Advances in Intrauterine Contraception and Therapeutic Intrauterine Devices, 2016–2026: A Targeted Scoping Review

Intrauterine contraception has changed over the past decade through longer validated duration, lower-dose hormonal devices, redesigned copper devices, new indications, and better safety surveillance. This targeted scoping review (OSF registration 10.17605/OSF.IO/3GUQF) mapped English-language primary human studies published from 1 January 2016 to 5 September 2026 in journals indexed in the Science Citation Index Expanded (SCIE). A reproducible search targeted to the major device programs, randomized trials, and large surveillance cohorts identified 766 PubMed/MEDLINE records, with no additional unique records from Scopus or Web of Science; of the 624 unique records screened, 123 reports were assessed, and 114, from 66 distinct trials, cohorts, or data sources, were included and appraised with design-specific Joanna Briggs Institute (JBI) tools. Two single-arm programs and a 7-year randomized trial supported the efficacy of 52 mg levonorgestrel intrauterine devices (LNG-IUDs) through 8 years. Lower-dose LNG-IUDs eased placement but were associated with higher ectopic pregnancy rates in four Scandinavian analyses and with less antidepressant use than the 52 mg device. Smaller or size-matched copper devices improved continuation and reduced expulsion in randomized comparisons, whereas a low-copper nitinol device had a higher 5-year pregnancy rate than expected with TCu380A. Perforation was uncommon but more frequent after postpartum insertion and during breastfeeding; immediate postpartum insertion carried the highest expulsion risk. One randomized trial and its secondary analyses supported the 52 mg LNG-IUD for emergency contraception. Therapeutic evidence was strongest for heavy menstrual bleeding and endometrial hyperplasia, whereas intrauterine ball and precious metal designs showed no consistent benefit. Progress refined rather than replaced the T-shaped IUD.