Intervention Review

Copper containing, framed intra-uterine devices for contraception

  1. Regina Kulier1,*,
  2. Paul O'Brien2,
  3. Frans M Helmerhorst3,
  4. Margaret Usher-Patel4,
  5. Catherine d'Arcangues5

Editorial Group: Cochrane Fertility Regulation Group

Published Online: 17 OCT 2007

Assessed as up-to-date: 19 AUG 2007

DOI: 10.1002/14651858.CD005347.pub3


How to Cite

Kulier R, O'Brien P, Helmerhorst FM, Usher-Patel M, d'Arcangues C. Copper containing, framed intra-uterine devices for contraception. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD005347. DOI: 10.1002/14651858.CD005347.pub3.

Author Information

  1. 1

    Geneva Foundation for Medical Education and Research, Geneva, Switzerland

  2. 2

    Westminster Primary Care Trust, Raymede Clinic, Westside Contraceptive Services, London, UK

  3. 3

    Leiden University Medical Center, Dept. of Gynaecology, Division of Reproductive Medicine and Dept. of Clinical Epidemiology, Leiden, Netherlands

  4. 4

    World Health Organization, Department of Reproductive Health and Research, Geneva 27, Switzerland

  5. 5

    WHO, Reproductive Health and Research, Geneva 27, Switzerland

*Regina Kulier, Geneva Foundation for Medical Education and Research, Route de Florissant 3, Geneva, CH-1208, Switzerland. regina.kulier@bluewin.ch.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 17 OCT 2007

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Intrauterine devices (IUD) are safe and effective methods of long term reversible contraception. The design, and copper content as well as placement of the copper on IUDs could affect their effectiveness and side-effect profile.

Objectives

We compared different copper IUDs for their effectiveness and side effects.

Search methods

Multiple electronic databases were searched with appropriate key words and names of the IUDs known to be in the market. We searched the reference lists of papers identified and contacted trialists when possible. There was no language restriction.

Selection criteria

Randomised controlled trials comparing different IUDs were considered. Trials needed to report on clinical outcomes.

Data collection and analysis

Data on outcomes and trial characteristics were extracted in duplicate and independently by two reviewers. Meta-analysis results are expressed as rate difference (RD) using a fixed-effects model with 95% confidence interval (CI). In the presence of significant heterogeneity a random-effects model was applied.

Main results

We included 35 trials, resulting in 18 comparisons of 10 different IUDs in approximately 48,000 women. TCu380A was more effective in preventing pregnancy than MLCu375 (RD 1.70%, 95% CI 0.07% to 2.95% after 4 years of use). TCu380A was also more effective than MLCu250, TCu220 and TCu200. There tended to be fewer pregnancies with TCu380S compared to TCu380A after the first year of use, a difference which was statistically significant in the fourth year (RD -1.62%, 95% CI -3.00% to -0.24%). This occurred despite more expulsions with TCu380S (RD 3.50%, 95% CI 0.36% to 6.63% at 4 years). MLCu375 was no more effective than TCu220 at 1 year of use, or MLCu250 and NovaT up to 3 years. Compared to TCu380A or TCu380S, none of the IUDs showed any benefits in terms of bleeding or pain, or any of the other reasons for early discontinuation. None of the trials that reported events at insertion found one IUD easier to insert than another or caused less pain at insertion. There is no evidence that uterine perforation rates vary by type of device. There are minimal randomised data on IUD use in nulliparous women.

Authors' conclusions

TCu380A or TCu380S appear to be more effective than other IUDs. No IUD showed consistently lower removal rates for bleeding and pain in comparison to other IUDs. There is no evidence that any particular framed copper device is better suited to women who have not had children.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Effectiveness of Copper-containing intra-uterine devices (coil)

T-shaped IUDs with copper on the arms are the most effective, have the longest duration of action and are the IUDs of choice.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

為避孕目的骨架上含銅的子宮內避孕器

長期的可逆避孕方法中,子宮避孕器(IUD)是安全和有效的方法。設計,和銅的含量,以及子宮避孕器中銅的配置可能會影響其效力和副作用的型態。

目標

我們依效力和副作用比較不同的含銅子宮避孕器。

搜尋策略

依照適當的關鍵詞和市場上已知子宮內避孕器的名稱, 搜尋多個電子資料庫。我們搜尋了找到文件的參考文獻,並儘可能接觸試驗者。沒有語言的限制。

選擇標準

比較不同子宮避孕器的隨機對照試驗進行了審議。試驗需要報告臨床結果。

資料收集與分析

數據結果和試驗特徵由兩個檢視者分別且獨立的取得。統合分析結果以使用95 %信賴區間(CI)的固定效果模式的率差(RD)來表示。在存在顯著的異質性中,隨機效果模式被應用。

主要結論

我們納入35個試驗,結果在大約48000婦女中有18個比較試驗,10種不同的子宮避孕器。TCu380A比MLCu375更有效地防止懷孕(4年後使用,RD 1.70 %,95 % CI為0.07 %至2.95 %)。TCu380A也比MLCu250,TCu220與TCu200更有效。一年使用後,TCu380S有較TCu380A少懷孕的趨勢,其中在第四個年頭其差異有統計學意義(RD −1.62 %,95 % CI為 −3.00 %到 −0.24 %)。儘管TCu380S有較多的排出,上述趨勢仍存在(RD 3.50 %,95 % CI為0.36 %到6.63 %,四年)。MLCu375在一年的使用沒有比TCu220更有效,或到三年的使用沒有比MLCu250和NovaT更有效。和TCu380A或TCu380S相比,就出血、疼痛或任何其他的原因而早期中止而言,沒有子宮避孕器顯示有任何好處。沒有任何試驗關於裝置時的狀況報告發現一種子宮避孕器裝入時會比另外一種容易或是引起較少的疼痛。沒有任何證據表明,子宮穿孔率會因避孕器類型有所不同。有極少的隨機數據談到在未生產過的婦女使用子宮避孕器。

作者結論

TCu380A或TCu380S似乎比其他子宮避孕器更有效。與其他子宮避孕器相較,沒有任何一種子宮避孕器顯示一致較低的因出血及疼痛的移除率。目前並沒有證據顯示任何特定的設計的含銅避孕器更適合還沒有子女的婦女。

翻譯人

本摘要由臺灣大學附設醫院張致遠翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

最常用的子宮避孕器(IUDs)(或線圈)是由細銅線纏繞T字形或馬蹄形框架而成。一些子宮避孕器有銅位在T的臂上。其作用的主要機制是為了防止受精。子宮避孕器的形狀及銅的量與配置影響其表現。T形子宮避孕器有銅位在T的臂上(TCu380A和TCu380S)是最有效的,擁有最長的作用時間且是子宮避孕器中的選擇。比較於其他子宮避孕器時,沒有任何一種子宮避孕器顯示一致較低的因出血及疼痛的移除率。目前並沒有證據顯示任何特定的設計的含銅避孕器更適合還沒有子女的婦女。