Mechanism of action, safety and efficacy of intrauterine devices : report of a WHO Scientific Group, meeting held in Geneva from 1 to 4 December 1986

1. Introduction -- 2. Background -- 3. Mechanism of action -- 4. Clinical studies of effectiveness -- 5. Timing of IUD insertion -- 6. Ectopic pregnancy -- 7. Pelvic inflammatory disease -- 8. Other problems -- 9. Patient selection and choice of method -- 10. Menstrual blood loss -- 11. IUDs versus other methods of contraception -- 12. The legal situation in the United States of America -- 13. Conclusions and recommendations for further research -- References

An expert summary of what can be concluded, on the basis of available evidence, about the mechanism of action, safety, and efficacy of intrauterine devices (‎IUDs)‎. Prepared by a group of 16 international experts, the report examines the findings and design of close to 350 studies in an effort to resolve several important questions, including the possibility that use of IUDs is associated with an increased risk of ectopic pregnancy or of pelvic inflammatory disease. The report draws additional authority for its conclusions from the number of large-scale randomized multicentre studies available for analysis. The most extensive sections of the report are devoted to a critical review of indications and contraindications for the use of IUDs. Separate sections examine the association between IUD use and the incidence of ectopic pregnancy, pelvic inflammatory disease, problems associated with menstrual blood loss, and other problems, such as expulsion, uterine perforation, restoration of fertility, and pregnancy with an IUD in place. Readers are given extensive practical advice concerning the management of complications as well as the specific precautions that can reduce the incidence of side-effects, whether serious or merely troublesome.