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Physical contraceptives—intrauterine devices
General information
Intrauterine contraceptive devices (IUCDs) have been reviewed [ , ]. Most are composed of bland synthetic materials or contain in addition a small amount of metallic copper. Others are designed to release either progesterone or a synthetic progestogen (for example levonorgestrel) [ , ]. IUCDs that release levonorgestrel are somewhat more effective than copper-containing devices, while those that release progesterone are less effective [ ].
Copper-containing IUCDs [ , ] became popular because local inflammatory reactions in the endometrium are more marked and the contraceptive effect is thus more pronounced [ ]. In addition, copper ions released from IUCDs reach concentrations in the luminal fluids of the genital tract that are toxic to spermatozoa and embryos. The ability of copper to induce the generation of free radicals and the formation of malonaldehyde may be involved in its contraceptive effect.
Migration of IUCDs
Migration of IUCDs is relatively rare, although they have been found in the omentum, rectosigmoid, peritoneum, bladder, appendix, small bowel, adnexa, and iliac vein. Most authors have recommended removal of copper-containing devices, because of the potential for inflammatory reactions, which can cause bowel obstruction and perforation [ ]. Two cases of migration of IUCDs to the bowel have been reported.
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A 29-year-old woman who had had a Copper 7 IUCD inserted 3 years before developed amenorrhea [ ].The intrauterine contraceptive was not in the uterine cavity and X-ray showed that it was positioned over the sacrum just to the right of the midline and outside the uterus. It later moved to the cecum and became completely embedded in the muscular layer after penetrating the serosal surface.
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A Copper-T IUCD migrated to the rectal lumen in a 36-year-old woman with menorrhagia for 3 month and a history of Copper-T insertion 6 years before [ ].
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A 28-year-old pregnant woman developed an ileal perforation 4 weeks after the insertion of a Multiload-Cu 375 IUCD [ ].
The last report documents the shortest interval between insertion and proven bowel injury by an IUCD.
Organs and systems
Skin
Perimenstrual dermatitis has been attributed to a copper-containing IUCD [ ].
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A 41-year-old woman had a 2-year history of a recurrent, self-healing rash associated with abdominal pain. She had had cholinergic urticaria since 1995 and had had a copper-containing IUCD inserted 12 years before. The eruption followed a cyclical pattern, invariably appearing 3–7 days before the menses and tending to improve spontaneously with the onset of bleeding. This non-itchy rash was associated with abdominal distension and cramps that followed a similar course. She had multiple non-itchy symmetrical erythematous papules on the upper trunk, neck, and arms. Patch-testing was positive for copper sulfate. The IUCD was removed and the abdominal symptoms subsided at the following cycle. Progressive resolution of the dermatitis was observed. No cutaneous eruption was observed after 8 months and no new lesions developed after a further 5 months.
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