Contraceptives Intrauterine Devices Kamal Kumar Gupta Intrauterine Devices

Contraceptives Intrauterine Devices Kamal Kumar Gupta

Intrauterine Devices • An intrauterine device (IUD) is a small object made of polyethylene or other polymers that is inserted by a health-care professional into the cavity of the uterus • IUDs prevent fertilization from taking place by blocking sperm from entering the uterine tubes. • Copper T 380 A®, which is approved for up to 10 years of use and has long-term effectiveness comparable to that of tubal ligation • Some women cannot use IUDs because of expulsion, bleeding, or discomfort.

IUD • Non-medicated: First generation IUD, Lippes loop • Medicated: Second generation IUD, Copper IUD • Medicated: Third generation IUD, hormonereleasing IUD

First generation IUD • Inert or nonmedicated devices, usually made up of polyethylene or other polymers • Different shapes and sizes-loops, spirals, coils, rings and bows • Lippes loops are commonly used in developing countries

Lippes loop • Double S shaped made of polyethylene • Nontoxic, non-tissue reactive and extremely durable • Contains small amount of barium sulphate for X ray observation • Attached thread or tail made up of nylon which project in the vagina after insertion • Tail can be felt to ensure that loop is at place • Four sizes A, B, C, D; larger size have greater antifertility effect and lower expulsion rate but higher removal rate because of pain and bleeding

Second generation IUD Copper containing IUD, have strong anti-fertility effect Smaller in size therefore easy to fit Copper-7 Copper T-200 Copper T-220 C Copper T-380 A or Ag Multiload devices such as ML-Cu-250 The number indicates surface area of the copper on the device Cu T-380 Ag indicates silver core over which copper wire is wrapped • Multiload devices are effective upto five years • •

Copper T intrauterine device (IUD) • This IUD is a small device that is shaped in the form of a “T. ” Doctor places it inside the uterus to prevent pregnancy. It can stay in uterus for up to 10 years. Typical use failure rate: 0. 8%.

Intrauterine device (IUD) • Copper containing • Small flexible plastic device containing copper sleeves or wire that is inserted into the uterus • Copper component damages sperm and prevents it from meeting the egg • >99% • Longer and heavier periods during first months of use are common but not harmful; can also be used as emergency contraception

Advantages of copper devices • • • Low expulsion rate Low side effects-pain and bleeding Easy to fit in Increased contraceptive effectiveness Effective as post coital contraceptive, if inserted within 3 -5 days of unprotected intercourse

Third generation IUD • Hormone releasing IUD • Progestasert: T shaped device filled with 38 mg of progesterone, releare in the uterus@65 mcg/day • It effect uterine lining, cervical mucusand sperm • LNG-20, Mirena: T shaped releasing 20 mcg of levonorgestrel • Low pregnancy rate

Intrauterine device (IUD) levonorgestrel • A T-shaped plastic device inserted into the uterus that steadily releases small amounts of levonorgestrel each day • Thickens cervical mucous to block sperm and egg from meeting • >99% • Decreases amount of blood lost with menstruation over time • Effective life 10 years

Mechanism of action of IUD • Causes a foreign body reaction in uterus resulting in cellular and biochemical changes in the endometrium and uterine fluids • Reduces viability of gamete and reduces chances of fertilization • Copper in Cu IUD also alter composition of cervical mucus may effect sperm motility capacitation and survival • Hormone releasing IUD increase the viscosity of cervical mucus and thus prevent the entry of sperm in the cervix • They make endometrium unfavourable for implantation

Change of IUD • Inert IUDs such as Lippes loop can be left as long as they are required • Cu IUD need to be released due to corrosion and mineral deposition on Cu • Same way hormone releasing IUD needs to be changed as the stored hormone may get exhausted

Advantages • Simplicity: simple insertion process, no hospitalization • Can stay in place as long as required • Inexpensive • Reversible

Ideal IUD candidate • • • Has given birth to at least one child No history of pelvic disease Normal menstrual period Willling to check IUD tail Has access to follow up

Timing of insetion • Most preferred time is during menstruation or within 10 days as during this time diameter of cervical canal is more so insertion is easy • First week after pregnancy- chances of expulsion and perforation are high, convenient time 6 -8 weeks after pregnancy

Side effects • Bleeding : greater volume and longer menstrual periods • Pain • Pelvic infection: Pelvic inflammatory disease(PID) • Uterine perforation • Pregnancy • Ectopic pregnancy • Expulsion