Takaisin Tulosta

Copper intrauterine device for emergency contraception

Evidence summaries
Heidi Alenius
Last reviewed as up-to-date 18.4.2020Latest change 18.4.2020

Level of evidence: A

Copper intrauterine device is effective for emergency contraception.

Summary

A Cochrane review «»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 «...»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.

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