Pioneers of the intrauterine device.

The history of the intrauterine device is remarkably short and its survival has been jeopardized several times from the beginning when Gräfenberg introduced the intrauterine ring in 1928, and later when product liability claims in the USA forced companies to withdraw the IUD from the market. However, a revival is happening, and one of the withdrawn copper IUDs has been re-introduced in the USA. In the 1980s, pessimism about the future of the IUD was based on the fact that there are still two major imperfections inherent in intrauterine contraception: its lack of protection against both 'gyne' and sexually transmitted disease. That IUDs, in contrast with some other methods, do not protect the wearer against microbiological invasion from the lower genital tract is correct, and will probably remain so notwithstanding the prophylactic use of antibiotics at the time of insertion. However, the solution to this imperfection is quite simple: clinicians must learn once and for all to adhere to the principle that bilateral monogamy is the first prerequisite for the safe use of this method of contraception. The second drawback of the IUD is the absence of so-called 'gyne' protection. Although seldom threatening women's health, menorrhagia, occasionally accompanied by pain, is a nuisance, and bleeding problems remain the most frequent single reason for the removal of an IUD. Consequently, research should concentrate on the alleviation of abnormal vaginal bleeding. Prevention is difficult, mainly because the etiopathology of abnormal bleeding is insufficiently understood. Menstrual hemostasis is a complex phenomenon and attempts at etiological treatment give poor results. However, because bleeding is, in all probability, related to an endometrial trauma caused by the geometric incompatibility between the frame of the IUD and the uterine cavity, it was logical for research to concentrate on correcting this factor. This review provides some historical notes about the pioneers who contributed to the improvement of intrauterine contraception since the introduction of the intrauterine ring by Gräfenberg in 1928 until the invention of the frameless device by Wildemeersch in 1984.