Cochrane systematic reviews of IUD trials: lessons learned.
BACKGROUND
Intrauterine devices (IUDs) are the most widely used reversible contraceptives in the world today, and decisions about their use should reflect the best available evidence.


METHODS
We performed a computer search of the Cochrane Library for all IUD-related reviews.


RESULTS
Eleven reviews related to IUDs have been registered in The Cochrane Library; 10 have been completed, and one is in progress. Topics include type of IUD, timing of insertion, clinical management, emergency contraception and use as gynecological treatment. The copper T380A is the most effective copper IUD; the levonorgestrel intrauterine system has efficacy comparable to that of IUDs with >250 mm(2) of copper. The frameless device may be comparable in efficacy to the copper T380A, although whether problems with the initial inserter are resolved is unclear. Immediate postpartum and postabortal insertion appears safe and effective, although trials comparing immediate to delayed insertions are scarce. Prophylactic antibiotics at the time of insertion appear unwarranted except in populations with a high prevalence of sexually transmitted diseases. Many nonsteroidal anti-inflammatory drugs reduce pain and bleeding associated with IUDs, although prophylactic use of ibuprofen does not improve continuation rates. The levonorgestrel system is superior to oral progestins in treating heavy uterine bleeding. This IUD compares favorably with endometrial ablation techniques and presents an alternative to hysterectomy for many women.


CONCLUSIONS
Trials are needed to evaluate immediate vs. delayed insertion after delivery or abortion and to explore emerging therapeutic uses of the levonorgestrel system, such as treatment of endometrial hyperplasia.
Grimes
David A
DA
Family Health, International, P.O. Box 13950, Research Triangle Park, NC 27796, USA. dgrimes@fhi.org
Lopez
Laureen M
LM
Manion
Carol
C
Schulz
Kenneth F
KF
D044363:Contraception, Postcoital / Q000379:methods; D003271:Contraceptive Agents, Female / Q000191:economics / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007435:Intrauterine Devices, Copper / Q000009:adverse effects* / Q000191:economics; D016912:Levonorgestrel / Q000191:economics / Q000627:therapeutic use*; D008595:Menorrhagia / Q000188:drug therapy; D016032:Randomized Controlled Trials as Topic
D003271:Contraceptive Agents, Female; D016912:Levonorgestrel