The intrauterine contraceptive device: An often-forgotten and maligned method of contraception

Although 90% of women at risk for unintended pregnancy in the United States use contraception, <1% of these women use the intrauterine contraceptive d evice. The mechanism of action of intrauterine contraceptive devices has be en controversial, but several studies suggest that interference with sperm migration or function and with fertilization may be the most likely mechani sms. More important, there is lack of compelling evidence that the intraute rine contraceptive device acts as an abortifacient. The risk for pelvic inf lammatory disease among users now appears to be extremely low, primarily as a result of better selection of candidates. A levonorgestrel-releasing int rauterine contraceptive device may offer some new therapeutic approaches fo r the treatment of certain gynecologic disorders. Although women who are no t at risk for pelvic inflammatory disease or sexually transmitted diseases are appropriate candidates for the intrauterine contraceptive device, it ap pears that use can be expanded to selected nulliparous women and women with certain medical conditions.