A Commentary Recommendation for Public Funding for the Provision of Intrauterine Devices for Women.

Intrauterine devices are gaining prevalence worldwide for family planning purposes because of its long-acting ature and reversibility. In fact, over 15% of married women were noted to use intrauterine contraception. Trends demonstrate highest usage in Asian countries, with at least 50% of Asian females utilizing IUDs for prevention of pregnancy. Sub-Saharan Africa remains an area where there is a substantial unmet need for family planning in general.

Two types of IUDs are available: hormonal and non-hormonal. The most commonly-available hormonal device goes by the name Mirena, and contains 52 mg of the progestin levonorgestrel (LNG), and is approved for use over 5 years, although studies have demonstrated efficacy to 7 years. Initial hormone release rate is 20 mcg/d, which declines to 10 mcg/d at the 5 year mark. Cumulative efficacy is 99.3% over 5 years (which is as effective as tubal sterilization). The majority of its contraceptive effect is through thickening of cervical mucous, impedance of sperm survival and endometrial atrophy, the latter of which explains the improvement of menstrual flow.

The mechanism of action of the non-hormonal IUD, however, depends predominantly on its inflammatory response which interferes with sperm passage, thus preventing fertilization. These nonhormonal devices can last between 3-12 years and are comprised of copper that may be designed in a multitude of shapes and sizes. This type, however, can be associated with heavier and/or crampier menses.

PDF LINK