The Choice Between Intrauterine Contraceptive Device Options: Examining the Evidence (2025)

Introduction: A wealth of clinically relevant information on long-acting reversible contraception (LARC) is available to support shared decision-making and enhance patient discussions. A scoping review of the topic was conducted to identify and present key clinically applicable evidence, providing valuable insights for clinical practice Methods: A comprehensive review of published literature was conducted to identify key clinical aspects of intrauterine contraceptive device selection, excluding contraceptive implants from the scope of long-acting reversible contraception. A systematic search was performed using the PubMed and Web of Science databases, covering publications from 2015 to 2024. The review followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to ensure methodological rigor. Multiple search strategies were employed to capture relevant clinical data comprehensively. Given the diverse nature of medical evidence, no study types were excluded, allowing the inclusion of randomized controlled trials, cohort studies, clinical perspectives, reviews, and case reports. Results: The review examined data obtained through multiple search strategies, focusing on commercially available intrauterine contraceptive devices in the U.S., including the Copper T380 and levonorgestrel intrauterine systems. Key aspects of device use were analyzed, including contraceptive effectiveness, recent updates in duration of use (e.g., Mirena extended from 5 to 8 years, Paragard from 10 to 12 years), and comparative complication rates (e.g., expulsion, embedment, fracture, malposition, perforation, and migration). Additional factors reviewed included common side effects such as dysmenorrhea and heavy menstrual bleeding, relative contraindications, pain associated with insertion and mitigation strategies, the relevance of device frame size, and the potential role of ultrasound for pre- and post-insertion assessment. While the full scope of this review cannot be presented in this abstract, the findings can be detailed in a more comprehensive format. Discussion: The effectiveness, ease of use, and simplicity of LARC, particularly in comparison to permanent sterilization, underscore its significant impact on female reproductive health. This topic warrants discussion in a large forum of Obstetrics and Gynecology practitioners. A systematic or comparable review like the one presented here does not appear to be readily available in the published medical literature.