an intra-uterine device (IUD) shortly after unprotected intercourse provides an
alternative emergency contraceptive method. It was first reported in1976. The
copper-T IUD was inserted in 97 women within 5 days after unprotected intercourse.
No pregnancy occurred within 3 months of the post-coital insertion of the IUD.
In a review article by Fasoil et al, nine studies of IUD used in post-coital
contraception were summarized. Information was available on a total of 879 women
in only one failure was reported. The timing of insertion varied from one to ten
days after unprotected intercourse. Data reported by Trussell et al showed
that there are five published reports describing a total of eight pregnancies
following 8400 post-coital IUD insertions. The failure rate was less than 0.1%.
In summary, the available data show that insertion of a copper-IUD is a highly
effective, safe and acceptable Emergency Contraception method.
To confirm the efficacy and acceptability of IUD in Emergency Contraception, a
multi-centre trial has been carried out in China since 1998 with technical and
financial support by WHO. A total of 1894 subjects were recruited. The one-year
follow-up as just been completed. The preliminary results showed that no pregnancy
occurred during the treatment cycle and no PID was reported up to one-year of
follow-up. Only four pregnancies occurred after 2, 6, 8 and 12 months after insertion
of the IUD. The advantages of IUD in Emergency Contraception were confirmed by
the present study. The method was not only highly effective, but also provided
up to 10 years of contraception. Failure due to further acts of unprotected intercourse
during the treatment cycle, which happens quite frequently (it was 40% - 50% in
our previous observations), could be avoided by using IUD.
Based on the above evidence, the currently revised IUD guideline has included
the IUD as a method of Emergency Contraception. The parous women would be strongly
recommended to insert IUD when they seek Emergency Contraception.
For proper screening and counselling, the following steps should be followed:
• According to the newly-published ‘Medical Eligibility Criteria
for Contraceptive Use’ by WHO, the only contra-indication to IUD for emergency
contraception is pregnancy. It is important to perform a urine pregnancy test
by using a sensitive method to rule out pregnancy.
Pelvic examination should be carefully performed by experienced providers to rule
out PID or STI.
• The effectiveness of IUD insertion
for Emergency Contraception as well as in the late use should not be overstated.
The failure rate could be stated as about 1%. Subjects should be informed to terminate
the unwanted pregnancy in case of failure.
The common side-effects of pain and bleeding induced by IUD insertion should be
informed to subjects properly.
• The subjects
should be requested for regular follow-up visits, and be encouraged to come back
if any problem occurs.