Intrauterine drug delivery for contraception and gynaecological treatment: novel approaches.

This chapter describes the development of new intrauterine drug delivery products, which are designed to provide improved methods for the prevention and treatment of gynaecological conditions, improvements to birth control methods, and higher levels of safety, user acceptability, compliance, and quality of life for women. The development of frameless intrauterine systems is such an attempt to improve on the performance and acceptability of established intrauterine contraception, potentially solving major problems encountered with conventional IUDs (e.g., expulsion, abnormal or excessive bleeding, and pain). However, the performance of frameless devices depends on proper anchoring of the device, which requires specific technical skills not required for the insertion of conventional IUDs. Moreover, current research paves the way for new developments. The frameless copper and LNG-releasing IUDs/IUSs and framed LNG-IUS are the beginning of a series of innovative developments in this field. New compounds, such as progesterone antagonists and selective progesterone receptor modulators (SPRMs), could be incorporated into polymeric drug delivery platforms for use in the uterus, cervix, or vagina, or subdermally. It is likely that current and new hormone-releasing intrauterine systems could also be useful for bleed-free contraception in HIV-positive (HIV+ women). It is hoped that this work will contribute to the increase in worldwide use of intrauterine contraception and to non-surgical treatment of frequently occurring women's health problems.