CopperBearing Intrauterine Devices IUDs Session I Characteristics of

Copper-Bearing Intrauterine Devices (IUDs) Session I: Characteristics of IUDs Copper T 380 A Session I, Slide 1

Copper IUDs: Objectives Participants will: • Describe the characteristics of copper IUDs in a manner that clients can understand • Demonstrate how to screen clients for eligibility to use the copper IUD • Describe when to start the use of the copper IUD • Explain to clients insertion and follow-up procedures, and when to return • Explain how to manage side effects • Address common concerns, misconceptions, and myths • Identify clients in need of referral for IUD-related complications. • Demonstrate how to insert and remove the IUD on an anatomical model. Session I, Slide # 2

Copper IUDs: Key Points for Providers and Clients Small plastic device inserted through the vagina and cervix into the uterus. • Works mainly by stopping sperm and egg from meeting. • Requires no user action. • Requires a clinically trained provider to properly insert and remove. • Most women can use copper IUDs, including women who have never been pregnant. Very effective • Very effective, with little to remember. • A woman can soon become pregnant when IUD is taken out. Long acting • Long acting – up to 12 years – depending on type of device. • Can be removed whenever woman wants. • For older women: should be removed 1 year after last menstrual period (menopause). Session I, Slide #3

Copper IUDs: Key Points for Providers and Clients Very safe Copper IUDs act locally on the reproductive tract and have no systemic effects. For this reason, copper IUDs can be used safely by breastfeeding women and by women who cannot use hormonal contraceptives. IUDs do not: • Leave the womb and move around the body. • Get in the way during intercourse, although sometimes the man may feel the strings. • Rust inside the body, even after many years. Some women have side-effects • Side-effects usually get better after first 3 months. • Side-effects include increase in menstrual bleeding or cramps. No protection against • For STI/HIV and AIDS protection, also use STIS or HIV/AIDS condoms. Session I, Slide #4

Copper IUDs • Copper IUDs have a small plastic frame with copper sleeves or wire around it – TCu-380 A, “Copper T” is most widely used copper IUD – Multiload 375 is another copper IUD commonly available in some countries Copper T-380 A Multiload 375 Session I, Slide # 5

Levonorgestrel IUDs (LNG-IUD) • A T-shaped plastic device that steadily releases a small amount of the hormone levonorgestrel each day • Insertion/removal procedure similar to copper IUDs • Slightly more effective than copper IUDs • Shorter duration of use: 3 -5 years, depending on brand • Work by preventing sperm from fertilizing an egg • Different side effects: lighter/no bleeding and hormonal side effects (such as headaches) • Typically less available and more expensive than copper IUDs • Fully covered under a different module Session I, Slide # 6

Effectiveness of IUDs In this progression of effectiveness, where would you place copper IUDs? More effective Implants Male Sterilization Female Sterilization Copper IUDs Progestin-only Injectables Combined Oral Contraceptives Male Condoms Standard Days Method Less effective Female Condoms Spermicides Session I, Slide # 7

Relative Effectiveness of Family Planning Methods Method # of unintended pregnancies among 1, 000 women in 1 st year of typical use No method 850 Withdrawal 220 Female condom 210 Male condom 180 Pill 90 Injectable 60 IUD (Copper/ LNG-IUD) Female sterilization 8/2 5 Vasectomy 1. 5 Implant 0. 5 Source: Trussell J. , Contraceptive Failure in the United States, Contraception 83 (2011) 397 - 404, Elsevier Inc. Session I, Slide #8

Copper IUDs: Mechanism of Action Prevents fertilization by: • Impairing the viability of the sperm • Interfering with movement of the sperm Source: Ortiz, 1996 Session I, Slide # 9

Copper IUDs: Characteristics • Safe and highly effective • Trained provider needed to insert and remove • Require no user action • Require pelvic exam • Long-acting (up to 12 • Possible pain or discomfort years) during insertion • Rapid return to fertility • Have potential side effects • No systemic effects • Complications are rare, but • Have health benefits may occur Source: CCP and WHO, 2018. • Do not protect against STIs/HIV Session I, Slide # 10

Copper IUDs: Health Benefits IUDs are known to: • Prevent risks of pregnancy • Reduce risk of ectopic pregnancy – Rate in IUD users is 12 in 10, 000 – Rate in women using no contraception is 65 in 10, 000 • May help protect against cervical and endometrial cancer Session I, Slide # 11

Copper IUD Possible Side-Effects If a woman chooses this method, she may have some side-effects. They are not usually signs of illness. After insertion: Other common side-effects: Some cramps for several days Longer and heavier periods Some spotting for a few weeks Bleeding or spotting between periods More cramps or pain during periods May get less after a few months Session I, Slide # 12

Copper IUDs: Counseling about Side Effects • Before insertion, describe common side effects: – Heavier and/or prolonged menstrual bleeding – Menstrual cramping – Spotting between periods • Explain that side effects: – Are not signs of illness – Usually become less within the first 3– 6 months • Encourage to come back with questions or concerns • If client cannot tolerate side effects, treatment or discontinuation may be necessary Session I, Slide # 13