Cochrane systematic reviews of IUD trials: lessons learned

BackgroundIntrauterine devices (IUDs) are the most widely used reversible contraceptives in the world today, and decisions about their use should reflect the best available evidence.Study DesignWe performed a computer search of the Cochrane Library for all IUD-related reviews.ResultsEleven reviews related to IUDs have been registered in The Cochrane Library; 10 have been completed, and one is in progress. Topics include type of IUD, timing of insertion, clinical management, emergency contraception and use as gynecological treatment. The copper T380A is the most effective copper IUD; the levonorgestrel intrauterine system has efficacy comparable to that of IUDs with >250 mm2 of copper. The frameless device may be comparable in efficacy to the copper T380A, although whether problems with the initial inserter are resolved is unclear. Immediate postpartum and postabortal insertion appears safe and effective, although trials comparing immediate to delayed insertions are scarce. Prophylactic antibiotics at the time of insertion appear unwarranted except in populations with a high prevalence of sexually transmitted diseases. Many nonsteroidal anti-inflammatory drugs reduce pain and bleeding associated with IUDs, although prophylactic use of ibuprofen does not improve continuation rates. The levonorgestrel system is superior to oral progestins in treating heavy uterine bleeding. This IUD compares favorably with endometrial ablation techniques and presents an alternative to hysterectomy for many women.DiscussionTrials are needed to evaluate immediate vs. delayed insertion after delivery or abortion and to explore emerging therapeutic uses of the levonorgestrel system, such as treatment of endometrial hyperplasia.