Would there be any benefit in developing an Intrauterine Device (IUD) that contains copper plus ultra-low dose progestin?

From the Guidelines

Developing an IUD that combines copper with ultra-low dose progestin could potentially offer significant benefits in terms of reducing menstrual side effects and improving contraceptive efficacy, while minimizing the risk of thrombosis associated with estrogen-containing contraceptives, as supported by the 2020 American College of Rheumatology guideline for the management of reproductive health in rheumatic and musculoskeletal diseases 1. This hybrid approach would leverage the complementary mechanisms of both components—copper's spermicidal effects and progestin's thickening of cervical mucus and thinning of the endometrium—potentially providing enhanced contraceptive efficacy compared to either type alone. The use of ultra-low dose progestin in combination with copper could help decrease the heavy menstrual bleeding and cramping often experienced with copper IUDs, as progestin IUDs have been shown to decrease these symptoms 1. Additionally, using a lower hormone dose than typical hormonal IUDs could minimize systemic hormonal effects like mood changes or breast tenderness. This combination could be particularly beneficial for women who experience significant menstrual side effects with copper IUDs but wish to avoid higher hormone doses or have contraindications to higher-dose hormonal methods, such as those with antiphospholipid antibody–positive patients, where estrogen-containing contraceptives are contraindicated due to the potential further increase in thrombosis risk 1. The development would need to carefully balance the progestin dose to maintain the copper IUD's hormone-free advantages while adding just enough progestin to mitigate side effects. Clinical trials would be necessary to determine the optimal copper-progestin ratio and to confirm that this combination maintains the long-term efficacy and safety profile that makes current IUDs so effective. Key considerations in the development of such an IUD would include:

• The specific progestin and its serum level, as these factors can affect thrombosis risk, with some progestins and higher serum levels potentially increasing the risk of venous thromboembolism (VTE) 1
• The potential benefits of reduced menstrual bleeding and cramping, which could be particularly beneficial for patients receiving anticoagulation therapy 1
• The need for careful balancing of the progestin dose to minimize systemic hormonal effects while maintaining the efficacy of the copper IUD.

From the Research

Benefits of Developing an IUD with Copper and Ultra-Low Dose Progestin

• The development of an IUD that contains copper plus ultra-low dose progestin could potentially offer the benefits of both copper and progestin IUDs, including effective contraception and non-contraceptive benefits such as reduced menstrual bleeding and pain management 2.
• Copper IUDs are highly effective in preventing pregnancy, with a failure rate of less than 1 per 100 women in the first year of use 3.
• Progestin IUDs, such as the levonorgestrel IUD, have been shown to be effective for emergency contraception and may offer additional benefits such as reduced menstrual bleeding and pain management 4, 5.
• The combination of copper and ultra-low dose progestin in an IUD could potentially reduce the side effects associated with copper IUDs, such as increased menstrual bleeding and cramping, while maintaining the effectiveness of the device 2, 6.

Potential Advantages of a Copper and Ultra-Low Dose Progestin IUD

• A copper and ultra-low dose progestin IUD could offer a unique combination of benefits, including effective contraception, reduced menstrual bleeding, and pain management, making it a potentially attractive option for women seeking a long-acting, reversible contraceptive method 2, 5.
• The ultra-low dose progestin component could potentially reduce the risk of hormonal side effects associated with progestin IUDs, such as headache, acne, and breast tension 2.
• The copper component could provide additional non-contraceptive benefits, such as reduced risk of ectopic pregnancy and pelvic inflammatory disease 6, 3.

Research Gaps and Future Directions

• Further research is needed to determine the safety and effectiveness of a copper and ultra-low dose progestin IUD, including its potential benefits and risks compared to existing IUDs 4, 5.
• Studies should investigate the optimal dosage of progestin and copper in the IUD, as well as its potential interactions with other medications and medical conditions 2, 6.
• Additional research is needed to understand the user experiences and acceptability of a copper and ultra-low dose progestin IUD, including its potential impact on menstrual bleeding, pain, and quality of life 2, 3.