantage. Reliable Source: My Girlfriend  :) Mark94539 19:59, 22 March 2007 (UTC)