Elsevier

Contraception

Volume 98, Issue 6, December 2018, Pages 467-470
Contraception

Original research article
Historical record-setting trends in IUD use in the United States,☆☆

https://doi.org/10.1016/j.contraception.2018.05.016Get rights and content

Introduction

“No other contraceptive method has undergone so rapid and thorough a change of medical reputation as that experienced by intrauterine devices over the past few years” [1]. These words from United States-based contraceptive researcher Christopher Tietze in 1966 also characterize the last 10 years in the United States.

Intrauterine devices (IUDs) were first marketed in the United States over 55 years ago, amid considerable skepticism. Since then, dramatic changes in use have occurred: fast rise, fast fall and fast rise again. This brief commentary updates previous publications on the history of intrauterine contraception in the United States [2], [3] and provides contextual background and new information on future products under investigation in the United States.

Section snippets

US data from the National Survey of Family Growth

Today, more women in the US use an IUD than ever before; approximately 4.4 million [4]. Likewise, this level represents the highest percentage of IUD use ever seen in this country (Fig. 1): 7.8% of all women (green dotted-dashed line), nearly 12% among women using contraception (blue dashed line), and over 16% among users of reversible contraception (red dotted line).1

Factors likely influencing the recent upswing

Much has been written about the initial rise and subsequent fall of the IUD that bottomed out in the mid-1990s [11]. Since the mid-1990s and through 2011, numerous factors have contributed to increases in IUD use, including those at the product, provider and patient levels [2], [12]. Since the previous publication [2], some additional factors include the following:

  • 65+ publications and broad disseminations from the Contraceptive CHOICE project [13].

  • Over 95% of Fellows of the American College of

Trends in user characteristics: age, parity, education and income

The recent trend of increasing IUD use has occurred across all demographic groups of women. Users of IUDs in the United States today represent a more heterogeneous population than in the past. As of 2014, the frequency of use of the IUD among women of different racial/ethnic groups and income levels was comparable; there were no significant differences in use of the IUD by these characteristics [4]. Age and parity remain the primary demographic characteristics by which IUD prevalence varies;

The products and their years

Twelve commercially important IUDs have been available in the United States (Fig. 2). From the early 1960s to 1988, eight different IUDs were marketed over various times. In 1976, married women using IUDs chose these products: Lippes Loop (38%), Copper 7 (28%), Dalkon Shield (17%) and the Saf-T-Coil (12%) [7]. Over the period 1989 through 2000, no new products were introduced. Since 2001, four hormonal IUDs became available; each product releases varying amounts of levonorgestrel and the Food

IUD use in other countries/regions

In 2014, the prevalence of IUD use in the United States reached a level that matched other developed nations (as a whole) (Table 1). Some regions and countries have noticeably higher and lower levels of use than the United States. China, for example, has always been an outlier of high IUD use, whereas the Oceanic region countries and many countries in Africa have traditionally had very low prevalence.

At the country-level, the reasons for high and low IUD use are due to a variety of

Copper vs. hormonal

In most countries, two types of intrauterine contraceptive options are registered and marketed for use: copper products and hormonal products. In the United States in 2014, approximately 74% of IUD use was hormonal and 26% was copper [25]. In countries that have very limited access to hormonal IUD products, such as China and many developing countries, there are dozens of copper IUD products for women to choose from [26]. In estimates from 2006 in 10 European countries, hormonal IUDs, as

Research on new IUDs in the United States

As reported in ClinicalTrials.gov [28], three new IUDs are undergoing clinical study in the United States (Table 2).

Two products are copper IUDs (Mona Lisa NT Cu380 Mini™ [29] and VeraCept™ [30],) and one is a levonorgestrel-releasing system (LevoCept™ [31]). The size/shape of the devices, diameter of insertion tubes and/or new materials may improve comfort and thus acceptability for users [32], [33]. Some of these modifications may be particularly important for nulliparous women who generally

Conclusions

IUD use has fluctuated greatly over a 55-year period in the United States. Today, US women can choose from five different products and use is at an all-time high. New products are being evaluated for safety, efficacy and possible advantages over existing technologies. Women prioritize a range of factors when selecting the best contraceptive method for their individual life circumstances [35], [36]. More options will enable women to choose personal and tailored approaches to management of

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    D.H. has served on Scientific Advisory Boards for Bayer HealthCare Pharmaceuticals, Teva Pharmaceuticals and OCON Medical. For past research, he received product donations from Bayer HealthCare Pharmaceuticals, Teva Pharmaceuticals and Merck Sharp & Dohme Corp. M.K reports no potential conflicts of interest.

    ☆☆

    The findings and opinions presented are those of the authors and do not necessarily reflect the views of FHI 360 or the Guttmacher Institute.

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