Intrauterine device efficacy

Phenobarbital, carbamazepine, and phenytoin potentially reduce efficacy of OCs, and many anticonvulsants are known teratogens. The use of condoms in conjunction with high-estrogen OCs or intrauterine devices (IUDs) may be considered for women taking these drugs. 

Meirik O, Farley TM, Sivin I. Safety and efficacy of levonorgestrel implant, intrauterine device, and sterilization. Obstet Gynecol 2001 97(4) 539-47. 

Probably the most widely used hormone preparations in the world are those used in healthy women who are not suffering from a disease. These are, of course, birth control pills, which usually contain derivatives of estrogen and progesterone. While they can be used in certain gynecologic disorders with efficacy, the vast majority of prescriptions are written to prevent pregnancy. Their development introduced a new era in society a virtually 100 percent effectiveness, replacing IUDs (intrauterine devices), condoms, creams, jellies, and diaphragms. 

World Health Organization (WHO). Mechanism of action, safety and efficacy of intrauterine devices. In Technical Report Series. Geneva WHO, 1987 753 91. 

Cytotoxicity In women, copper-based intrauterine devices as effective contraceptives have long been used. However, an analysis of the levonorgestrel intrauterine system (LNG-IUS) concluded significant efficacy and lower side effects compared to a copper T380A (intrauterine device), except for acne reported in LNG-IUS. LNG-IUS also shows improved duration of menstrual bleeding, dysmenorrhoea and haemoglobin levels [87 , 88 J. 

There are numerous choices of contraception for women, and the efficacy and costs of each must be balanced when giving advice, both to the individual and to the community at large. Hormonal contraception is still the most effective method of fertility control, and in this section only hormonal contraception will be considered. However the relative merits of other methods such as intrauterine contraceptive devices (lUCDs), condoms, and vaginal or cervical caps should be kept in mind as alternatives. Condoms in particular have important advantages in limiting spread of sexually transmitted disease. 

A systematic review of Mirena, an intrauterine progestogen release system (56), has attracted correspondence (57,58). Like other devices, Mirena releases levonorgestrel, in this case 20 micrograms/day. Since it had no greater efficacy than the Copper T device and was very much more costly, the debate has turned on safety. Amenorrhea is common with this device, as with others like it, and correspondents have pointed out that this is regarded by many women as an unwelcome complication. 

Etamsylate is more widely used to treat menorrhagia, including that associated with use of intrauterine contraceptive devices (10-12), although its efficacy has been challenged. A meta-analysis of drugs available in primary care showed that tranexamic acid was the most effective... 

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