Talk:Copper IUD/Archive 1

Archive 1

Facts?

Where are the facts refuting the "myths" on this page?

It claims that the IUD does not increase the risk of ectopic pregnancies, but the Planned Parenthood website says the opposite.

"A pregnancy that happens while using an IUD, however, is more likely to be ectopic than one that happens when not using an IUD. "

http://www.plannedparenthood.org/pp2/portal/medicalinfo/birthcontrol/pub-contraception-iud.xml#1103415686264::-7880598834388752785

1. IUDs reduce the overall number of pregnancies
2. Out of the pregnancies that occur, the percentage that are ectopic increases in cases with the IUD
3. The overall number of ectopic pregnancies decreases with IUDs

These statements do not conflict. — Omegatron 19:56, 2 December 2005 (UTC)

How does it work?

I still don't understand after reading this article how a copper IUD works. I only know how the hormonal one works because I know birth control pills contain hormones and I'm assuming the IUD uses similar ones. --Ntg 04:32, 5 January 2006 (UTC)

My understanding is that it prevents the uterine wall from becoming a viable host for fertilized eggs. I had an IUD inserted 3-weeks ago and now the string is missing and the ultra sound didn't clearly confirm that the IUD was still in my uterus. So now they need xrays.

• Good question, indeed not covered by the article - well spotted :-) I'm not sure that anyone is absolutely sure, probably combination of the plastic IUD itself causing a mild local inflammation that makes local environment hostile to sperm and then the very low levels of copper add to this anti-sperm effect. Anyone care to add to this discussion something a little more scientifically precise, before I try and add a 'Mechanism of Action' section ?
• Secondly really need to split off the IUS stuff to its own article (info & the nice picture)

David Ruben ^Talk 00:19, 6 January 2006 (UTC)

The National Health Service has a reasonably concise explanation here. --Arcadian 03:40, 6 January 2006 (UTC)

Many thanks; I will update the article. --Ntg 04:41, 6 January 2006 (UTC)

I too had seen the NHS explanation - just did not think its simplistic description really qualified, vs some fuller primary source or research papaer. David Ruben ^Talk 18:07, 17 February 2006 (UTC)

commons.wikimedia.org

can someone make those picture available on "commons.wikimedia.org"?? Thanks, 132.68.246.17 22:47, 11 March 2006 (UTC)

Proposed Infobox for individual birth control method articles

Let's all work on reaching a consensus for a new infobox to be placed on each individual birth control method's article. I've created one to start with on the Wikipedia Proposed Infoboxes page, so go check it out and get involved in the process. MamaGeek (Talk/Contrib) 12:23, 14 June 2006 (UTC)

Definition?

I've usually thought of an IUD as any device that resides completely in the uterus (as opposed to the early inter-uterine devices that were both in the uterus and the vagina). This definition would encompass copper-T devices like the Paraguard, copper bead devices like the Gynefix, and also hormonal devices like the IUS.

But some edits have reffered to the (to me) general term 'intrauterine device' as if it were synonomous with only the Paraguard. Is this the definition that Wikipedia should use? Lyrl 12:11, 2 July 2006 (UTC)

I would not generally include the progesterone hormonal Mirena coil (IUS) when generally discussing (the pros/cons of) IUDs. IUDs work by foreign-body reaction/low-concentration copper disolved off them, whilst IUS work probably more by the release of the progesterone. IUDs may increase the heaviness of periods, IUS are used as a treatment for excessively heavy periods (menorrhagia) thus halving the need to resort to hysterectomies for this condition. IUDs may be used as an Emergency contraception, but IUS are ineffective for this. So yes IUS are a device that resides in the uterine cavity, but I would not group it as an IntraUterine Device (note use as a group noun rather than adjective) in the manner that this term is usually applied. I've been considering removing the current discussion of IUS from the IUD article, providing just a 'See also' link to the specific IUS article with a brief explanation of the differences. David Ruben ^Talk 01:52, 3 July 2006 (UTC)

5-July-2006 edits

I made too many changes to describe in the editing blurb, so I'm putting my comments here:

The article says they may be used 2-10 years, so I added that to the infobox. The 10 years is for ParaGuard, I believe, while the 2 years is for the Mirena. Because of the de-emphasis on the hormonal version, later editors might want to change that to 3-10 years to reflect only copper devices.

I removed "most inexpensive" as fertility awareness methods could compete for that title.

I tried to broaden the descriptions of different types by listing different brands, and describing T-shape vs. GyneFix, etc.

I combined discussion of effectiveness with discussion of how they work.

I tried to straighten out contraindications, side effects, and history of the device. These were previously all jumbled together (i.e. discussion of the Dalcon Shield and subsequent unpopularity in U.S. was in the "Side effects" section), some side effects were in the "Misconceptions" section, etc. I also expanded the history discussion somewhat (I would like to work on that section more as I have time).

I absorbed the cited information in the "Misconceptions" section into the rest of the article. The section title did not seem very encyclopedic. The uncited information had been tagged for a long time without editor response, so I removed it.

I seperated out the hormonal device into a small section near the end of the article. Lyrl 01:58, 6 July 2006 (UTC)

Dalkon Shield comment deletion

Not accurate. "negative publicity"--there was no negative publicity. There was public awareness of the damage done by this horrible device. Cindery 03:18, 30 July 2006 (UTC)

Controversy?

A paper from 1967 is referenced and then the statement "The debate has continued essentially unchanged for decades"?

I suppose the studies done in 1987, 1988, 1996, and the review published in 2002 are complete irrelevent to this 'debate'?

I would support some expansion of the "Mechanism of action" section, explaining that some people have moral problems with the back-up mechanism of preventing embryo implantation and a wikilink to the Beginning of pregnancy controversy article.

But the current "Controversy" section seems, well, outdated. Experimental evidence from the 80s has quite clearly demonstrated that the primary mechanism of action is anti-fertilization. The 2002 review states that there is evidence for secondary anti-pre-implanted embryo mechanisms - having that published in the American Journal of Obstetrics and Gynecology seems pretty mainstream. I question that there is any remaining controversy over the mechanism of action, and so I'm questioning the existence of the "Controversy" section. Lyrl ^Talk _Contribs 02:38, 26 August 2006 (UTC)

Well debated, your suggested modifications seem very sensible David Ruben ^Talk 03:07, 26 August 2006 (UTC)

Well. ya got me I guess. I've no doubt I could find solid peer-reviewed work showing that nearly half of all pregnancies prevented by IUDs are of the implantation-prevention variety, but my access to materials is not good at present and I am very ill. You may have noticed on another Talk page on related topics my statement that although I am pro-choice, I'm even more pro-truth. The research I've seen that supports anti-fertilization as the main IUD mode of action or, even more frequently, research and summaries of research that claim the mode is unknown, has been truly shoddy (yes, one of them was in the American Journal of Obstetrics and Gynecology). There certainly is remaining controversy among serious researchers and I'm afraid your own predilections have led you to see a wipeout where there is none. But all I can do at present is say oh well and hope someone with ready access to online journals comes along someday, reads this Talk page and gets cracking on the truth. JDG 22:54, 27 August 2006 (UTC)

To me, the studies that washed the uterine cavities of volunteers seems fairly decent. In volunteers without IUDs, the researchers found lots of live sperm and some embryos. In volunteers with IUDs, the researchers found dead sperm and no embryos. The studies were small (I imagine it was difficult to find volunteers), so they do not have statistical significance regarding any secondary mechanisms. But it seemed fairly conclusive, to me, that the most common mechanism was spermicidal/ovicidal.

I would like to think of myself as pro-truth also (I've been involved in editing the emergency contraception article to remove claims it has been "proven to not have postfertilization effects"). As I don't see anything morally wrong with preventing implantation, I am not sure what predilections would distort my opinions of IUD mechanisms.

On that note, now you have me very curious - what issues are in the studies that makes their results questionable? Lyrl ^Talk _Contribs 23:28, 27 August 2006 (UTC)

I would have to review them to jog my memory. It was mostly the tiny number of subjects and the use of the word "appears" in every other sentence that makes the results questionable. Also, I don't dismiss research done in the `60s. Maybe I'm turning into a crotchety old jobber, but I increasingly find that work done by people who were in their prime in the 50s and 60s is consistently better than later generations, whether it's manufactured goods, literary works, space programs or what have you. So if the scientists of that day said the primary mode of action is to prevent implantation, I listen... Honestly, I didn't expect my "Controversy" section to remain in the form I wrote it at all, but I was hoping people would come and work on it rather than blowing it away wholesale. It's enough if a significant minority of all IUD-terminated pregancies are post-fertilization-- say, 25%. People with a sincere belief that life starts at conception would want to know this about IUDs. And they should be allowed to know it. The current state of public education on the matter, which Wikipedia has joined thanks to the efforts of folks like you and Andrew c., would lead these people to believe there is no significant chance that IUDs sometimes work this way. Sorry, but that's shameful to me. Everybody deserves clear information on basic facts so they can apply their own right/wrong valuations. They shouldn't be steered away because functionaries in the health professions (not to mention the IUD manufacturers) want to steer IUDs clear of political storms in that direction. While those storms go on, folks need to make decisions in their own lives... Take a close look at the following from a 1996 study: "Therefore, the common belief that the major mechanism of action of IUDs in women is through destruction of embryos in the uterus (i.e., abortion) is not supported by the available evidence. In Cu-IUD users, it is likely that few spermatozoa reach the distal segment of the fallopian tube, those that encounter an egg may be in poor condition. Thus, the few eggs that are fertilized have little chance for development and their possibility for survival in the altered tubal milieu become worse as they approach the uterine cavity." The key phrase the few eggs that are fertilized have little chance for development is expertly swept under a rug of verbiage assuring the reader that the "major mechanism" is not abortifacient (this is from an abstract that surrounds this excerpt with many more such assurances). But exactly how many eggs were found fertilized in this study? They never seem to give a number or a percentage. But since the number of people in the study is so small, a bit of logic tells us that the number of such eggs cannot have been vanishingly small... This is where the controversy lies and it is alive and well in `06. I really wish you'd restore the section but with wording that seems responsible to you. JDG 03:35, 28 August 2006 (UTC)

It's not that I disagree with presenting information about postfertilization effects, I just don't see it as a complicated enough subject to have a seperate section. Hopefully, too, presenting the information near the top of the article - in the "Effectiveness and mechanism of contraception" section - might get it to more readers than a controversy section all the way at the bottom. Would it be better to strengthen the wording in the effectiveness section? Maybe replace the third sentence with something along the lines of: "Although the spermicidal and ovicidal mechanisms account for a majority of prevented pregnancies, the IUD also prevents the development of pre-implanted embryos". Or add something about it not being known how often the anti-embryonic effects occur?

The whole ethical discussion I moved into the pregnancy controversy article a few months ago, because the topic is relevent to so many different articles. Does that seem like it was a bad idea?

I completely agree about things built in the 60's - my company is looking to replace some 50-year-old just-recently-worn-out hardness testers, and we're being told by current manufacturers we'll be lucky if the new ones last 20 years. On the topic of IUDs, however, my impression was that there wasn't any research done in the 60's on how IUDs worked - that it was purely speculation. From a 1968 publication: "It became apparent at the conference that little was known concerning the mode of action of IUDs in humans or in animals."

One study from 1969 indicates basically the same thing as the studies from the 80s - that the IUD is definitely spermicidal from experimental evidence, and very plausibly ovicidal and embryocidal (pre-implantation) from the same mechanisms. I agree it would be wrong to try to hide the likely embryocidal nature of IUDs, but at the same time it would be inaccurate to say that is the primary method by which they work.

Like JDG, I am also frustrated about researchers blowing off the postfertilization effects of contraceptive methods, and have complained about it on the EC talk page (and been warned against doing original research by drawing different conclusions from studies than the researchers did). But if given the option, I would rather not even give article space to that group of researchers, instead just stating in the article what the studies seem to indicate. Lyrl ^Talk _Contribs 01:01, 29 August 2006 (UTC)

Gynefix changes

Done, mostly by taking out the claims for GyneFix which are unsubstantiated (e.g. that it is recommended for nulliparous women). I've extensively rewritten the GyneFix article, though I've only managed to find one suitable medical article to put in for backup (most of it's on word of mouth, alas, though it's all what doctors have told me, and the evidence that it is almost impossible to find a doctor to insert the GyneFix alone tells you quite a bit), and I still haven't figured out how to put in footnotes.

Elettaria 15:12, 10 September 2006 (UTC)

Removal of "duplicate" references

From Wikipedia:Citing sources#Full citations: Page numbers are essential whenever possible.

The editor who deleted the page number links and references seems to have been acting in good faith to make the references easier to read, but this action violated Wikipedia policy because it made it more difficult to verify the cited statements. Lyrl ^Talk _C 20:42, 1 January 2007 (UTC)

My reference entry did list the page numbers of the journal article:

Treiman K, Liskin L, Kols A, Rinehart W (1995). "IUDs--an update". Popul Rep B (6):1-35. [PMID 8724322].

The PDF version of the journal article is slower to load and may be somewhat more difficult to navigate around than the HTML version, but the PDF version includes pictures not included in the HTML version and the PDF version tables are easier to read.

This Wikipedia article cites this single journal article 18 times. Why do we need 14 different references for this single journal article, individually citing "chapters" that are: 3, 4, 4, 5, 6, 7 and 8 paragraphs long (some "chapters" sharing the same page), two "sidebars" that are 1 and 1 1/2 pages long, as well as a table that takes up less than a quarter of one page in the journal article?

Providing one full and complete reference to a single journal article--especially one that includes a direct link to a copy of the journal article that is freely available online--should surely be sufficent for those who want to verify the cited statements, instead of cluttering the references section with 14 separate references for the same single journal article.

It may look a little odd in the references section to have 18 citations of a single journal article as a source, but that fairly represents the extent to which this Wikipedia article relies on a single journal article.

It is also not necessary to provide an access date for an online copy of a journal article published in print 11 years ago since the content of the published journal article should not change.

69.208.167.86 23:23, 1 January 2007 (UTC)

This issue also came up in the IntraUterine System article. That was slightly different because one of the documents (from the FDA) was a scanned PDF, so the text could not be searched - I felt specific page number were particularly helpful in that case.

But even when the PDF has searchable text, I find it very helpful to have the exact page number and a url link directly to the relevant paragraph when navigating nearly 30 pages of text.

The resolution in the IUS article was to have a "References" section listing the major references, but to go ahead and list exact page numbers individually in the "Footnotes" section.

My understanding on access date was that it was there to provide information on the last known "live" date in case the link went dead. Johns Hopkins has no particular obligation or commitment to maintaining the online version of the article. The accessdate is only relevant to the name of the url link; obviously the article text is fixed and should be available indefinitely in the normal offline channels.

Lyrl ^Talk _C 00:15, 2 January 2007 (UTC)

PID

"IUDs do not protect against STDs, and unlike barrier contraceptives and hormonal contraceptives, do not protect against developing pelvic inflammatory disease (PID)"

I may have missed something, but do any contraceptives protect against PID? I appreciate that it can result from some STDs, but other than condoms protecting from most STDs, I wasn't aware that any contraceptive providing protection from PID - the extra bit on the end of the sentence seems a bit redundant. —Preceding unsigned comment added by 89.243.1.76 (talk • contribs) 02:37, 13 January 2007

I believe that women who have STDs and use hormonal contraception are less likely to develop PID than women who have STDs and do not use hormonal contraception. So hormonal contraception does not protect against STDs, but does protect (somewhat) against PID.

I agree the current sentence is confusing, though. I'll think about how to clean it up. Lyrl ^Talk _C 03:58, 13 January 2007 (UTC)

Hatcher & Nelson (2004). "Combined Hormonal Contraceptive Methods" in Hatcher, Contraceptive Technology, 18th ed., p. 401:

• Advantages and Indications
  • General health benefits
    • 4. Reduced risk of hospitalization for gonorrheal PID.

Hatcher (2004). "Depo-Provera Injections, Implants, Progestin-Only Pills (Minipills)" in Hatcher, Contraceptive Technology, 18th ed., p. 466:

• Advantages and Indications
  • Advantages of All Progestin-Only Methods
    • 2. Noncontraceptive benefits.
      • Decreased risk of endometrial cancer, ovarian cancer, and pelvic inflammatory disease (PID)

Grimes (2004). "Intrauterine Devices (IUDs)" in Hatcher, Contraceptive Technology, 18th ed., p. 501:

• Special Issues
  • Upper-genital-tract Infection
    • Three persistent biases led to the wrong conclusion about the risk of IUD-related infection. First, many studies used an inappropriate comparison group for IUD users: women using other contraceptives. Many of these contraceptives, such as the pill or condom, decrease the risk of salpingitis, thus biasing the comparison against the IUD.

Speroff & Darney (2005). "Oral Contraception" in A Clinical Guide for Contraception, 4th ed., p. 88:

• Infections And Oral Contraception
  • Viral STIs.
    • For women not in a stable, monogamous relationship, a dual approach is recommended, combining the contraceptive efficacy and protection against pelvic inflammatory disease (PID) offered by estrogen-progestin contraception with the use of a barrier method for prevention of viral STIs.
  • Bacterial STIs.
    • Because pelvic infection is the single greatest threat to the reproductive future of a young woman, the now recognized protection offered by oral contraception against PID is highly important. The risk of hospitalization for PID is reduced by approximately 50-60%, but at least 12 months of use are necessary, and the protection is limited to current users. Furthermore, if a patient does get a pelvic infection, the severity of the salpingitis found at laparoscopy is decreased. The mechanism of this protection remains unknown. Speculation includes thickening of the cervical mucus to prevent movement of pathogens and bacteria-laden sperm into the uterus and tubes and decreased menstrual bleeding, reducing movement of pathogens into the tubes as well as a reduction in "culture medium." This protection probably accounts for the greater fertility rate observed in previous users of oral contraception.

Speroff & Darney (2005). "Injectable Contraception" in A Clinical Guide for Contraception, 4th ed., p. 205:

• Advantages
  • Other benefits associated with depot-medroxyprogesterone acetate use include a decreased risk of endometrial cancer comparable with that observed with oral contraceptives and probably the same benefits associated with the progestin impact of oral contraceptives: reduced menstrual flow and anemia, less pelvic inflammatory disease (PID), less endometriosis, fewer uterine fibroids, and fewer ectopic pregnancies.

Mishell (2004). "Contraception", in Strauss & Barbieri, Yen & Jaffe's Reproductive Endocrinology, 5th ed., p. 920:

• Oral Steroid Contraceptives
  • Non-contraceptive Health Benefits
    • Other Benefits
      • Another benefit is protection against salpingitis, commonly referred to as pelvic inflammatory disease (PID). The relative risk of PID among OC users in most studies is about 0.5, a 50% reduction. OCs reduce the development of acute salpingitis in women infected with gonorrhea. Ectopic pregnancy risk is also reduced by more than 90% in current users, and OCs may reduce the incidence in former users by decreasing their risk of salpingitis.

Mishell (2004). "Contraception", in Strauss & Barbieri, Yen & Jaffe's Reproductive Endocrinology, 5th ed. p. 926:

• Long-Acting Contraceptive Steroids
  • Injectable Suspensions
    • Depot Formulation of Medroxyprogesterone Acetate
      • Non-contraceptive Health Benefits
        • In a summarization by Cullins, there is good epidemiologic evidence that use of DMPA reduces the risk of iron deficiency anemia, PID, and endometrial cancer.

69.208.196.181 04:47, 13 January 2007 (UTC)

Weight Gain

The article lists a disadvantage as no weight gain. I think that lack of weight gain is an advantage, not a disadvantage. Reliable Source: My Girlfriend  :) Mark94539 19:59, 22 March 2007 (UTC)

IUDs safe and effective in high-risk patients

"...we now know that IUDs are safe to use in all women who don't have an acute infection of the cervix. Therefore, young, unmarried, sexually active women can now be considered good candidates for this contraceptive option, which doesn't require taking a pill, patch, or injection...(Catherine A. Matthews, M.D.)" [1] Brian Pearson 05:48, 6 August 2007 (UTC)

"Marguiles Coil or Marguiles Spiral"

Surely Margulies? Flapdragon 10:14, 21 August 2007 (UTC)

The source I used (wayback machine link - the page seems to have been taken down from the original server) does indeed say "Marguiles". A Google search for Marguiles IUD gets about 120 hits as opposed to almost 700 hits for Margulies IUD, so based on popularity, Margulies would seem to be correct. Lyrl^Talk _C 23:13, 21 August 2007 (UTC)

Nickel

False and misleading original research by "jennifer0246" that she put into a ""ParaGard/Nickel connection??" journal entry crossposted on August 13, 2006 to the VaginaPagina, IUD Divas, and birthcontrolled LiveJournal communities was subsequently added by Lyrl on October 11, 2006 to the Contraindications section of this article as a newly invented contraindication citing misinformation from unreliable sources falsely stating that "the wires wrapped around the T-frame of the ParaGard IUD are nickel wires plated with copper", falsely implying that the 10-20% of women who are allergic to nickel (the most common contact allergen) should not use the ParaGard IUD.

• The wires wrapped around the vertical stem of the ParaGard^® TCu-380A IUD are not "nickel wires plated with copper", they are "pure electrolytic copper wire".

• Nickel allergy has not been shown to cause adverse effects in women with copper-releasing IUDs, and is not a contraindication to IUD use.

• Some dermatologists doubt the clinical relevance of a positive copper patch test (showing a "copper allergy" to direct skin contact with copper) in women with an IUD releasing copper in an daily amount that is a small percentage of the daily amount of dietary copper absorbed systemically.

• A journal entry by "jennifer0246" crossposted to the VaginaPagina, IUD Divas, and birthcontrolled LiveJournal communities is not a reliable source.

• The PMID 12284219 abstract, written by a POPLINE abstract editor (the article's authors did not write an abstract), that distorts and misrepresents the contents of an article featuring half-baked theories about HIV-transmission by three confused Mexican ob/gyn's who reference a 21-year-old textbook, Fisher AE (1986) Contact Dermatitis, 3rd ed. ISBN 0-8121-0971-6, that does not support (but instead contradicts) their wacky fictitious claims, is not a reliable source. PubMed abstracts of journal articles that you have not read should not be cited as references in Wikipedia articles.

These are reliable sources:

The current FDA-approved ParaGard label information

ParaGard^® also contains copper: approximately 176 mg of wire coiled along the vertical stem

Speroff & Darney (2005). A Clinical Guide for Contraception, 4th ed. ISBN 0-7817-6488-2, p. 226

Copper IUDs

This group of IUDs in represented in the United States by the TCu-380A (the ParaGard)

The pure electrolytic copper wire wound around the 36-mm stem weighs 176 mg

McCarthy & Ratnam (1994). "The Multiload 375" in Bardin & Mishell (eds.) Proceedings from the Fourth International Conference on IUDs ISBN 0-7506-9585-4, p. 261

The differences between the MLCu375 and its predecessor are the area of exposed copper, the thickness (and length) of the wire, and the tightness with which the coils are packed together on the stem.

The wire itself is 99.99% pure copper with a surface area of 345-395mm², diameter of 0.39-0.41 mm, and length of 285-305 mm using 305-361 mg Cu.

A mean release rate of 37 µg Cu per day has been calculated for the device over a 5.5 year period.

The loss of copper was 8% of the original load at 3 years and 18% after 5 years.

Cu loss is not significantly higher in the first year of use and does not effect serum levels.

Jouppila P, Niinimäki A, Mikkonen M (1979). Copper allergy and copper IUD. Contraception. 19(6): 631-7. PMID 487812

The mean weight of the copper wire used in the Copper-T 200 is 98 mg.

The daily release of copper has been estimated to be 40-50 µg. The release rate of copper from the device constitutes, however, only two per cent of the normal daily copper requirement. No elevations of copper or ceruloplasmin have been noticed in humans.

In the previously reported cases of Barranco PMID 5055098 and Barkoff PMID 971979, there is some doubt of true copper allergy. In the case of Barranco the positive test with 5 percent CuSO₄ was not ascertained to be allergic in nature when testing weaker solutions. In the case of Barkoff the allergy to copper was demonstrated by scratch test, which is not a current method in diagnosis of metal allergy, so the erythemal reaction found in urticarial skin was probably irritant in nature.

Our daily food contains chromium less than 1 mg and nickel 300-500 µg. These amounts are seldom if ever capable of producing any symptoms of delayed type allergy. Against this background, it seems evident that the small amount of nickel, only 0.0003%,

present in a copper IUD is harmless even to an individual hypersensitive to nickel.

Frentz G, Teilum D (1980). Cutaneous eruptions and intrauterine contraceptive copper device. Acta Derm Venereol. 60(1): 69-71. PMID 6153839

Cutaneous allergic reactions to copper are extremely rare.

In several cases of cutaneous eruptions in IUCD-using women, attention has been drawn to the IUCD as a possible cause of the dermatitis or of progression in preexisting skin disease, but final proof has constantly been lacking.

The copper in the IUCDs used in Denmark is quite pure and any contamination to the copper, for example in Gravigard^® (Searle) which contains 115 mg copper with surface area of 200 mm² does not exceed 0.01% according to the registration specifications.

On request the manufacturer reported a nickel content of 0.00032-0.00038% in the copper wire in the IUCD. Spectorgraphical analyses of nine copper wires from IUCDs as performed at NKT Metals, confirmed these figures, even though a certain fluctuation was found—as is be expected in electrolytically purified copper. The maximum nickel content—found in one of the nine IUCDs—was 0.001%.

We found no proof of IUCD-provoked or -aggravated dermatitis in this investigation.

Two theoretical questions arise:
1. Do negative patch tests and negative intracutaneous tests for delayed reactions definitely rule out an internal provocation with metals as an etiological factor in a skin eruption, considering the differing routes of administration, the various possible proteins which render the metal a whole antigen, and the different concentrations of the antigen at the sites of application?
2. Is the minimal amount of nickel in the IUCD of any importance—especially in nickel-sensitive women?

As an approach to this we have tabulated (Table I) the daily ingestion of copper and absorption as measured by urinary excretion of nickel, the amounts of copper and nickel which, according to reports in the literature, have elicited in intracutaneous tests local delayed reactions in rather sensitive individuals, and daily maximal release of copper and nickel from the IUCD, calculated for the first weeks following insertion since the amount of metal released declines subsequently.

Table I. Approximate amounts of copper and nickel in turnover, intracutaneous tests, and daily release from intra-uterine copper device

	Copper	Nickel
Daily absorption (Cu) or excretion in urine (Ni), µg	800	1.5
Amount of metal found in intracutaneous tests, µg	2	10
Amount of metal in intracutaneous tests, which may elicit type IV reaction, µg	0.5	0.001
Maximum amount of metal released daily from copper device, µg	90	0.0009

From these figures, it seems unlikely that even markedly nickel-sensitive women would develop allergic nickel dermatitis as a result of insertion of an IUCD.

Cutaneous allergic reactions to the metal in the IUCD are believed to be very rare and of a minor practical significance.

Wohrl S, Hemmer W, Focke M, Gotz M, Jarisch R (2001). Copper allergy revisited. J Am Acad Dermatol. 45(6): 863-70. PMID 11712031

In contrast to the common metal allergens

(nickel, cobalt, palladium, and chromium), copper is believed to be only a rare cause of allergic contact dermatitis. Additionally, copper has a low sensitizing potential. However, the regularly positive patch test results reported in selected patient groups (8.5%; 14%) coincide with our own observations about copper hypersensitivity. The clinical relevance of such positive results often remains in doubt. In the past, there had been speculations that copper allergy might be a cause of complaints in females using a copper intrauterine device (IUD). In most of the cases this concept had to be rejected.

In contrast to most of the other known metal allergens, copper is also an essential trace element. Therefore there exists an efficient protein transport system involving metallothionein. Copper levels in the normal healthy skin can be up to 7 µg/g dry weight.

The clinical relevance of the observed copper hypersensitivity reactions often remain in doubt. In most of the cases, the symptoms of allergic contact dermatitis could be attributed to the more prominent allergens nickel and cobalt.

Monovalent sensitization to copper is a rare event. In contrast to this, positive patch tests to copper do not seem to be a rare finding. In most of the cases they originate in a cross-reactivity to nickel and can therefore be considered specific.

We conclude that positive patch tests to copper are mostly specific; however,

they are usually of low clinical relevance.

BC07 21:11, 1 October 2007 (UTC)

expulsion and strings?

This article doesn't really explain what expulsion is, how it occurs, or its effects. It also doesn't really explain the presence of strings. I'm not knowledgeable enough to add this information. Is someone else able to? —Preceding unsigned comment added by 143.229.182.248 (talk) 05:29, 26 February 2008 (UTC)

If an IUD is expelled, that means it fell out of the uterus. Generally it comes out the same way it got in - through the cervix and into the vagina. The effect is loss of protection from pregnancy.

To aid in removal, the IUD has a string on it that hangs out of the uterus. Like a tampon has a string that hangs out to aid in removal.

Is that the information you were looking for? Lyrl^Talk _C 21:45, 26 February 2008 (UTC)

As to the most recent scientific sources ...

[[2]] April 2008: James Trussel and Elizabeth G. Raymond (Professors that are certainly not pro-lifers) "Copper IUDs can be inserted up to the time of implantation—five to seven days after ovulation—to prevent pregnancy. Thus, if a woman had unprotected intercourse three days before ovulation occurred in that cycle, the IUD could prevent pregnancy if inserted up to ten days after intercourse. Because of the difficulty in determining the day of ovulation, however, many protocols allow insertion up to only five days after unprotected intercourse. The latest WHO guidelines allow IUDs to be inserted up to day 12 of the cycle with no restrictions and at any other time in the cycle if it is reasonably certain that she is not pregnant.12 A copper IUD can also be left in place to provide effective ongoing contraception for up to ten years. But IUDs are not ideal for all women. Women with current sexually transmitted infections (STIs) are not good candidates for IUDs; insertion of the IUD in these women can lead to pelvic infection, which can cause infertility if untreated. Women not exposed to STIs have little risk of pelvic infection following IUD insertion,13 and use of a copper IUD is not associated with an increased risk of tubal infertility among nulligravid women (whereas infection with chlamydia is).14"

So, as to famous professors (Trussel is often cited on "emergency contraception" of wikipedia, but not here ... why?), IUDs have an efficient anti-implantation effect ... and in this Wikipedia article, the anti-implantation effect is presented as very secondary or inexistent ("there is no evidence ..."): this wikipedia article seems to me more than non-neutral, more than POV, it is contradictory with reliable scientific sources.

Should we not let our personal ethical opinions aside in order to accept the reliable scientific sources? Or I do not understand Wikipedia? 77.109.115.58 (talk) 16:43, 7 May 2008 (UTC) (Coatlaxopeuh from Wikipedia in French)

When used as an ongoing contraception method, the primary way the IUD works is to prevent fertilization. When used as emergency contraception, during that first cycle preventing implantation may be the primary mechanism. The Trussel reference should probably be included in a discussion about use as emergency contraception, but not as the normal way the IUD works. Lyrl^Talk _C 21:40, 7 May 2008 (UTC)

OK, you can do this because you are english speaking (I might write a strange English). 83.134.194.253 (talk) 09:59, 8 May 2008 (UTC) (Coatlaxopeuh from another computer)

very confused!

I think this article needs to specify when it is referring to both types of coil, and when to only the copper kind or whatever.

I'm confused by the "the primary way the IUD works is to prevent fertilisation" bit. If it is the hormone-free coil, how can it do that- sperm will just go round it, won't they? I mean, the device doesn't go up the fallopian tubes does it, so the sperm can happily go up there and fertilise the egg (the production of the egg can't have been effected by a device that is non-hormonal, can it?). Merkin's mum 03:56, 10 May 2008 (UTC)

"The presence of a device in the uterus prompts the release of leukocytes and prostaglandins by the endometrium. These substances are hostile to both sperm and eggs; the presence of copper increases this spermicidal effect." Does that help? Lyrl^Talk _C 11:35, 10 May 2008 (UTC)

Aah, thanks. I looked them up. L's in particular, and maybe P's, appear to be related to the immune system. Does the change in the immune system effect the whole body, or does it manage to be very localized? I'm thinking of people who need to keep their immune system deliberately low, due to a transplant or something. Merkin's mum 19:58, 10 May 2008 (UTC)

Effect is localised - foreign body reaction is a local inflammatory response, and the concentration of copper is very low, and absorbed levels even lower. As for second question, issue is not that immunosuppression will prevent the IUCD from working, but rather that their insertion or presence pose a greater infection risk than in those with normal immune function - as British National Formulary includes under th elist of cautions: "..., drug- or disease- induced immunosuppression (risk of infection - avoid if marked immunosuppression), ...". David Ruben ^Talk 22:41, 10 May 2008 (UTC)

Aaah, I should have thought of that. You know your stuff! :) Merkin's mum 20:37, 11 May 2008 (UTC)

Views of the Roman Catholic Church

I don't see any reason why there shouldn't be a section in this article about religious views of the IUD. It isn't giving undue weight, since the Catholic church is not an "extremely small (or vastly limited) minority." (WP:UNDUE) This article should not just be about the IUD as a medical device, but also how it fits into our culture. The mechanism of action of the IUD is distinguished from other contraceptive devices in certain religious groups because it is believed to be "abortofacient," so I think it is extremely useful and informative to include this fact in this article, and not only general articles like Catholic teachings on sexual morality and Contraception. The article Condom includes a brief description of the Catholic church's views, so I don't understand why the same kind of summary is objected to in this article.

In case it matters, I am not religious and I completely disagree with the church's viewpoint on this issue. However, I was really glad to see someone had added it to the article, because I think it is so useful to include the cultural and religious issues surrounding the IUD, and I've been extremely disappointed to see people deleting it. --Ships at a Distance (talk) 03:38, 13 December 2008 (UTC)

The edit was not a section on religious views of the IUD, it was coverage of an official communication by the Roman catholic church.

• The item lumped all Catholics together, as if the official utterances of the Papacy are the views of all Catholics. (see for instance Religious views on birth control, Catholics for Choice)
• The item was not specific to the IUD, the official church position on the IUD does not appear to differ significantly from its view of most contraceptive methods. (It could be put more concisely as "The Roman Catholic Church condemns any artificial birth control.")
• Note that the section in Condom deals specifically with issues particular to Condoms (i.e. protection from STDs). While some non-condom contraceptive methods (e.g. other barriers) provide some STD protection, the effects are much smaller, and the methods are not promoted for that purpose near as much as condoms are.

Since there are already several articles dealing with religious views of contraception, there is no reason to just rehash the general views of the religions here, any coverage should focus specifically on the IUD (e.g. how it is viewed differently than other methods, etc.)

Side note - Since it used to be thought that IUD might impede implantation, but more recent evidence indicates that it works earlier, preventing fertilization, coverage of religious views on the IUD may need particular care to establish time frame/what information about method of action a given view was based on. Zodon (talk) 07:58, 13 December 2008 (UTC)

Could we use this information to begin a section on religious views of the IUD in general? What would be the best way to provide information on the religious issues, or the controversy of the IUD being abortofacient, which are both seriously lacking in this article? Obviously IUDs do not attract the same kind of attention that condoms do, but because they have a unique mechanism of action there are unique reasons why anti-abortion groups oppose them. This article would be more useful if it could provide information on which groups oppose them and why, and which groups do not consider them abortion. I don't think the casual reader will try to get this kind of information from an article as general as Catholic teachings on sexual morality, which this article does not even link to. I know that I would like to learn more about how the IUD specifically fits into the larger abortion debate, and it would make sense for that information to be summarized clearly here. A lot of people still believe that IUDs prevent implantation, and they will want to learn how IUDs are viewed in different ideologies, especially if they subscribe to one themselves. --Ships at a Distance (talk) 20:05, 13 December 2008 (UTC)

It doesn't seem to be a very useful starting place since the official Catholic view for IUD doesn't appear to differ much from their view of most other contraceptives. (i.e., if I was researching this, Roman Catholic official policy looks like a dead end. Though one might try material from some of the other Catholic views.)

As a starting point, a link to the articles on Religious views on birth control, and possibly Christian views on contraception, and Jewish views on contraception would be shorter, and give broader coverage.

Afraid I don't have any particularly good leads to suggest in researching this. Zodon (talk) 21:12, 13 December 2008 (UTC)

There is an article whose sole topic is the controversy about contraceptives that some believe prevent implantation: Beginning of pregnancy controversy. That used to be linked in this article's "mechanism of action" section, and I accidentally removed it while doing some copy editing a few months ago. I've re-added the link. Hopefully that will address the issue of making information available that Ships is concerned about, while keeping this article focused on the topic of the device itself. Lyrl^Talk _C 23:21, 13 December 2008 (UTC)

IUCD

Here in Canada these devices are classified by the literature as intrauterine contraceptive devices (IUCD) and include both hormonal and non hormonal types.Doc James (talk · contribs · email) 11:00, 22 January 2009 (UTC)

Mirena IUD

Hi everyone. I was just wondering why there isn't a picture or more information about the Mirena IUD on here? It is one of only two IUDs in use in the United States. I think there needs to be more information about it. There at least needs to be a picture of it if one that is not copyrighted can be found. --PaladinWriter (talk) 14:48, 1 February 2009 (UTC)

Most of the information about Mirena is in the article about hormonal IUDs (IntraUterine System). Zodon (talk) 21:32, 1 February 2009 (UTC)

IUD picture and nickel

Could I also suggest that you change the IUD picture? It's quite a lot larger than a real-life IUD, which might mislead (not to mention scare) people, and having a colour version would help as well.

You might want to mention that some copper IUDs have a small amount of nickel in them. A woman posted in http://iud-divas.livejournal.com/ about this a while ago, she was allergic to nickel and discovered too late that the IUD that was already in her contained nickel. She confirmed it directly from the manufacturer, I think it was Paragard but you should be able to check through the past entries of that forum.

Elettaria 23:12, 10 September 2006 (UTC)

Something I've noticed, the commercials advertising these devices definitely don't look so big, they look rather small, and kind of "flimsy" (I think they bend one between two fingers...) - do the sizes of the "devices" vary...? --67.34.188.252 (talk) 23:40, 18 March 2009 (UTC)

A picture with a ruler for scale might help. Most of the devices I have seen have been of similar size (about an inch to inch and a half), (e.g. Paragard is 36 mm by 32 mm). Zodon (talk) 07:01, 19 March 2009 (UTC)

GyneFix

I looked into GyneFix very thoroughly when researching my IUD, and I think that the information about it in this article is misleading.

GyneFix is very little used, despite having been around for a number of years and promising to revolutionise IUDs. The theory was that the frameless device and small size would be less likely to cause increased cramping and blood loss, thus making it particularly suitable for nulliparous women or those with heavy periods. From what a number of gynaecologists have told me, this did not turn out to be the case in practice: the increase in cramping and blood flow was the same as for other types of copper IUD. There was also a theory that the expulsion rate would be lower, but again this was not borne out in practice.

In addition, the insertion procedure is much more difficult because the device has to be anchored to the uterine wall, which requires very careful placement. It takes far longer to learn how to insert this IUD, and many doctors do not have the additional time, but more importantly, there is a greatly increased risk of uterine perforation during insertion, and many doctors who have learned to insert the GyneFix have stopped because of this.

Since there are no additional benefits but there are several additional risks, it is almost impossible to find a doctor who will insert the GyneFix. Even in Europe, where there is a wider range of copper IUDs than in the US and a larger proportion of women using them, there may be no one offering the GyneFix in an entire country.

So the GyneFix is certainly not recommended for nulliparous women anywhere that I know of (apart from by the manufacturer, whose advice is not being taken by doctors). In the UK a smaller T-shaped copper IUD such as the Nova T380 is usual for nulliparous women.

I researched the Gynefix because I am nulliparous and had expelled my first IUD, and this one sounded less likely to be expelled due to the anchoring method. A number of gynaecologists warned me against it, however. Apparently several doctors at my local Family Planning Clinic (the Edinburgh one, which has a superb reputation for IUD insertion) had trained in Gynefix insertion, but all but one of them had stopped due to several perforations (which I think were the first ever perforations at this clinic). The one gynaecologist who could insert them hadn't done one in years because of their unpopularity for the above reasons. I only know of one other clinic in the UK where Gynefixes may be inserted, but again they strongly prefer not to.

Elettaria 09.09.06

Please be bold and change the information to be accurate. You might also be interested in fixing up the Gynefix article. Lyrl ^Talk _Contribs 23:30, 9 September 2006 (UTC) where does it show though. I think the only problem with doctors is that they defy new contraceptives because too many don't even think in the directive of IUDs in general. After all , all what they want is to earn money like everybody else. I personally neither had an increase in bleeding nor any complications and in boards which discuss this there has nt been one either. Another thing that may deter people from using it is that it is not covered by health service. —Preceding unsigned comment added by 82.83.69.226 (talk) 05:54, 25 May 2009 (UTC)

Why split IUD into 3 articles?

IUD was covered by two articles - Intrauterine system (IUD that contain hormones), and Intrauterine device - which covered non-hormonal devices.

The IUS article has been renamed to IUD with progestin. And the IUD article has been split into two parts, this article and Intrauterine device. To what purpose? What advantage is there in having this extra article, rather than the pair? Unless there is clear advantage to the split - I think that should recombine the Intrauterine device and the IUD with copper articles. Zodon (talk) 05:53, 8 April 2010 (UTC)

Response at Wikipedia_talk:WikiProject_Medicine/Reproductive_medicine_task_force#Recent_split_and_renaming_of_IUD_articles. --Arcadian (talk) 10:52, 8 April 2010 (UTC)

Requested move

The following discussion is an archived discussion of a requested move. Please do not modify it. Subsequent comments should be made in a new section on the talk page. No further edits should be made to this section.

The result of the move request was: no consensus to move as some of the split issues seem to have been taken care of. Feel free to re-request, for example, that this page be given a name other than "IUD with copper". Regards, Arbitrarily0 ^(talk) 13:02, 30 May 2010 (UTC)

---

IUD with copper → Intrauterine device — The Intrauterine device article was moved to a new name (IUD with copper)[3], however almost all the content of the article is about Intrauterine devices in general (rather than just the copper containing ones). Fixing the articles would amount to a cut and paste merge of IUD with copper into Intrauterine device. Swapping the two articles, and then restoring the section on types of IUD to the IUD article will give a cleaner history. Then IUD with copper can be expanded as desired. See discussion linked above. Zodon (talk) 02:05, 18 April 2010 (UTC)

• Intrauterine device → IUD with copper

Article name

If split to remain - why the name "IUD with copper"? Many non-hormonal IUDs do/did not contain copper. (Grafenberg ring, steel ring, lippes loop, etc.) Google search "IUD with copper" turns up 36,400 pages, whereas "non-hormonal IUD" gives over 220,000. Zodon (talk) 05:58, 8 April 2010 (UTC)

Historical information about non-hormonal, non-copper devices would be best addressed at Intrauterine device. (I've added a link to Gräfenberg's ring there, but you may wish to integrate it into the prose. --Arcadian (talk) 10:56, 8 April 2010 (UTC)