Had time to read the latest journals? Catch up on some recent research by reading these mini-reviews by Dr Brett Daniels.
This paper reports on a randomised comparative trial of the levonorgestrel-containing IUCD (Mirena®) and copper containing IUCD (TCu380A ParaGard®) commenced by WHO in 1993, and conducted primarily in developing countries.1 Approximately 1900 women were allocated to each device and followed up annually for seven years. Data were available at the seven-year follow-up for 682 women in the copper IUCD group and 398 women in the levonorgestrel group. The cumulative seven-year pregnancy rate of the levonorgestrel IUCD was 0.5 pregnancies per 100 women, a significantly lower rate than 2.5 per 100 for the copper IUCD. The discontinuation rates at seven years were 70.6 and 40.8 per cent respectively, although this difference does not achieve statistical significance. The main reasons for discontinuing the levonorgestrel IUCD were amenorrhea and reduced bleeding, particularly in Chinese women. For the copper IUCD the main reason for discontinuation was increased bleeding, especially among non-Chinese women. These results confirm that intrauterine devices are highly effective contraceptives. The changes in bleeding seen with both devices in this study is as would be predicted by most clinicians and there may be some value in ensuring women are aware of these potential changes before inserting IUCDs, and being aware of possible cultural differences in acceptability of these changes.