INTRAUTERINE DEVICES

INTRAUTERINE DEVICES Types of UDs:First generation IUDs: non medicated Second generation : copper containingThird generation : hormone releasingIn india under national family welfare programme CU-T-200B is being used.From year 2002,Cu-T-380 A has been introduced in the programme

First generation IUDs:Lippes loopDouble shaped deviceMade up of polyethyleneContains small amount of barium sulphate to allow X-ray examinationHas a tail made up of nylonExists in four sizes A,B,C,D

Second generation IUDs:Came up in 1970s by adding Cu to the IUDsMetallic copper was known to have strong anti-fertility effectsThe numbers included in the names refer to the surface area(in sq. mm) of the copper on the device.

Cu-T-200BNova TEarlier devices:- Copper 7- Copper T-200Newer devices a. Cu-T-220 C Cu-T-380ANova TMultiload Cu 250,375

MULTILOAD 375Advantages:Low expulsion rateLower incidence of side effects eg.pain and bleedingEasier to fit in nulliparous womenBetter tolerated by nulliparaIncreased contraceptive effectivenessEffective as post coital contraceptiveThird generation IUDS:-Progestasert : T shaped device filled with 38mg of progesterone-LNG-20: a T shaped IUD releasing 20mcg of levonorgestrel

LEVONOGERSTREL IUD

PROGESTASERT

Mechanism of action of IUDs:-causes cellular and biochemical changes in the endometrium-these changes impair the viability of the gametes and hence reduce its chances of fertilization-hormone releasing IUDs increase the viscosity of the cervical mucus and thereby prevent sperm from entering the cervix.

Effectiveness: devicePreganancy rate%Expulsion rate%Removal rate %Lippes loop 3 12-2012-15Cu-72-3611TCu-2003811TCu-380A0.5-0.8514Progesterone IUD1.3-1.62.79.3Levonogestrel IUD0.2617Change of IUDs:-lippes loop may be left in place indefinitely.-Cu-T-380A is approved for 10yrs-NOVA T for 5 yrs-levonogestrel used for atleast 7 yrs.Advantages of IUDs:Simple to insertInsertion takes place only few minutesInexpensiveContraceptive effect is reversibleVirtually free of systemic metabolic side effects associated with hormonal pills.Highest continuation rateContraindications a. absoluteSuspected pregnancyPelvic inflammatory diseasesVaginal bleedingCancer of cervix, uterusPrevious ectopic pregnancy

Relative:-anaemia-menorrhagia-history of PID-purulent cervical discharge-distortions of the uterine cavity

Ideal IUD candidate:The planned parenthood federation of america(PPFA)-who has borne at least one child-has no history of pelvic disease-has menstural period-is willing to check the IUD tail-has acess to follow-up and treatment of potential problems-is in a monogamous relationship.What is the ideal time for insertion and why is follow-up important??

Side effects and complications:-bleeding-pelvic infection-uterine perforation-pregnancy-ectopic pregnancy-expulsion-fertility after removal-cancer and teratogenesis-mortality-pain