The intrauterine device and its dynamics

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This paper shifts focus from family planning to reproductive health components, including fertility regulation, pregnancy outcomes, and safe sex, to discuss the dynamics of intrauterine devices (IUDs).

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This narrative paper discusses reproductive health service elements and, in that broader context, focuses on the dynamics of intrauterine devices (IUDs), including their mechanisms of action, safety considerations, and clinical complications as reflected in prior literature. It reviews historical and guideline-style sources (e.g., WHO technical reports and professional statements) and summarizes evidence from studies and trials regarding IUD types and outcomes such as pelvic inflammatory disease, ectopic pregnancy, and tubal infertility. A major caveat is that the article is not an original clinical study but a synthesis of existing reports, so conclusions depend on the quality and heterogeneity of cited evidence rather than new data. This paper does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index, since endometriosis appears only tangentially in the quoted list of conditions associated with dysmenorrhea.

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Abstract

In the past decade, attention has shifted from family planning (often made available through population programs) to reproductive health--a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters related to the reproductive system and its function and processes. Reproductive health has three components: the ability to procreate, regulate fertility and enjoy sex; the successful outcome of pregnancy through infant and child survival and growth; and the safety of the reproductive process. According to Mitchell et al., the following are key elements in a reproductive health program: (a) Family planning services that offer complete and accurate information about all contraceptive methods and that make contraceptive services, supplies and counseling accessible. (b) Antenatal care, which research suggests lowers rates of maternal mortality. (c) Safe delivery services, so that all women deliver under some type of supervised care and so that referral systems are established to provide emergency treatment of life-threatening complications of delivery. (d) Postnatal care that contributes to a woman's ability to have a speedy and complete recovery from the stress of pregnancy and childbirth, to enjoy sexual relations without pain and to have safe pregnancies and deliveries in the future. (e) Management of the complications of abortion where safe abortions are not available. (f) Infertility services that enable women to achieve their reproductive goals; and effective screening for or control of reproductive tract infections (RTIs), because RTIs are the most common preventable cause of involuntary infertility and ectopic pregnancy, as well as of chronic pelvic pain and recurrent infection. (g) Management and treatment of systemic sexually transmitted diseases (STDs), such as HIV and hepatitis B. (h) Symptomatic treatment of urinary tract infections. (i) Detection and treatment of breast and reproductive tract cancers, such as cervical cancer. (j) Attention to and treatment of dysmenorhea, which in some cases is the first sign of other problems, such as pelvic inflammatory disease, endometriosis, fibroids, endometrial cancer and ectopic pregnancy. (k) Nutritional supplementation to meet the special needs of adolescents, pregnant or lactating women, and women older than 50 years. (1) Services for menopause and other health problems that women encounter as they grow older. (m) Services for adolescents, including family planning and STD prevention and treatment. It shall be clear that many institutions delivering reproductive health services operate significantly below their physical capacity to see clients, and that much of the equipment required for expanding reproductive health services may already be available for use in family planning and other health services. In this context, we would therefore like to discuss the dynamics of IUDs.
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Abstract

In the past decade, attention has shifted from family planning (often made available through population programs) to reproductive health – a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters related to the reproductive system and its function and processes. Reproductive health has three components: the ability to procreate, regulate fertility and enjoy sex; the successful outcome of pregnancy through infant and child survival and growth; and the safety of the reproductive process. According to Mitchell et al., the following are key elements in a reproductive health program: (a) Family planning services that offer complete and accurate information about all contraceptive methods and that make contraceptive services, supplies and counseling accessible. (b) Antenatal care, which research suggests lowers rates of maternal mortality. (c) Safe delivery services, so that all women deliver under some type of supervised care and so that referral systems are established to provide emergency treatment of life-threatening complications of delivery. (d) Postnatal care that contributes to a woman's ability to have a speedy and complete recovery from the stress of pregnancy and childbirth, to enjoy sexual relations without pain and to have safe pregnancies and deliveries in the future. (e) Management of the complications of abortion where safe abortions are not available. (f) Infertility services that enable women to achieve their reproductive goals; and effective screening for or control of reproductive tract infections (RTIs), because RTIs are the most common preventable cause of involuntary infertility and ectopic pregnancy, as well as of chronic pelvic pain and recurrent infection. (g) Management and treatment of systemic sexually transmitted diseases (STDs), such as HIV and hepatitis B. (h) Symptomatic treatment of urinary tract infections. (i) Detection and treatment of breast and reproductive tract cancers, such as cervical cancer. (j) Attention to and treatment of dysmenorhea, which in some cases is the first sign of other problems, such as pelvic inflammatory disease, endometriosis, fibroids, endometrial cancer and ectopic pregnancy. (k) Nutritional supplementation to meet the special needs of adolescents, pregnant or lactating women, and women older than 50 years. (l) Services for menopause and other health problems that women encounter as they grow older. (m) Services for adolescents, including family planning and STD prevention and treatment. It shall be clear that many institutions delivering reproductive health services operate significantly below their physical capacity to see clients, and that much of the equipment required for expanding reproductive health services may already be available for use in family planning and other health services. In this context, we would therefore like to discuss the dynamics of IUDs. Similar content being viewed by others

References

Mitchell MD, Littlefield J, Gutter S. Costing of reproductive Health services. Fam Plann Perspect. 1999;25:17-21. Trieman K, Liskin L, Kols A, Rinehart W. IUDs — An update. Population Reports, Series B, No. 6, Baltimore, Johns Hopkins School of Public Health, December 1995. World Health Organization. Mechanisms of Action and Safety of Intrauterine Devices. World Health Organization Technical Report Series No. 753, Geneva, 1987. International Planned Parenthood Federation, International Medical Advisory Panel. Statement on intrauterine devices. IPPF Med Bull, vol. 29,no. 4, October 1995. Cates W, Grimes DA, Ory HW, Tyler CW. Publicity and the public health: the elimination of IUD-related abortion deaths. Fam Plann Perspect. 1977;9:138. Burkman RT, for the Women's Health Study. Association between intrauterine devices and pelvic inflammatory disease. Obstet Gynecol. 1981;57:269-75. Van Os WAA. The Multiload Intrauterine Device. Development and Evaluation. PhD Dissertation, University of Utrecht, 1987. Edelman DA, Porter CW. The new intrauterine contraceptive devices. Adv Contracept. 1993;9:83-91. Thiery M, Van der Pas H, Van Kets H. The MLCu375 intrauterine contraceptive device. Adv Contracept. 1985;1:37-44. World Health Organization. The TCu380AA, Multiload 250 and Nova T IUDs at 3, 5, and 7 years of use — results from three randomized multicentre trials. Contraception. 1990;42:141-58. Wheeler RG, Buschblom RL, Marshall RK. A rational basis for IUD design and develoment. In: RG Wheeler, GW Duncan, JJ Speidel, eds. Intrauterine Devices. New York: Academic Press. 1974. Edelman DA, Berger GS, Keith L. Intrauterine Devices and their Complications. Boston: GK Hall. 1979. Sandmire HF. Fertility after intrauterine device discontinuation. Adv Contracept. 1986;2:327-35. Chow W-H, Daling JR, Weiss NS, Moore DE, Soderstrom RM, Metch BJ. IUD use and subsequent tubal ectopic pregnancy. Am J Public Health. 1986;76:536-9. Daling JR, Weiss NS, Metch BJ et al. Primary tubal infertility in relation to the use of an intrauterine contraceptive device. N Engl J Med. 1985;312:937-41. Cramer DW, Schiff I, Schoenbaum SC et al. Tubal infertility and the intrauterine contraceptive device. N Engl J Med. 1985;312:941-7. Van Kets HE, Van der Pas H, Delbarge W, Thiery M. A randomized comparative study of the TCu380A and Cu-Safe 300 IUDs. Adv Contracept. 1995;11;123-9. Van Kets H, Vrijens M, Van Trappen Y et al. The frameless GyneFix intrauterine implant: a major improvement in efficacy, expulsion and tolerance. Adv Contracept. 1995;11:131-42. Van Os WAA, de Nooyer CCA, Kivijarvi A, Nahmonovici C. Intracervical anchoring: a new approach to intrauterine contraception. Adv Contracept. 1993;9:65-70. Author information Authors and Affiliations Rights and permissions About this article Cite this article Van Os, W. The intrauterine device and its dynamics. Advances in Contraception 15, 119–132 (1999). https://doi.org/10.1023/A:1006797625923 Issue date: DOI: https://doi.org/10.1023/A:1006797625923

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Condition tags

endometriosischronic_pelvic_paininfertility

MeSH descriptors

Intrauterine Devices Intrauterine Devices Contraindications Family Planning Services Female Humans Intrauterine Devices, Copper Pelvic Inflammatory Disease Pelvic Inflammatory Disease Pregnancy

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