Copper IUDs effective as emergency contraception

Copper intrauterine devices (IUDs) are safe and highly effective for emergency contraception and regular contraception and are extremely cost-effective as an ongoing method, authors of a meta-analysis concluded.

To evaluate the existing data to estimate the efficacy of IUDs for emergency contraception, researchers reviewed studies published in English or Chinese, with a defined population of women who presented for emergency contraception and were provided with an IUD, and in whom the number of pregnancies was ascertained and loss to follow-up was clearly defined.

Forty-two studies from six countries between 1979 and 2011 included eight different types of IUDs and 7,034 women. The maximum timeframe from intercourse to insertion of the IUD ranged from 2 days to 10 or more days; the majority of insertions (74% of studies) occurred within 5 days of intercourse.

Results appeared online May 8 in Human Reproduction.

Among 7,034 post-coital IUD insertions, there were 10 pregnancies, for an overall failure rate of 0.14% (95% CI, 0.08% to 0.25%). Six pregnancies occurred among 5,629 subjects in the studies conducted in China (failure rate, 0.11%; 95% CI, 0.05% to 0.23%) and the remaining four pregnancies occurred among 200 subjects in one study conducted in Egypt. The latter study was considered an outlier, and without it the overall failure rate would be 0.09% (95% CI, 0.04% to 0.19%).

The authors concluded that IUDs are a highly effective method of contraception after unprotected intercourse because they are safe for the majority of women, highly effective and cost-effective when left in place as ongoing contraception for as long as 10 years, with some evidence for longer use.

“The cost, clinical protocols and lack of awareness among both patients and providers are barriers to a greater uptake of IUDs for emergency contraception,” the authors wrote. “Increasing the use of IUDs for emergency contraception is an important strategy for reducing an individual woman's chance of becoming pregnant after unprotected intercourse. In addition, if left in place for ongoing contraception, copper IUDs provide highly effective contraception for at least 10 years, and can contribute to decreasing unintended pregnancy rates over the long term.”