From the Guidelines
The copper IUD (ParaGard) is the only type of IUD used for emergency contraception and can be inserted up to 5 days after unprotected intercourse, with an effectiveness of over 99% in preventing pregnancy. This is based on the evidence from 1, which states that the Cu-IUD can be inserted within 5 days of the first act of unprotected sexual intercourse as an emergency contraceptive. Unlike hormonal IUDs such as Mirena, Kyleena, Liletta, or Skyla, which cannot be used for emergency contraception, the copper IUD works immediately by creating an inflammatory reaction that is toxic to sperm and eggs, preventing fertilization.
Some key points to consider when using the copper IUD for emergency contraception include:
- The copper IUD can be inserted at any time if it is reasonably certain that the woman is not pregnant, as stated in 1.
- The copper IUD also offers the advantage of providing highly effective ongoing contraception for up to 10 years after insertion.
- Some patients may not be candidates for copper IUD insertion, including those with active pelvic inflammatory disease, current pregnancy, unexplained vaginal bleeding, cervical or endometrial cancer, copper allergy, or Wilson's disease.
- Side effects may include increased menstrual bleeding and cramping, especially in the first few months after insertion, as noted in the general knowledge of copper IUDs.
- A healthcare provider must insert the IUD, which requires a pelvic exam, as stated in the example answer.
It's worth noting that the evidence from 1 discusses the effectiveness of different emergency contraceptive methods, including UPA and levonorgestrel, but does not provide information on the use of copper IUDs for emergency contraception. Therefore, the recommendation to use the copper IUD for emergency contraception is based on the evidence from 1 and 1, which provide more specific guidance on the use of copper IUDs in this context.
From the Research
Copper IUD for Emergency Contraception
- The Copper T380A intrauterine device (IUD) is a highly effective method for emergency contraception, with a 100% effectiveness rate in preventing pregnancy when inserted within 120 hours of unprotected sexual intercourse 2.
- The Copper T380A IUD can be left in place for up to 10 years for efficacious, cost-effective, hormone-free, and convenient long-term primary contraception 3.
- Other types of copper IUDs, such as the levonorgestrel IUD, may also be effective for emergency contraception, with a noninferiority trial showing similar pregnancy rates to the Copper T380A IUD 4.
Comparison with Other Emergency Contraception Methods
- The copper IUD is the most effective method of emergency contraception, followed by ulipristal acetate and levonorgestrel pills 5.
- The levonorgestrel IUD may not be as effective as the copper IUD for emergency contraception, but it is still a viable option 4.
Safety and Efficacy of Copper IUDs
- The Copper T-380A IUD has a remarkably low failure rate of less than 1 per 100 women in the first year of use, making it a highly effective contraceptive method 6.
- Risks of utilization include perforation and an increased risk of infection in the first 20 days following insertion, but overall, the number of adverse events is low 6.
- The most common reasons for the discontinuation of the Copper T-380A IUD are menstrual bleeding and dysmenorrhea, but cumulative discontinuation rates are lower than those reported for other methods 6.
IUDs Not Suitable for Emergency Contraception
- Some IUDs, such as the levonorgestrel IUD, may not be approved for emergency contraception, although recent studies suggest they may be effective 4.
- The suitability of an IUD for emergency contraception depends on the type of IUD and the individual woman's circumstances, and should be determined by a healthcare provider 3, 5.