Takaisin Tulosta

Copper intrauterine device for emergency contraception

Evidence summaries
Heidi Alenius
Last reviewed as up-to-date 6.6.2024Latest change 6.6.2024

Level of evidence: A

Copper intrauterine device is the most effective method for emergency contraception.

Summary

A Cochrane review «Interventions for emergency contraception»1 «Shen J, Che Y, Showell E et al. Interventions for ...»1 included 3 studies with a total of 695 subjects. In one trial comparing Copper intrauterine device (Cu-IUD) with expectant management there were fewer pregnancies in the IUD group (RR 0.09, 95% CI 0.03 to 0.26, n=300), which is in line with results from nonrandomised studies (3 pregnancies/3 470 women, failure rate 0.09%). There was no conclusive evidence of a difference in the risk of pregnancy between the Cu-IUD and mifepristone (RR 0.33, 95% CI 0.04 to 2.74; 2 RCTs, n = 395).

A study «Bellows BK, Tak CR, Sanders JN et al. Cost-effecti...»3 compared the cost-effectiveness of emergency contraception strategies over 1 year in US dollars. In 1000 women seeking emergency contraception, the estimated direct medical costs of $1 228 000 and 137 unintended pregnancies with ulipristal acetate, compared to $1 279 000 and 150 unintended pregnancies with oral levonorgestrel, $1 376 000 and 61 unintended pregnancies with copper intrauterine devices, and $1 558 000 and 63 unintended pregnancies with oral levonorgestrel plus same-day levonorgestrel intrauterine device. The copper intrauterine device was the most cost-effective emergency contraception strategy in the majority (63.9%) of model iterations and, compared to ulipristal acetate, cost $1957 per additional pregnancy prevented. When the proportion of obese women in the population increased, the copper intrauterine device became even more most cost-effective.

A meta-analysis «Cleland K, Zhu H, Goldstuck N et al. The efficacy ...»2 included 42 studies conducted in 6 countries (China, Egypt, Italy, the Netherlands, and the UK) between 1979 and 2011 and included 8 different types of IUD and 7034 women. The maximum timeframe from intercourse to insertion of the IUD ranged from 2 days to 10 or more days; the majority of insertions (74% of studies) occurred within 5 days of intercourse. The pregnancy rate was 0.09%. Altogether, there were 10 pregnancies, 6 pregnancies occurred among 5629 subjects in the studies conducted in China (failure rate = 0.11%; 95% CI = 0.05–0.23%) and 4 pregnancies occurred among 200 subjects in one study conducted in Egypt.

The copper-IUD is assessed as the most effective method for emergency contraception «...»4.

Clinical comments

IUD is the only method to provide ongoing contraception if left in situ, and thus highly cost-effective.

References

  1. Shen J, Che Y, Showell E et al. Interventions for emergency contraception. Cochrane Database Syst Rev 2017;(8):CD001324. «PMID: 28766313»PubMed
  2. 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(7):1994-2000. «PMID: 22570193»PubMed
  3. Bellows BK, Tak CR, Sanders JN et al. Cost-effectiveness of emergency contraception options over 1 year. Am J Obstet Gynecol 2018;218(5):508.e1-508.e9. «PMID: 29409847»PubMed
  4. Faculty of Sexual and Reproductive Healthcare. FSRH guideline – Emergency contraception. London: Faculty of Sexual and Reproductive Healthcare, March 2017, amended July 2023. «https://www.fsrh.org/standards-and-guidance/documents/ceu-clinical-guidance-emergency-contraception-march-2017/»1