Study finds American women may benefit from IUD only available in Europe and Canada
Penn research suggests Food and Drug Administration should consider approving more and smaller IUDs.
Among women who have never given birth, smaller copper intra-uterine devices (IUDs) available outside the United States were less likely to be removed due to bleeding and pelvic pain compared to a larger, FDA-approved copper IUD, according to new research published in NEJM Evidence by a group led by Perelman School of Medicine at the University of Pennsylvania. While the larger IUDs are 99 percent effective at preventing pregnancies over three years, researchers found the mini IUDs were still very effective (at 95 percent) for the same duration.
“Birth control is very personal, and women deserve options when selecting the method right for them,” said Courtney Schreiber, MD, MPH, chief of the division of Family Planning and the Stuart and Emily Mudd Professor of Human Behavior & Reproduction at Penn. “Since uteruses stretch during pregnancy, women who have not delivered babies are more likely to have smaller uteruses and might benefit from the mini IUDs available in Europe and Canada. A particular birth control may be very effective at preventing pregnancy, but if it causes someone adverse reactions bad enough to warrant its removal, it’s not doing its job. That’s why the increased pregnancy risk over three years with the smaller copper versions may be acceptable for some women.”
Not the most common contraceptive, but an important one
According to the Centers for Disease Control and Prevention (CDC), approximately 10 percent of women aged 15-49 in the United States have an IUD, a T-shaped contraceptive device inserted into the uterus by a medical professional to prevent pregnancy. IUDs are either hormonal or non-hormonal. Hormonal IUDs are made of plastic and prevent pregnancy by releasing progestin to thicken cervical mucus, which provides a barrier for sperm, and thins the uterine lining, which makes it harder for a fertilized egg to implant. Non-hormonal options are made of copper, and the copper itself kills sperm, preventing pregnancy.
“Some women prefer copper IUDs because they last longer than hormonal options, (up to 10 years compared to 3 to 8 years), allow for regular periods, and, upon removal, fertility returns immediately,” said Schreiber. But roughly 20 percent of American women who choose copper IUDs have them removed within the first year, she said.
And that’s likely due, at least in part, to pain and bleeding caused by the size. Even though it’s only roughly a centimeter larger than the small ones, just the size of a pea, in a person’s uterus, that’s meaningful.
Neither the FDA-approved copper IUD, nor the mini IUD available abroad are new. The larger American IUD hit the market in the late ‘80s, and the mini IUD became available in the mid ‘90s.
Another IUD option for Americans coming soon
Since the time of this study, which was conducted for 37 months, a smaller copper IUD called Miudella is FDA approved. Although it’s 99 percent effective, it only lasts three years and is still a few millimeters larger than devices used abroad.
“We are happy our patients have more devices to consider since we conducted our study, but I think this new product shows we are behind other parts of the world and that there is a market for smaller copper IUDs that are effective and less likely to cause pain and bleeding,” said Schreiber. “In addition, mini IUDs may be a perfect option for women who are only looking for protection for a short period of time. Based on our research, we would encourage pharmaceutical companies to develop and market mini IUDs for use in the United States and for the FDA to review them.”