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Copper intrauterine devices (copper IUDs) are small devices inserted into the uterus by a doctor or medical practitioner. For a copper device, the release of copper ions into the cervical environment reduces both the motility and the viability of sperm; plus copper IUDs release ions that are toxic to sperm and keep ova from maturing, preventing fertilization (Batar, 2010).
Copper IUDs do not affect sexual activity and the best designs have the lowest failure rate—less than 1 per 100 users. Once in place, they can remain there for 10 to 13 years (depending on type), and some have been approved for up to 30 years (Batar, 2010). For women older than 30, copper IUDs provide the same degree of protection as tubal occlusion (Renner & Edelman, 2011). Furthermore, evidence appears strong that copper IUDs have a protective effect against endometrial cancer, reducing the risk by approximately 60% (Batar, 2010). Copper IUDs can be inserted up to five days after unprotected sex to prevent pregnancy (99% effective vs. 84% of oral levonogestrel), immediately after an abortion, and immediately after birth (i.e., just before release from hospital (Black, Sakhaei, & Garland, 2010).
The negatives of copper IUDs are that they must be inserted by a medical professional, and insertion is sometimes painful (Batar, 2010). Sometimes, the device is expelled from the uterus and must be re-inserted; this generally happens in the first few months (Batar, 2010). Copper IUDs are associated with longer menstrual bleeding and spotting, and they don’t protect against STDs (Forthofer, 2009). In about 0.1% of women, the IUD perforates the uterus, causing bleeding, pain, and possibly pelvic infection (Batar, 2010). The risk of pelvic infection is greatest in the first few months after insertion and is highest within 3 weeks of insertion; a follow-up visit 4 weeks after insertion can check for this problem (Forthofer, 2009) . It is believed that this higher risk may be due to unrecognized STD (particularly chlamydia) at time of insertion; thus pre-testing for STDs may reduce the risk of a pelvic infection from insertion (Bhathen & Guillebaud, 2008).
The primary contraindications for insertion of a copper IUD is current pregnancy, current STD infection, or current pelvic infection; a past history of any of these is not a contraindication (Black, et al., 2010). In the case of failure, removal of the IUD in the first trimester is recommended to avoid complications later in the pregnancy (Bhathena & Guillebaud, 2008). Although some doctors prefer smaller sized versions of the copper IUD for younger women, there is no evidence that supports that preference; there is no medical evidence of any age restrictions for copper IUDs (Forthofer, 2009).
With the new rules on insurance companies, any woman with health insurance must be able to receive contraceptives at no charge or co-pay (Rovner, 1 August 2011). However, even if paid in full by the woman, copper IUDs are the most cost effective reversible form of contraception because it is long-lasting, requires only minimal medical intervention (typically 1 to 3 insertions over reproductive lifetime), and its effectiveness approaches that of sterilization, particularly in women over 30 (Renner & Edelman, 2011).