The efficacy of intrauterine devices for emergency contraception: a systematic review of 35 years of experience.
Open accessAbstract
BACKGROUND: Intrauterine devices (IUDs) have been studied for use for emergency contraception for at least 35 years. IUDs are safe and highly effective for emergency contraception and regular contraception, and are extremely cost-effective as an ongoing method. The objective of this study was to evaluate the existing data to estimate the efficacy of IUDs for emergency contraception. METHODS: The reference list for this study was generated from hand searching the reference lists of relevant articles and our own article archives, and electronic searches of several databases: Medline, Global Health, Clinicaltrials.gov, Popline, Wanfang Data (Chinese) and Weipu Data (Chinese). We included studies published in English or Chinese, with a defined population of women who presented for emergency contraception and were provided with an IUD, and in which the number of pregnancies was ascertained and loss to follow-up was clearly defined. Data from each article were abstracted independently by two reviewers. RESULTS: The 42 studies (of 274 retrieved) that met our inclusion criteria were conducted in six countries between 1979 and 2011 and included eight different types of IUD and 7034 women. The maximum timeframe from intercourse to insertion of the IUD ranged from 2 days to 10 or more days; the majority of insertions (74% of studies) occurred within 5 days of intercourse. The pregnancy rate (excluding one outlier study) was 0.09%. CONCLUSIONS: IUDs are a highly effective method of contraception after unprotected intercourse. Because they are safe for the majority of women, highly effective and cost-effective when left in place as ongoing contraception, whenever clinically feasible IUDs should be included in the range of emergency contraception options offered to patients presenting after unprotected intercourse. This review is limited by the fact that the original studies did not provide sufficient data on the delay between intercourse and insertion of the IUD, parity, cycle day of intercourse or IUD type to allow analysis by any of these variables.
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Insertion of a copper-containing IUD ≤5 days after unprotected sex can reduce pregnancy risk from a sex act by approximately 99%.
“Insertion of a copper-containing IUD ≤5 days after unprotected sex can reduce pregnancy risk from a sex act by approximately 99% (60).”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [60]
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- Authors
- Cleland, K., Zhu, H., Goldstuck, N., Cheng, L., & Trussell, J.
- Affiliations
- Princeton University (US)
- Shanghai Jiao Tong University (CN)
- Shanghai Institute of Planned Parenthood Research (CN)
- University of Hull (GB)
- Corresponding author
- Cleland, K.
- Venue
- Human Reproduction
- Publisher
- Oxford University Press (OUP)
- Published
- 2012-05-08
- Volume
- 27
- Issue
- 7
- Pages
- 1994-2000
- ISSN
- 0268-1161 (ISSN-L)
- 1460-2350
- PMC
- PMC3619968
- OpenAlex
- W2124536101
- Cited by
- 265
- References
- 37
- Citations by year
- 2026: 13 · 2025: 12 · 2024: 12 · 2023: 14 · 2022: 13 · 2021: 16 · 2020: 14 · 2019: 24 · 2018: 8 · 2017: 25 · 2016: 29 · 2015: 21 · 2014: 31 · 2013: 22 · 2012: 8
- FWCI
- 4.06
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Human Reproduction (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R24HD047879)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ectopic Pregnancy Diagnosis and Management
- Social Sciences › Political Science and International Relations › International Human Rights and Reproductive Law
- Keywords
- intrauterine devices, emergency contraception, contraceptive efficacy, pregnancy rate, unprotected sex, IUD insertion timing, cost-effectiveness
- MeSH terms
- Clinical Trials as Topic, Contraceptive Agents, Female, Cost-Benefit Analysis, Female, Humans, Intrauterine Devices, Pregnancy, Time Factors, Databases, Factual, Levonorgestrel, Contraception, Postcoital, History, 20th Century, History, 21st Century
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