The Multiload IUD with an exposed copper surface area of 250 mm2 (MLCu250) was developed in 1972 and has become one of the most widely used IUDs. Modifications to the MLCu250 include an increase in the area of exposed copper wire to 375 mm2 (the MLCu375) and an increase in the diameter of copper wire from 0.3 to 0.4 mm. The Multiload has been evaluated extensively in noncomparative and comparative clinical trials. In these latter studies the MLCu250 performed better than the Cu-7 and TCu-200, and the MLCu375 performed better than the Fincoid or Nova T and about equally as well as the TCu380. Pooled data from over 26,000 insertions of the MLCu250 gave the following 3-year cumulative event rates (per 100 women): pregnancy, 2.0; expulsion, 3.1; removal for pain/bleeding, 7.1. Comparative studies of the Multiload and other IUDs have shown all IUDs in current use are associated with similar rates of pelvic inflammatory disease. IUDs such as the MLCu375 that have larger copper surface areas appear to be associated with lower ectopic pregnancy rates. Follow-up studies of women who have had their Multiloads removed indicate that use of the device does not impair future fertility or affect pregnancy outcome. All IUD users, regardless of the type of IUD used, are at risk of complications. On balance, the benefits of IUD usage far exceed the associated risks.
Since 1962, breast implants made of a silicone elastomer envelope filled with either silicone or saline have been used by an estimated l-2 million women in the United States alone. Given that women in the United States have a lifetime risk of breast cancer of approximately 1 l%, and the concerns which have been expressed about the risks associated with the use of silicone breast implants, we reviewed the medical literature to thoroughly evaluate the risks of breast cancer to users of these implants.Our review of case reports and series, surveys of plastic surgeons, case-control and cohort studies did not show any evidence that women who use silicone breast implants are at any increased risk of breast cancer. Neither of two large cohort studies found any increased risk of breast cancer among the 11 676 women in one study [1] or the 3111 women in the other study [2] with breast implants. In both studies, approximately 85% of the women used silicone gel implants. One of these studies [1] found that breast implant users were at a reduced risk of breast cancer! Even if allowances are made for underreporting of breast cancer cases among * Corresponding author, Tel.: +I 619 2805587.breast implant users, neither study provides any evidence of an increased risk of breast cancer.There remains the question of whether the use of silicone implants per se delays the early detection of breast cancer. Issues related to the detection of breast cancer among women with augmented breasts are whether: (1) the frequency of a missed diagnosis of breast cancer is different for women with or without augmented breasts; and (2) the presence of breast implants significantly delays the diagnosis of breast cancer. The first issue has not been adequately evaluated. However, if there was a higher frequency of missed breast cancer diagnoses among breast implant users, one would then expect that this group of women would present with more advanced breast cancers. The few studies [3-51 that have evaluated the characteristics of the cancers among women with and without breast implants have not found that the cancers of the implant group are any different from those of other women. In addition, there is no evidence that patients with breast cancers have their cancers diagnosed at a later stage than patients without breast implants [5,6].For women with silicone breast implants, the available data do not show an increased risk of 0020-7292/94/507.00 0 1994 International Federation of Gynecology and Obstetrics SSDI 0020-7292(94)02181-W
In a follow-up evaluation of 3721 Multiload IUD users, the removal rate for medical reasons other than bleeding/pain was only 2.6 per 100 women at three years. Most of these removals were for reasons that appeared to be unrelated to IUD use. The removal rate for pelvic inflammatory disease was 0.3 per 100 woman years. Women were followed up for up to three years after removal of their IUDs. Among women with PID at least 70% of those who desired pregnancy subsequently became pregnant, a rate similar to that of women who had their IUDs electively removed to become pregnant. The study provides further data on the safety of intrauterine contraception.
In this review paper some guidelines for IUD use are presented that if followed should reduce the incidence of IUD-related complications. Recent IUD developments are discussed including the levonorgestrel-releasing T, a new variation of the Multiload, and IUDs designed for postpartum insertion. Since significant improvements in IUD safety will most likely result from a better understanding of IUD-related side-effects and adverse reactions, the paper includes recommendations for future IUD research that could enhance the safety, effectiveness and acceptability of available IUDs.
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