IUCD Dr Sharon D Rasquinha Intrauterine contraceptive device

IUCD Dr. Sharon D. Rasquinha

Intrauterine contraceptive device : • Learning objectives : • Define an IUCD • Enumerate the type of IUCD • Describe the mechanism of action. • Enumerate their advantages and disadvantages • Indications/contraindications and complication • List the criteria for selection of a client for IUCD • Describe the technique • Other uses of IUCD

• IUCD are small flexible devices made of plastic or metal or in combination meant for insertion into uterus cavity for contraception. • Grafenberg ring • 1960 Lippes loop • Frames are made of polyethylene, (P-Ethylene vinyl acetate) • Impregnated with barium sulphate – radio opaque • All IUCD have nylon tail

TYPES : Three generations • First generation : Lippe’s loop • Second generation : Contain copper – Cu. T 200, multiload 250 – Cu. T 380 A, Cu. T 220 c, Nova T, multiload 375 Third generation : Hormone containing – P LNG Open / closed Copper IUCD are of several types N No against the designation of each device denotes the surface area of copper in mm 2 • Copper T 220 c and Cu. T 380 A are available in NFPP • Cu. T 200 are effective for five year • Cu. T 380 A – 10 years • •

Hormone releasing IUCD • Acts as a delivery system for the hormones. • Beneficial to women with menorrhagia. Progestasart : • T shaped device made of ethylene vinyl acetate copolymer • Vertical shaft is fitted with a capsule contain 38 mg of progesterone. • 65 mg/day • To be replaced every year.

Levonorgestrel devices : • LNG 20 mirena, Levonova emiley • Delivers 20 mg of LNA/day • Replaced every 5 years • MOA : Blocks sperm migration. • Spermicidal effect of lysocomal activation • Accelerated lirbal motility. • makes end hostile to implantation.

Advantages : • Effective soon after insertion • Not linked to sexual activity • Not interferes with intercourse • No need for constant motivation • No risk of drug interaction • Does not affect breast feeding • Removal of device is easy • Return of fertility is noted soon after removal • No systemic side effects

Disadvantages : • Do not protect from STD

Complications : • Cramps syncopal attacks • Perforation • Expulsion • Menorrhagia • Infection

Indications : • Parous women in R. age breast feeding mothers as postcoital contraception C/I : • Suspected pregnancy • Abnormalities GT • PID • Cervicilin/vaginities • Genital bleeding • Uterine pathology • Severe anemia • Previous h/o EP • Multiple sexual partners

• • • Time of insertion Post menstrual Postnatal – 6 weeks Post placental After an abortion 1 trimester MTP

• Technique of insertion • Post insertion advice • Missing Cu. T threads

• IUCD – an effective reversible long term c. method. Each device has a Nylon thread attached to lower end. • They have a life of 3 -5 years. 50 g of cu is eluted daily in the uterus. • Copper T 380 A – paraguard – 10 years • Progestasart is T shaped has 38 mg of progesterone. 65 mg of hormone is released daily. • Forms thick plug of mucus – prevents sperm penetration • Required yearly replacement.

Mirena : • contained 52 mg of LNG – releasing 20 mg daily. • Life of 5 years FR of 0. 1 – 0. 4 HWY • Frameless IUCD and fibroblast releasing 14 mcg P daily for 3 years. • Gyneflex is 3 -4 cu long, 12 mm in width adapts to the shape of uterine cavity. • It contained 6 copper beads on monofilament poly propylene thread. Thread is knotted at one end which is fixed to the fundus. • Ensure device within the intramural portion of FT

Patient selection : • Low risk for STD • Multiparous • Monogamous relationship • Desirous of long term reversible method, but not permanent method. • Unhappy / unreliable user of ocp.

Uses : • Contraception • Post coital contraception • Following excision of uterine septum. Asherman’s syn. • Hormonal in menorrhagia. • In women on tamoxifen for breast ca. Mirena can counteract Endo hyperplasia.

C/I : • Suspected pregnancy • PID • Presence of fibroids • Severe anemia • Diabetic • Heart disease • Previous ectopic • Scarred uterus • Avoid in unmarried / nullipara • Septate uterus

• • • During / soon after period After MTP Immediate PP 24 hr. of delivery 6 weeks PN

MOA : • Foreign body in uterus renders irrigation of spermatozoa difficult. • FB provokes uterine contractility thro’ PG’s, decreased tubal peristalsis. • Leucotytic infiltration in endo. Macrophages engulf the fertilized egg. • Released copper brings about certain enzymatic and metabolic change in endometrial tissue. • Progesterone carrying devices alters the cervical mucus which prevent sperm penetration, endometrial atrophy.

Complication : • Immediate : – Difficulty in insertion – Vasovagial attack – Uterine cramps

• Early : – Expulsion (2 -5%) – Perforation (1 -2%) – Spotting, menorrhagia – Dysmenorrhea – Vaginal infects – Actinomycosis

• Late : – PID – Pregnancy – Ectopic pregnancy – Menorrhagia

Misplaced IUCD : • Causes are – uterus has enlarged thro’ preg. • Threads have curled up • Perforation has occurred • Expelled out