Answers to questions on intrauterine devices, EC
What is your approach when checking for copper allergy in women considering use of the Copper T380A (ParaGard, FEI, Addison, TX)? What are your directions on use of the levonorgestrel-only EC, Plan B (Barr Pharmaceuticals, Pomona, NY)?
Comments are offered by David Archer, MD, professor of obstetrics and gynecology and director of the Clinical Research Center at the Eastern Virginia Medical Center in Norfolk; Philip Darney, MD, professor of obstetrics and gynecology at the University of California-San Francisco; and Robert Hatcher, MD, MPH, professor of gynecology and obstetrics at Emory University School of Medicine in Atlanta.
Question: How do you recommend screening for copper allergies in women who want a ParaGard intrauterine device (IUD)? We usually ask if the woman is able to wear cheap jewelry. If no, then we have assumed that that woman is not a candidate. Recently, we have had women who can’t wear cheap jewelry but have successfully used a copper IUD previously. We would like to know what we should be asking a woman to best screen for a copper allergy. Should we have her go out and buy a copper bracelet and wear it for a period of time?
Archer: Metal allergies are unusual. See this report (Hostynek JJ, Maibach HI. Copper hypersensitivity: Dermatologic aspects. Dermatol Ther 2004; 17:328-333). In the report, it states, ". . . considering the widespread use of copper IUDs and the importance of copper in coinage, items of personal adornment and industry, unambiguous reports of sensitization to the metal are extremely rare, and even fewer are the cases which appear clinically relevant."
Darney: I think your latter suggestion is the best one because most cheap jewelry won’t give direct copper exposure. I have been inserting copper IUDs since they were first made and have never seen an allergy.
Question: What are the dosing instructions for Plan B?
Hatcher: Women using Plan B should be told: "If you are taking progestin-only emergency contraceptive pills, swallow the two pills as one dose as soon as possible within 120 hours after unprotected sex. Do not take any extra pills. More pills will not decrease the risk of pregnancy any further." These instructions were written by Felicia Stewart, MD, James Trussell, PhD, and Paul Van Look, MD, PhD, and may be found on p. 298 of the 18th edition of Contraceptive Technology (Ardent Media, New York City). For progestin-only emergency contraception, anti-nausea medicine is not recommended in the Contraceptive Technology instructions for using Plan B.
What is your approach when checking for copper allergy in women considering use of the Copper T380A (ParaGard, FEI, Addison, TX)? What are your directions on use of the levonorgestrel-only EC, Plan B (Barr Pharmaceuticals, Pomona, NY)?
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