WHAT WE HAVE LEARNED FROM RECENT IUD STUDIES - A RESEARCHERS PERSPECTIVE

Many studies published on intrauterine devices (IUDs) during the last six years have consistently reported findings in favor of IUD use. Not able among these findings are: IUDs are not abortifacients; newly deve loped IUDs are highly effective and the efficacy is long-lasting; IUDs can be safely used by most lactating women, with lower removal rates attributable to bleeding and/or pain; and immediate postplacental IUD insertion reduces the risk of expulsion usually associated with postpa rtum insertion. Most importantly, in apparent contrast to results ofte n reported in the late 1960s through the early 1980s, recent findings show that IUDs per se, especially the medicated ones, are not associat ed with an increased risk of pelvic inflammatory disease (PID), nor ar e they associated with an increased risk of ectopic pregnancy or subse quent infertility.There are still issues concerning IUD use that are c ontroversial in spite of numerous studies. Should some of the contrain dications currently listed for IUD use be modified according to the ne wer findings? Is the risk of uterine perforation increased when the IU D is inserted in lactating women? Do IUD tails increase the risk of PI D? Does oral use of antibiotics at IUD insertion help prevent postinse rtion PID? There are also issues that have not been sufficiently addre ssed, and more information from empirical studies is needed. These inc lude: the effect of the insertor's skill on IUD performance; IUD use i n nulliparous as well as in older women; the relationship between IUD use and chlamydia infection; and long-term IUD use and safety, includi ng actinomycosis, etc. Answers are also needed by administrators facin g difficult programmatic decisions. For instance, should programs invo lving massive IUD removal be implemented as many IUD-wearing women are approaching or passing menopause? Similarly, are large programs to re move less-effective devices and replace them with newer and more effec tive IUDs advisable? This article reviews the state-of-the-art finding s from recent IUD studies on the above issues.