Intrauterine contraceptive devices--a reappraisal.

The intrauterine contraceptive device (IUD) is a highly effective and safe form of reversible contraception. It does not cause pelvic inflammatory disease, ectopic pregnancy or infertility; it could be used by most nulligravidae; in its latest form it can be used to treat excessive menstrual loss, and it acts by preventing fertilisation not implantation. These statements contrast sharply with many of our long-standing prejudices about the method. New IUDs contribute to this change in perception. Nevertheless, patients selection, limiting use to mutually monogamous relationships, care with fitting and access to expert help with problems (including rare failure pregnancies and removal difficulties) are all required to maintain the acceptability and usefulness of this method.