Session I, Slide 1

Copper-Bearing Intrauterine Devices (IUDs)

Copper T 380A

Session I: Characteristics of IUDs

Session I, Slide # 2

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 #3

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 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).

IUDs: Key Points for Providers and Clients

Copper IUD

Session I, Slide #4

Very safe Copper-bearing 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 STIS or HIV/AIDS

• For STI/HIV and AIDS protection, also use condoms.

IUDs: Key Points for Providers and Clients

Copper IUD

Session I, Slide # 5

Copper IUDs

• Copper IUDs have a small plastic frame with copper sleeves or wire around it

– TCu-380A, “Copper T” is most widely used copper IUD

– Multiload 375 is another copper IUD commonly available in some countries

Multiload 375

Copper T-380A

Session I, Slide # 6

Effectiveness of IUDs

In this progression of effectiveness, where would you place copper intrauterine devices (IUDs)?

Implants

Male Sterilization

Female Sterilization

Progestin-only Injectables

Combined Oral Contraceptives

Male Condoms

Standard Days Method

Female Condoms

Spermicides

Less effective

More effective

Copper IUDs

Session I, Slide #7

Relative Effectiveness of Family Planning Methods

Method # of unintended pregnancies among1,000 women in 1st year of typical use

No method 850

Withdrawal 220

Female condom 210

Male condom 180

Pill 90

Injectable 60

IUD (CU-T 380A / LNG-IUS) 8 / 2

Female sterilization 5

Vasectomy 1.5

Implant 0.5Source: Trussell J., Contraceptive Failure in the United States, Contraception 83 (2011) 397- 404, Elsevier Inc.

Session I, Slide # 8

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

• Trained provider needed to insert and remove

• Require pelvic exam

• Possible pain or discomfort during insertion

• Have potential side effects

• Complications are rare, but may occur

• Do not protect against STIs/HIV

• Safe and highly effective

• Require no user action

• Long-acting (up to 12 years)

• Rapid return to fertility

• No systemic effects

• Have health benefits

Source: CCP and WHO, 2011.

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 (2 in 10,000 for

Copper T380A)

– Rate in women using no contraception is 65 in 10,000

• Help protect against endometrial cancer

Session I, Slide # 11

After insertion:

Some cramps for several days

Some spotting for a few weeks

Other common side-effects:

Longer and heavier periods

Bleeding or spotting between periods

More cramps or pain during periods

May get less after a few months

If a woman chooses this method, she may have some side-effects. They are not usually signs of illness.

Possible Side-EffectsCopper IUD

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