Abstract
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.
Resumé
Le dispositif intra-utérin Multiload mis au point en 1972, dont la superficle d'exposition de cuivre est de 250 mm2 (MLCu250), est devenu le stérilet le plus largement utilisé. Ce MLCu250 a été modifié d'une part en augmentant la superficie du fil de cuivre exposé à 375 mm2 (le MLCu375) et d'autre part en portant le diamètre de ce fil de 0,3 à 0,4 mm. Le dispositif Multiload a fait l'objet de nombreuses évaluations par des essais cliniques non comparatifs et comparatifs. Dans ces derniers, le MLCu250 s'est révélé plus efficace que le Cu-7 et le TCu-200, et le MLCu375 plus efficace que le Fincoid ou le Nova T et à peu près aussi valable que le TCu380. La mise en commun des données relatives à 26,000 insertions du MLCu250 a fait ressortir les taux d'événements suivants cumulés sur trois ans (pour 100 femmes): grossesses, 2,0; expulsions, 3,1; retraits pour cause de douleurs ou de pertes sanguines, 7,1. Les études comparatives portant sur le Multiload et les autres DIU ont montré que tous les dispositifs utilisés couramment sont associés à des taux similaires d'affections pelviennes inflammatoires. Les dispositifs tels que le MLCu375 qui présentent une aire de cuivre plus importante semblent associés à des taux moins élevés de grossesses ectopiques. Des études de sulvi chez les femmes qui s'étaient fait enlever le dispositif Multiload qu'elles portaient ont indiqué que son utilisation ne compromet pas la fécondité ultérieure et n'a pas d'incidence sur l'aboutissement de la grossesse. Toutes les utilisatrices de DIU, sans distinction du type de stérilet employé, sont exposées à des risques. Mais, tous comptes faits, les avantages qu'apporte l'usage de ces dispositifs excèdent de beaucoup les risques qui lui sont associés.
Resumen
EI DIU Multiload con una expuesta área de cobre de 250 mm2 (MLCu250) fue puesto en práctica en 1972 y es uno de los DIU más usados. Las modificaciones del MLCu250 incluyen un aumento a 375 mm2 (el MLCu375) en el área expuesta de cobre, y un aumento do 0,3 a 0,4 mm en el diámetro del alambre de cobre. El Multiload ha sido extensamente evaluado en pruebas clínicas no comparadas y comparadas. En estos estudios más recientes, el MLCu250 actuó mejor que el Cu7 y que el TCu200 y el MLCu375 mejor que el Fincoid o el Nova T, y aproximadamente igual que el TCu380. Los datos combinados de más de 26 000 inserciones del MLCu250 han proporcionado las siguientes tasas acumulativas de eventos en tres años (por 100 mujeres); embarazo 2,0; expulsión 3,1; remoción por dolor/sangrado 7,1. Estudios comparativos del Multiload y otros DIU de uso corriente, están asociados a tasas similares de enfermedad inflamatoria pelviana. DIU tales como el MLCu375, que poseen una mayor superficie de cobre, parecen estar asociados con tasas menores de embarazos ectópicos. Estudios de seguimiento en mujeres cuyos Multiload fueron quitados, indican que el uso del dispositivo no perjudica la futura fertilidad ni afecta el resultado del embarazo. Todos las usuarias de DIU, no importa que tipo, corren riesgo de complicaciones. Haciendo un balance, los beneficios del uso de un DIU por lejos exceden los riesgos asociados.
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References
ZipperJ., MedelM., PasteneL. and RiveraM. (1974). Factors that limit the efficacy of copper-carrying IUDs. In:Intrauterine Devices: Development, Evaluation and Program Implementation. R.G.Wheeler, G.W.Duncan, J.J.Speidel, eds. Academic Press, New York
VanOsW.A.A., EdelmanD.A. and BadrawiH.H. (1987). The future of intrauterine contraception.Adv. Contracept.,3, 227–235
Van Os, W.A.A., Rhemrev, P.E.R., Bomert, L. and Aartsen, E.J. (1974). Experience with a combined multiload intrauterine device. Paper presented at the 8th World Congress of Fertility and Sterility, November 3–9, Buenos Aires, Argentina
VanOsW.A.A., HaspelsA.A., RhemrevP.E.R., LoenderslootE.W., LoSin SjoeE. and deNooyerC.A.A. (1977). Evaluation comparative du MLCu250.Rev. Franc. Gynec.,72, 829–832
ThieryM., ven derPasH., VanOsW.A.A., TauberP.F., DombrowiczN., MacDonaldJ.S., HaspelsA.A., DrogendijkA.C., vanKetsH. and BoogersW. (1979). Three years' experience with the MLCu250, a new copper-wired intrauterine contraceptive device.Br. J. Fam. Plan.,5(2), 36–38
vanKetsH.E., ThieryM., van derPasH., DelbekeL., VanOsW.A.A., TauberP.F., DombrowiczN., MacDonaldJ.S., HaspelsA.A. and DrogendijkA.C. (1980). Interim insertion of the MLCu250 intrauterine contraceptive device.Contracept. Del. Syst.,1, 149–154
Wilson, J. (1981). A randomised trial and a comparative study between the copper 7 200 and the Multiload Cu 250. Paper presented at the VIII Asian and Oceanic Congress of Obstetrics and Gynaecology, Melbourne, October 25
MylotteM.J. and LoudonN. (1982). Interim insertion of Multiload Cu 250 IUCD.Br. J. Obstet. Gynaecol., (supplement),4, 41–42
SnowdenR. (1982). General assessment of the Multiload Cu250 intrauterine device. UK network of IUCD research clinics.Br. J. Obstet. Gynaecol. (supplement),4, 58–64
ThieryM., vanKetsH., VanOsW. and DombrowiczN. (1982). The MLCu250; clinical experience in Belgium and The Netherlands.Br. J. Obstet. Gynaecol. (supplement),4, 51–53
GohT.H., SivanesaratnamV., AngE.S. and YipY.C. (1982). Clinical evaluation of the Multiload 250 Cu-IUD in a Malaysian family planning clinic.Singapore J. Obstet. Gynaecol.,13, 21–23
McCarthyT., LimL.S., ChewS.C., LimS.M., ChengM.C.E., LeeS.C., YoungY.M. and RatnamS.S. (1983). Comparative studies of IUDs in Singapore.Contracept. Del. Syst.,4, 219–225
ThieryM., van derPasH. and VanOsW. (1983). Performance of Multiload IUD models with different copper loads.Contracept. Del. Syst.,4, 227–230
BatarI. (1985). Clinical experience with the MLCu250 IUD (eight-year results).Adv. Contracept.,1, 329–335
RhemrevP.E.R., VanOsW.A.A., EdelmanD.A. and BadrawiH.H. (1988). Medical removals of the Multiload IUD.Adv. Contracept.,4, 125–130
VanOsW.A.A., ThieryM., van derPasH., RhemrevP.E.R., deNooyerC. and KleinhoutJ. (1981). Comparison of four different models of the Multiload copper IUD.Contracept. Del. Syst.,2, 275–280
ThieryM., van derPasH. and vanKetsH. (1985). The MLCu375 intrauterine contraceptive device.Adv. Contracept.,1, 37–44
ThieryM., van derPasH., DelbekeL. and vanKetsH. (1980). Comparative performance of two copper-wired IUDs (MLCu250 and TCu200). Immediate postpartum and interval insertion.Contracept. Del. Syst.,1, 27–35
LadehoffP., HansenM.K., LarsenS., SorensenT. and WestergaardJ.G. (1983). A comparison of two IUDs: Multiload Cu250 and Copper T200.Contracept. Del. Syst.,4, 9–13
McCarthyT.G., ChewS.C., LimS.M., ChengM.C.E. and RatnamS.S. (1986). A prospective randomized comparative trial of the Gravigard, Latex Leaf, Dalkon Shield and Multiload Cu 250 IUDs.Aust. N.Z.J. Gynaecol.,26, 228–232
GohT.H., HutapeaH., McCarthyT., SinnathurayT.A., SivanesaratnamV., SemD.K., NanafishM.J., SimadjuntakP., LimL.S., RatnamS.S. and KarimS.M. (1985). A multicenter randomized comparative study of ML Cu250, TCu-220C and Cu-7 IUDs.Adv. Contracept. Del. Syst., monographI, pp. 126–130
SaureA., HirvonenE., KivijarviA. and TimonenH. (1985). Comparative performance of Fincoid, Nova-T and ML 375 IUDs. In:Intrauterine Contraception. Advances and Future Prospects, G.I.Zatuchni, A.Goldsmith, J.J.Sciarra, eds. Harper & Row, Philadelphia
ColeL.P., PottsD.M., ArandaC., BehlilovicB., EtmanE-S., MorenoJ. and RandicL. (1985). An evaluation of the TCu 380Ag and the Multiload Cu375.Fertil. Steril.,43, 214–217
deCastroA. and AnguianoJ.M. (1986). Comparative performance of two-copper IUDs: Nova-T and MLCu375.Adv. Contracept.,2, 155–159
WilsonJ. (1986). A randomized trial of the Nova T, the MLCu375, and the MLAgCu250 IUDs: 1 and 2 year results.Adv. Contracept.,2, 247–248
deCastroA., Perez-IglesiasR., VicandiF., ZapicoA. and Lopez-SalvaA. (1987). Comparison of two copper IUDs: the MLCu375 and the Nova-T.Adv. Contracept.,3, 319–322
McCarthyT., RamachandranL. and RatnamS.S. (1987). Interim 4-year results of a comparative study between the Nova T and the Multiload 250.Adv. Contracept.,3, 323–326
LimL.S., McCarthyT.G., YongY.M. and RatnamS.S. (1985). Post-abortion insertion of MLCu250 and MLCu 375-a comparative trial.Contraception,31, 471–477
vanLithD.A.F., duPlesiss-AlblasM., QueridoL., vanSchieK.J. and BeckhuizenW. (1981), Postabortion insertion of the Multiload IUD.Contracept. Del. Syst. 2, 337–342
EmensJ.M. and ShahS.R. (1982). Early postpartum insertion of the Multlload Cu250 intrauterine device.Br. J. Obstet. Gynaecol. (supplement),4, 43–45
EdelmanD.A., BergerG.S. and KeithL. (1979).Intrauterine Devices and Their Complications. G.K. Hall & Co., Boston
ThieryM., van derPasH., VanOsW. and vanKetsH. (1978). Clinical experience with two newer copper-loaded IUDs (TCu 220C and MLCu250). Simultaneous use of an IUD and spermicide. Postplacental insertion of the MLCu 250. In:Human Fertilization, H.Ludwig and P. F.Tauber, eds., Georg Thieme Publishers, Stuttgart
KivijarviA., TimonenH., HirvonenE. and KajanojaP. (1985). Modern copper IUDs: one year multicenter trial.Adv. Contracept. Del. Syst., monographII, pp. 302–309
GohT.H., SinnathurayT.A., SivanesaratnamV., SenD.K., LimL.S., RatnamS.S., KarimS.M.M., McCarthyT., HutapeaH., HanafiahM.J. and SimandjuntakP. (1983). A randomized comparative evaluation of the copper 7, Multiload copper 250 and T copper-220C IUDs.Contraception,27, 75–84
Mechanism of Action, Safety and Efficacy of Intrauterine Devices. (1987). World Health Organization, Geneva, Technical Report Series 753
FyllingP. (1987). Clinical performance of Copper-T-200, Multiload-250 and Nova-T. A comparative multicentre study.Contraception,35, 439–446
LeeN.C., RubinG.L., OryH.W. and BurkmanR.T. (1983). Type of intrauterine device and the risk of pelvic inflammatory disease.Obstet. Gynecol.,62, 1–6.
SivinI. (1985). IUD-associated ectopic pregnancies. In:Intrauterine Contraception: Advances And Future Prospects. G.Zatuchni, A.Goldsmith and J.J.Sciarra, eds., Harper & Row, Philadelphia
SandmireH.F. (1986). Fertility after intrauterine device discontinuation.Adv. Contracept.,2, 327–335
GaleraF., CastanoF., AlberdiJ.M. and GutierrezF. (1987). Estudio estadistico comparado de tres tipos de dispositvos intrauterinos.Rev. Iberoam. Fertil.,4, (21), 33–38
SocpronoR. (1988). Return to fertility following use of the Multiload IUD.Adv. Contracept.,4, 95–108
SkjcldestadF.E. and BrattH. (1987). Return of fertility after use of IUDs (Nova-T, MLCu250 and MLCu375).Adv. Contracept.,3, 139–145
WilsonJ. (1987). A New Zealand study of fertility after IUD use including complications: 1-, 2-, 3-and 4-year results. Abstract #29.Adv. Contracept.,3, 191–192
TietzeC. (1978). What price fertility control? Lower than that of unwanted pregnancy.Contemp. OB-GYN,12(1), 32–36
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Van Os, W.A.A., Edelman, D.A. Fifteen years' experience with the Multiload IUD. Adv Contracept 4, 165–178 (1988). https://doi.org/10.1007/BF01849434
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DOI: https://doi.org/10.1007/BF01849434