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Intrauterine contraception: Devices, candidates, and selection

Authors
Gillian Dean, MD, MPH
Alisa B Goldberg, MD, MPH
Section Editor
Robert L Barbieri, MD
Deputy Editor
Kristen Eckler, MD, FACOG

INTRODUCTION

Intrauterine contraception is the most commonly used method of long-acting reversible contraception because of its high efficacy and safety, ease of use, and low cost. It provides a nonsurgical option for pregnancy prevention that is as effective as surgical sterilization. Modern intrauterine contraceptives are made of plastic and release either copper or a progestin to enhance the contraceptive action of the device.

This topic will discuss intrauterine device (IUD) types, selection, and use in specific populations. Issues related to intrauterine device insertion, removal, side effects, and complications are discussed separately. (See "Intrauterine contraceptive device: Insertion and removal" and "Intrauterine contraception: Management of side effects and complications".)

Several terms are used to describe intrauterine contraception, including IUD and intrauterine contraceptive; the progestin-containing device is also referred to as an intrauterine system. In this topic, we use the term IUD for all types of intrauterine contraception.

BACKGROUND

Prevalence — The IUD is the most commonly used method of reversible contraception worldwide, and is used by an average of 23 percent of female contraceptive users, with a range of <2 to >40 percent depending on the country [1,2]. In 2014, IUDs were used by 27 percent of female contraceptive users in Asia and 17 percent of female contraceptive users in Europe [2]. Use of IUDs has increased in the United States (US): In the decade from 2002 to 2012, IUD use rose from 2 to nearly 12 percent among US women using contraception [3-5]. Actively informing women about benefits, risks, and common side effects of IUDs appears to improve consideration and acceptance of the method [6,7].

Myths, misperceptions, and barriers to use — Several factors have limited widespread use of the IUD in the US, including a history of negative publicity; misinformation regarding the risks of infection, ectopic pregnancy, and infertility; misinformation about eligible candidates for IUD use; misconceptions about the mechanism of action of the IUD; lack of clinician training; and fears of litigation [8].

                                            

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References
Top
  1. United Nations. World Contraceptive Use 2011. http://www.un.org/esa/population/publications/contraceptive2011/contraceptive2011.htm (Accessed on March 20, 2014).
  2. Buhling KJ, Zite NB, Lotke P, et al. Worldwide use of intrauterine contraception: a review. Contraception 2014; 89:162.
  3. Finer LB, Jerman J, Kavanaugh ML. Changes in use of long-acting contraceptive methods in the United States, 2007-2009. Fertil Steril 2012; 98:893.
  4. Mosher WD, Martinez GM, Chandra A, et al. Use of contraception and use of family planning services in the United States: 1982-2002. Adv Data 2004; :1.
  5. Kavanaugh ML, Jerman J, Finer LB. Changes in Use of Long-Acting Reversible Contraceptive Methods Among U.S. Women, 2009-2012. Obstet Gynecol 2015; 126:917.
  6. Arrowsmith ME, Aicken CR, Saxena S, Majeed A. Strategies for improving the acceptability and acceptance of the copper intrauterine device. Cochrane Database Syst Rev 2012; :CD008896.
  7. Harper CC, Rocca CH, Thompson KM, et al. Reductions in pregnancy rates in the USA with long-acting reversible contraception: a cluster randomised trial. Lancet 2015; 386:562.
  8. Stanwood NL, Garrett JM, Konrad TR. Obstetrician-gynecologists and the intrauterine device: a survey of attitudes and practice. Obstet Gynecol 2002; 99:275.
  9. Hubacher D. The checkered history and bright future of intrauterine contraception in the United States. Perspect Sex Reprod Health 2002; 34:98.
  10. Simms I, Rogers P, Charlett A. The rate of diagnosis and demography of pelvic inflammatory disease in general practice: England and Wales. Int J STD AIDS 1999; 10:448.
  11. Weström L. Incidence, prevalence, and trends of acute pelvic inflammatory disease and its consequences in industrialized countries. Am J Obstet Gynecol 1980; 138:880.
  12. Grimes DA. Intrauterine device and upper-genital-tract infection. Lancet 2000; 356:1013.
  13. Farley TM, Rosenberg MJ, Rowe PJ, et al. Intrauterine devices and pelvic inflammatory disease: an international perspective. Lancet 1992; 339:785.
  14. Walsh T, Grimes D, Frezieres R, et al. Randomised controlled trial of prophylactic antibiotics before insertion of intrauterine devices. IUD Study Group. Lancet 1998; 351:1005.
  15. Birgisson NE, Zhao Q, Secura GM, et al. Positive Testing for Neisseria gonorrhoeae and Chlamydia trachomatis and the Risk of Pelvic Inflammatory Disease in IUD Users. J Womens Health (Larchmt) 2015; 24:354.
  16. Sufrin CB, Postlethwaite D, Armstrong MA, et al. Neisseria gonorrhea and Chlamydia trachomatis screening at intrauterine device insertion and pelvic inflammatory disease. Obstet Gynecol 2012; 120:1314.
  17. Hubacher D, Grimes DA, Gemzell-Danielsson K. Pitfalls of research linking the intrauterine device to pelvic inflammatory disease. Obstet Gynecol 2013; 121:1091.
  18. Browne H, Manipalviratn S, Armstrong A. Using an intrauterine device in immunocompromised women. Obstet Gynecol 2008; 112:667.
  19. Stringer EM, Kaseba C, Levy J, et al. A randomized trial of the intrauterine contraceptive device vs hormonal contraception in women who are infected with the human immunodeficiency virus. Am J Obstet Gynecol 2007; 197:144.e1.
  20. Heikinheimo O, Lehtovirta P, Aho I, et al. The levonorgestrel-releasing intrauterine system in human immunodeficiency virus-infected women: a 5-year follow-up study. Am J Obstet Gynecol 2011; 204:126.e1.
  21. Heikinheimo O, Lehtovirta P, Suni J, Paavonen J. The levonorgestrel-releasing intrauterine system (LNG-IUS) in HIV-infected women--effects on bleeding patterns, ovarian function and genital shedding of HIV. Hum Reprod 2006; 21:2857.
  22. Achilles SL, Creinin MD, Stoner KA, et al. Changes in genital tract immune cell populations after initiation of intrauterine contraception. Am J Obstet Gynecol 2014; 211:489.e1.
  23. American College of Obstetricians and Gynecologists Committee on Gynecologic Practice, Long-Acting Reversible Contraception Working Group. ACOG Committee Opinion no. 450: Increasing use of contraceptive implants and intrauterine devices to reduce unintended pregnancy. Obstet Gynecol 2009; 114:1434.
  24. Sivin I, Stern J. Health during prolonged use of levonorgestrel 20 micrograms/d and the copper TCu 380Ag intrauterine contraceptive devices: a multicenter study. International Committee for Contraception Research (ICCR). Fertil Steril 1994; 61:70.
  25. Sivin I. Dose- and age-dependent ectopic pregnancy risks with intrauterine contraception. Obstet Gynecol 1991; 78:291.
  26. Furlong LA. Ectopic pregnancy risk when contraception fails. A review. J Reprod Med 2002; 47:881.
  27. Backman T, Rauramo I, Huhtala S, Koskenvuo M. Pregnancy during the use of levonorgestrel intrauterine system. Am J Obstet Gynecol 2004; 190:50.
  28. Hubacher D, Lara-Ricalde R, Taylor DJ, et al. Use of copper intrauterine devices and the risk of tubal infertility among nulligravid women. N Engl J Med 2001; 345:561.
  29. Andersson K, Batar I, Rybo G. Return to fertility after removal of a levonorgestrel-releasing intrauterine device and Nova-T. Contraception 1992; 46:575.
  30. Mirena package insert. http://labeling.bayerhealthcare.com/html/products/pi/Mirena_PI.pdf (Accessed on June 27, 2013).
  31. Liletta package insert. http://pi.actavis.com/data_stream.asp?product_group=1960&p=pi&language=E (Accessed on April 24, 2015).
  32. Skyla package insert. http://labeling.bayerhealthcare.com/html/products/pi/Skyla_PI.pdf (Accessed on April 24, 2015).
  33. Thonneau PF, Almont T. Contraceptive efficacy of intrauterine devices. Am J Obstet Gynecol 2008; 198:248.
  34. World Health Organization. Medical eligibility criteria for contraceptive use. www.who.int (Accessed on January 19, 2012).
  35. Committee on Adolescence. Contraception for adolescents. Pediatrics 2014; 134:e1244.
  36. Grimes DA, Mishell DR Jr. Intrauterine contraception as an alternative to interval tubal sterilization. Contraception 2008; 77:6.
  37. Curtis KM, Tepper NK, Jatlaoui TC, et al. U.S. Medical Eligibility Criteria for Contraceptive Use, 2016. MMWR Recomm Rep 2016; 65:1.
  38. Backman T, Huhtala S, Blom T, et al. Length of use and symptoms associated with premature removal of the levonorgestrel intrauterine system: a nation-wide study of 17,360 users. BJOG 2000; 107:335.
  39. Jensen JT, Nelson AL, Costales AC. Subject and clinician experience with the levonorgestrel-releasing intrauterine system. Contraception 2008; 77:22.
  40. Birgisson NE, Zhao Q, Secura GM, et al. Preventing Unintended Pregnancy: The Contraceptive CHOICE Project in Review. J Womens Health (Larchmt) 2015; 24:349.
  41. Diedrich JT, Zhao Q, Madden T, et al. Three-year continuation of reversible contraception. Am J Obstet Gynecol 2015; 213:662.e1.
  42. Diedrich JT, Madden T, Zhao Q, Peipert JF. Long-term utilization and continuation of intrauterine devices. Am J Obstet Gynecol 2015; 213:822.e1.
  43. Paragard package insert. http://www.paragard.com/Pdf/ParaGard-PI.pdf#page=4 (Accessed on April 29, 2015).
  44. Davies GC, Feng LX, Newton JR, et al. Release characteristics, ovarian activity and menstrual bleeding pattern with a single contraceptive implant releasing 3-ketodesogestrel. Contraception 1993; 47:251.
  45. Croxatto HB, Mäkäräinen L. The pharmacodynamics and efficacy of Implanon. An overview of the data. Contraception 1998; 58:91S.
  46. Barnhart KT, Schreiber CA. Return to fertility following discontinuation of oral contraceptives. Fertil Steril 2009; 91:659.
  47. Mansour D, Gemzell-Danielsson K, Inki P, Jensen JT. Fertility after discontinuation of contraception: a comprehensive review of the literature. Contraception 2011; 84:465.
  48. Chiou CF, Trussell J, Reyes E, et al. Economic analysis of contraceptives for women. Contraception 2003; 68:3.
  49. Trussell J, Hassan F, Lowin J, et al. Achieving cost-neutrality with long-acting reversible contraceptive methods. Contraception 2015; 91:49.
  50. Rivera R, Yacobson I, Grimes D. The mechanism of action of hormonal contraceptives and intrauterine contraceptive devices. Am J Obstet Gynecol 1999; 181:1263.
  51. Stanford JB, Mikolajczyk RT. Mechanisms of action of intrauterine devices: update and estimation of postfertilization effects. Am J Obstet Gynecol 2002; 187:1699.
  52. Alvarez F, Brache V, Fernandez E, et al. New insights on the mode of action of intrauterine contraceptive devices in women. Fertil Steril 1988; 49:768.
  53. Ortiz ME, Croxatto HB. Copper-T intrauterine device and levonorgestrel intrauterine system: biological bases of their mechanism of action. Contraception 2007; 75:S16.
  54. El-Habashi M, El-Sahwi S, Gawish S, Osman M. Effect of Lippes loop on sperm recovery from human fallopian tubes. Contraception 1980; 22:549.
  55. Mechanism of action, safety and efficacy of intrauterine devices. Report of a WHO Scientific Group. World Health Organ Tech Rep Ser 1987; 753:1.
  56. Ortiz ME, Croxatto HB, Bardin CW. Mechanisms of action of intrauterine devices. Obstet Gynecol Surv 1996; 51:S42.
  57. Seleem S, Hills FA, Salem HT, et al. Mechanism of action of the intrauterine contraceptive device: evidence for a specific biochemical deficiency in the endometrium. Hum Reprod 1996; 11:1220.
  58. Sağiroğlu N. Phagocytosis of spermatozoa in the uterine cavity of woman using intrauterine device. Int J Fertil 1971; 16:1.
  59. Ammälä M, Nyman T, Strengell L, Rutanen EM. Effect of intrauterine contraceptive devices on cytokine messenger ribonucleic acid expression in the human endometrium. Fertil Steril 1995; 63:773.
  60. Wilcox AJ, Weinberg CR, Armstrong EG, Canfield RE. Urinary human chorionic gonadotropin among intrauterine device users: detection with a highly specific and sensitive assay. Fertil Steril 1987; 47:265.
  61. Segal SJ, Alvarez-Sanchez F, Adejuwon CA, et al. Absence of chorionic gonadotropin in sera of women who use intrauterine devices. Fertil Steril 1985; 44:214.
  62. Patai K, Szilagyi G, Noszal B, Szentmariay I. Local tissue effects of copper-containing intrauterine devices. Fertil Steril 2003; 80:1281.
  63. Tetrault AM, Richman SM, Fei X, Taylor HS. Decreased endometrial HOXA10 expression associated with use of the copper intrauterine device. Fertil Steril 2009; 92:1820.
  64. Lewis RA, Taylor D, Natavio MF, et al. Effects of the levonorgestrel-releasing intrauterine system on cervical mucus quality and sperm penetrability. Contraception 2010; 82:491.
  65. Scommegna A, Pandya GN, Christ M, et al. Intrauterine administration of progesterone by a slow releasing device. Fertil Steril 1970; 21:201.
  66. Mandelin E, Koistinen H, Koistinen R, et al. Levonorgestrel-releasing intrauterine device-wearing women express contraceptive glycodelin A in endometrium during midcycle: another contraceptive mechanism? Hum Reprod 1997; 12:2671.
  67. Videla-Rivero L, Etchepareborda JJ, Kesseru E. Early chorionic activity in women bearing inert IUD, copper IUD and levonorgestrel-releasing IUD. Contraception 1987; 36:217.
  68. Heinemann K, Reed S, Moehner S, Minh TD. Comparative contraceptive effectiveness of levonorgestrel-releasing and copper intrauterine devices: the European Active Surveillance Study for Intrauterine Devices. Contraception 2015; 91:280.
  69. Speroff L, Darney P. A Clinical Guide for Contraception, 3rd ed, Lippincott Williams & Wilkins, Philadelphia 2001.
  70. Hostynek JJ, Maibach HI. Copper hypersensitivity: dermatologic aspects. Dermatol Ther 2004; 17:328.
  71. De la Cruz D, Cruz A, Arteaga M, et al. Blood copper levels in Mexican users of the T380A IUD. Contraception 2005; 72:122.
  72. Cleland K, Zhu H, Goldstuck N, et al. The efficacy of intrauterine devices for emergency contraception: a systematic review of 35 years of experience. Hum Reprod 2012; 27:1994.
  73. Cheng L, Che Y, Gülmezoglu AM. Interventions for emergency contraception. Cochrane Database Syst Rev 2012; :CD001324.
  74. Toivonen J. Intrauterine contraceptive device and pelvic inflammatory disease. Ann Med 1993; 25:171.
  75. Sivin I, Schmidt F. Effectiveness of IUDs: a review. Contraception 1987; 36:55.
  76. Peterson HB, Xia Z, Hughes JM, et al. The risk of pregnancy after tubal sterilization: findings from the U.S. Collaborative Review of Sterilization. Am J Obstet Gynecol 1996; 174:1161.
  77. O'Brien PA, Kulier R, Helmerhorst FM, et al. Copper-containing, framed intrauterine devices for contraception: a systematic review of randomized controlled trials. Contraception 2008; 77:318.
  78. French R, Van Vliet H, Cowan F, et al. Hormonally impregnated intrauterine systems (IUSs) versus other forms of reversible contraceptives as effective methods of preventing pregnancy. Cochrane Database Syst Rev 2004; :CD001776.
  79. Long-term reversible contraception. Twelve years of experience with the TCu380A and TCu220C. Contraception 1997; 56:341.
  80. Bahamondes L, Faundes A, Sobreira-Lima B, et al. TCu 380A IUD: a reversible permanent contraceptive method in women over 35 years of age. Contraception 2005; 72:337.
  81. Wu JP, Pickle S. Extended use of the intrauterine device: a literature review and recommendations for clinical practice. Contraception 2014; 89:495.
  82. Diedrich JT, Desai S, Zhao Q, et al. Association of short-term bleeding and cramping patterns with long-acting reversible contraceptive method satisfaction. Am J Obstet Gynecol 2015; 212:50.e1.
  83. Lowe RF, Prata N. Hemoglobin and serum ferritin levels in women using copper-releasing or levonorgestrel-releasing intrauterine devices: a systematic review. Contraception 2013; 87:486.
  84. Guleria K, Agarwal N, Mishra K, et al. Evaluation of endometrial steroid receptors and cell mitotic activity in women using copper intrauterine device: Can Cu-T prevent endometrial cancer? J Obstet Gynaecol Res 2004; 30:181.
  85. Curtis KM, Marchbanks PA, Peterson HB. Neoplasia with use of intrauterine devices. Contraception 2007; 75:S60.
  86. Kyleena Prescribing Information. US Food and Drug Administration (FDA) approved product information. Revised September 2016. US National Library of Medicine. http://www.accessdata.fda.gov/drugsatfda_docs/label/2016/208224s000lbl.pdf (Accessed on October 14, 2016).
  87. Creinin MD, Jansen R, Starr RM, et al. Levonorgestrel release rates over 5 years with the Liletta® 52-mg intrauterine system. Contraception 2016; 94:353.
  88. Xiao BL, Zhou LY, Zhang XL, et al. Pharmacokinetic and pharmacodynamic studies of levonorgestrel-releasing intrauterine device. Contraception 1990; 41:353.
  89. Nilsson CG, Haukkamaa M, Vierola H, Luukkainen T. Tissue concentrations of levonorgestrel in women using a levonorgestrel-releasing IUD. Clin Endocrinol (Oxf) 1982; 17:529.
  90. Nilsson CG, Lahteenmaki PL, Luukkainen T, Robertson DN. Sustained intrauterine release of levonorgestrel over five years. Fertil Steril 1986; 45:805.
  91. Luukkainen T, Lähteenmäki P, Toivonen J. Levonorgestrel-releasing intrauterine device. Ann Med 1990; 22:85.
  92. Seeber B, Ziehr SC, Gschlieβer A, et al. Quantitative levonorgestrel plasma level measurements in patients with regular and prolonged use of the levonorgestrel-releasing intrauterine system. Contraception 2012; 86:345.
  93. Orme ML, Back DJ, Breckenridge AM. Clinical pharmacokinetics of oral contraceptive steroids. Clin Pharmacokinet 1983; 8:95.
  94. Sivin I, Lähteenmäki P, Ranta S, et al. Levonorgestrel concentrations during use of levonorgestrel rod (LNG ROD) implants. Contraception 1997; 55:81.
  95. Cleland K, Raymond EG, Westley E, Trussell J. Emergency contraception review: evidence-based recommendations for clinicians. Clin Obstet Gynecol 2014; 57:741.
  96. Eisenberg DL, Schreiber CA, Turok DK, et al. Three-year efficacy and safety of a new 52-mg levonorgestrel-releasing intrauterine system. Contraception 2015; 92:10.
  97. Sivin I, el Mahgoub S, McCarthy T, et al. Long-term contraception with the levonorgestrel 20 mcg/day (LNg 20) and the copper T 380Ag intrauterine devices: a five-year randomized study. Contraception 1990; 42:361.
  98. Andersson K, Odlind V, Rybo G. Levonorgestrel-releasing and copper-releasing (Nova T) IUDs during five years of use: a randomized comparative trial. Contraception 1994; 49:56.
  99. http://www.drugs.com/pro/skyla-iud.html (Accessed on February 21, 2013).
  100. Nelson A, Apter D, Hauck B, et al. A global randomized phase III Pearl Index study comparing the efficacy and safety of two low-dose levonorgestrel-releasing intrauterine systems (LNG-IUSS) in nulliparous and parous women. Fertil Steril 2012; 98:S5.
  101. McNicholas C, Maddipati R, Zhao Q, et al. Use of the etonogestrel implant and levonorgestrel intrauterine device beyond the U.S. Food and Drug Administration-approved duration. Obstet Gynecol 2015; 125:599.
  102. Rowe P, Farley T, Peregoudov A, et al. Safety and efficacy in parous women of a 52-mg levonorgestrel-medicated intrauterine device: a 7-year randomized comparative study with the TCu380A. Contraception 2016; 93:498.
  103. Barbieri R. Brigham and Women's Hospital, Harvard Medical School, 2016, personal communication.
  104. Hidalgo M, Bahamondes L, Perrotti M, et al. Bleeding patterns and clinical performance of the levonorgestrel-releasing intrauterine system (Mirena) up to two years. Contraception 2002; 65:129.
  105. Abou-Setta AM, Al-Inany HG, Farquhar CM. Levonorgestrel-releasing intrauterine device (LNG-IUD) for symptomatic endometriosis following surgery. Cochrane Database Syst Rev 2006; :CD005072.
  106. Lethaby AE, Cooke I, Rees M. Progesterone or progestogen-releasing intrauterine systems for heavy menstrual bleeding. Cochrane Database Syst Rev 2005; :CD002126.
  107. Yoost J. Understanding benefits and addressing misperceptions and barriers to intrauterine device access among populations in the United States. Patient Prefer Adherence 2014; 8:947.
  108. Bilian X. Chinese experience with intrauterine devices. Contraception 2007; 75:S31.
  109. Thomsen RJ, Rayl DL. Dr. Lippes and his loop. Four decades in perspective. J Reprod Med 1999; 44:833.
  110. Van Kets H, Van der Pas H, Thiery M, et al. The GyneFix implant systems for interval, postabortal and postpartum contraception: a significant advance in long-term reversible contraception. International Study Group on Intrauterine Drug Delivery. Eur J Contracept Reprod Health Care 1997; 2:1.
  111. O'Brien PA, Marfleet C. Frameless versus classical intrauterine device for contraception. Cochrane Database Syst Rev 2001; :CD003282.
  112. Wildemeersch D. New frameless and framed intrauterine devices and systems - an overview. Contraception 2007; 75:S82.
  113. O'Brien PA, Marfleet C. Frameless versus classical intrauterine device for contraception. Cochrane Database Syst Rev 2005; :CD003282.
  114. Meirik O, Rowe PJ, Peregoudov A, et al. The frameless copper IUD (GyneFix) and the TCu380A IUD: results of an 8-year multicenter randomized comparative trial. Contraception 2009; 80:133.
  115. Committee on Adolescent Health Care Long-Acting Reversible Contraception Working Group, The American College of Obstetricians and Gynecologists. Committee opinion no. 539: adolescents and long-acting reversible contraception: implants and intrauterine devices. Obstet Gynecol 2012; 120:983.
  116. American College of Obstetricians and Gynecologists Committee on Gynecologic Practice. ACOG committee opinion. No. 337: Noncontraceptive uses of the levonorgestrel intrauterine system. Obstet Gynecol 2006; 107:1479.
  117. Nelson AL. Contraindications to IUD and IUS use. Contraception 2007; 75:S76.
  118. Nelson AL, Hatcher RA, Zieman M, et al. Managing Contraception. Tiger, Georgia: Bridging the Gap Foundation, 2000.
  119. Zapata LB, Whiteman MK, Tepper NK, et al. Intrauterine device use among women with uterine fibroids: a systematic review. Contraception 2010; 82:41.
  120. Grigorieva V, Chen-Mok M, Tarasova M, Mikhailov A. Use of a levonorgestrel-releasing intrauterine system to treat bleeding related to uterine leiomyomas. Fertil Steril 2003; 79:1194.
  121. Trinh XB, Tjalma WA, Makar AP, et al. Use of the levonorgestrel-releasing intrauterine system in breast cancer patients. Fertil Steril 2008; 90:17.
  122. Soini T, Hurskainen R, Grénman S, et al. Levonorgestrel-releasing intrauterine system and the risk of breast cancer: A nationwide cohort study. Acta Oncol 2016; 55:188.
  123. Dinger J, Bardenheuer K, Minh TD. Levonorgestrel-releasing and copper intrauterine devices and the risk of breast cancer. Contraception 2011; 83:211.
  124. Combination oral contraceptive use and the risk of endometrial cancer. The Cancer and Steroid Hormone Study of the Centers for Disease Control and the National Institute of Child Health and Human Development. JAMA 1987; 257:796.
  125. Mishell DR Jr. Noncontraceptive health benefits of oral steroidal contraceptives. Am J Obstet Gynecol 1982; 142:809.
  126. Harada T, Momoeda M, Taketani Y, et al. Low-dose oral contraceptive pill for dysmenorrhea associated with endometriosis: a placebo-controlled, double-blind, randomized trial. Fertil Steril 2008; 90:1583.
  127. Gardner FJ, Konje JC, Bell SC, et al. Prevention of tamoxifen induced endometrial polyps using a levonorgestrel releasing intrauterine system long-term follow-up of a randomised control trial. Gynecol Oncol 2009; 114:452.
  128. Nexplanon prescribing information. http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b03a3917-9a65-45c2-bbbb-871da858ef34 (Accessed on May 19, 2015).
  129. Mansour D, Korver T, Marintcheva-Petrova M, Fraser IS. The effects of Implanon on menstrual bleeding patterns. Eur J Contracept Reprod Health Care 2008; 13 Suppl 1:13.
  130. Darney P, Patel A, Rosen K, et al. Safety and efficacy of a single-rod etonogestrel implant (Implanon): results from 11 international clinical trials. Fertil Steril 2009; 91:1646.
  131. Kelekci S, Kelekci KH, Yilmaz B. Effects of levonorgestrel-releasing intrauterine system and T380A intrauterine copper device on dysmenorrhea and days of bleeding in women with and without adenomyosis. Contraception 2012; 86:458.
  132. French R, Sorhaindo AM, Van Vliet HA, et al. Progestogen-releasing intrauterine systems versus other forms of reversible contraceptives. Cochrane Database Syst Rev 2004.
  133. Chi C, Huq FY, Kadir RA. Levonorgestrel-releasing intrauterine system for the management of heavy menstrual bleeding in women with inherited bleeding disorders: long-term follow-up. Contraception 2011; 83:242.
  134. Braga GC, Brito MB, Ferriani RA, et al. Oral anticoagulant therapy does not modify the bleeding pattern associated with the levonorgestrel-releasing intrauterine system in women with thrombophilia and/or a history of thrombosis. Contraception 2014; 89:48.
  135. Buttini MJ, Jordan SJ, Webb PM. The effect of the levonorgestrel releasing intrauterine system on endometrial hyperplasia: an Australian study and systematic review. Aust N Z J Obstet Gynaecol 2009; 49:316.
  136. Suhonen S, Holmström T, Lähteenmäki P. Three-year follow-up of the use of a levonorgestrel-releasing intrauterine system in hormone replacement therapy. Acta Obstet Gynecol Scand 1997; 76:145.
  137. Gardner FJ, Konje JC, Abrams KR, et al. Endometrial protection from tamoxifen-stimulated changes by a levonorgestrel-releasing intrauterine system: a randomised controlled trial. Lancet 2000; 356:1711.
  138. Dominick S, Hickey M, Chin J, Su HI. Levonorgestrel intrauterine system for endometrial protection in women with breast cancer on adjuvant tamoxifen. Cochrane Database Syst Rev 2015; :CD007245.
  139. Heikkinen S, Koskenvuo M, Malila N, et al. Use of exogenous hormones and the risk of breast cancer: results from self-reported survey data with validity assessment. Cancer Causes Control 2016; 27:249.
  140. Lyus R, Lohr P, Prager S, Board of the Society of Family Planning. Use of the Mirena LNG-IUS and Paragard CuT380A intrauterine devices in nulliparous women. Contraception 2010; 81:367.
  141. Black A, Francoeur D, Rowe T, et al. SOGC clinical practice guidelines: Canadian contraception consensus. J Obstet Gynaecol Can 2004; 26:219.
  142. Prager S, Darney PD. The levonorgestrel intrauterine system in nulliparous women. Contraception 2007; 75:S12.
  143. Hubacher D. Copper intrauterine device use by nulliparous women: review of side effects. Contraception 2007; 75:S8.
  144. Hall AM, Kutler BA. Intrauterine contraception in nulliparous women: a prospective survey. J Fam Plann Reprod Health Care 2016; 42:36.
  145. Brockmeyer A, Kishen M, Webb A. Experience of IUD/IUS insertions and clinical performance in nulliparous women--a pilot study. Eur J Contracept Reprod Health Care 2008; 13:248.
  146. Petersen KR, Brooks L, Jacobsen B, Skouby SO. Intrauterine devices in nulliparous women. Adv Contracept 1991; 7:333.
  147. Hubacher D, Reyes V, Lillo S, et al. Pain from copper intrauterine device insertion: randomized trial of prophylactic ibuprofen. Am J Obstet Gynecol 2006; 195:1272.
  148. Farmer M, Webb A. Intrauterine device insertion-related complications: can they be predicted? J Fam Plann Reprod Health Care 2003; 29:227.
  149. Sääv I, Aronsson A, Marions L, et al. Cervical priming with sublingual misoprostol prior to insertion of an intrauterine device in nulliparous women: a randomized controlled trial. Hum Reprod 2007; 22:2647.
  150. Friedman JO. Factors associated with contraceptive satisfaction in adolescent women using the IUD. J Pediatr Adolesc Gynecol 2015; 28:38.
  151. Hov GG, Skjeldestad FE, Hilstad T. Use of IUD and subsequent fertility--follow-up after participation in a randomized clinical trial. Contraception 2007; 75:88.
  152. Huggins GR, Cullins VE. Fertility after contraception or abortion. Fertil Steril 1990; 54:559.
  153. Correia L, Ramos AB, Machado AI, et al. Magnetic resonance imaging and gynecological devices. Contraception 2012; 85:538.
  154. ACOG Committee on Practice Bulletins-Gynecology. ACOG practice bulletin. Clinical management guidelines for obstetrician-gynecologists. Number 59, January 2005. Intrauterine device. Obstet Gynecol 2005; 105:223.
  155. Wan YL, Holland C. The efficacy of levonorgestrel intrauterine systems for endometrial protection: a systematic review. Climacteric 2011; 14:622.
  156. Suvanto-Luukkonen E, Kauppila A. The levonorgestrel intrauterine system in menopausal hormone replacement therapy: five-year experience. Fertil Steril 1999; 72:161.
  157. Varila E, Wahlström T, Rauramo I. A 5-year follow-up study on the use of a levonorgestrel intrauterine system in women receiving hormone replacement therapy. Fertil Steril 2001; 76:969.
  158. Hampton NR, Rees MC, Lowe DG, et al. Levonorgestrel intrauterine system (LNG-IUS) with conjugated oral equine estrogen: a successful regimen for HRT in perimenopausal women. Hum Reprod 2005; 20:2653.
  159. Nelson AL. Buyer beware. Contraception 2009; 80:495.
  160. http://www.miwww.acog.org/departments/dept_notice.cfm?recno=19&bulletin=4785 (Accessed on July 15, 2010).
  161. Stoddard AM, Xu H, Madden T, et al. Fertility after intrauterine device removal: a pilot study. Eur J Contracept Reprod Health Care 2015; 20:223.
  162. Coskun E, Cakiroglu Y, Aygun BK, et al. Effect of copper intrauterine device on the cyclooxygenase and inducible nitric oxide synthase expression in the luteal phase endometrium. Contraception 2011; 84:637.
  163. Xin ZM, Cao LM, Xie QZ, et al. Effects of the copper intrauterine device on the expression of cyclooxygenase-1 and -2 in the endometrium. Int J Gynaecol Obstet 2009; 105:166.