Intrauterine Contraceptive Device

IUCD is a device made of polyethylene which is impregnated with barium sulphate (which is radiopaque) so that the presence or absence can be detected by ultrasound or radiograph. It has a nylon thread attached to it’s lower end which protrudes through the cervical canal into the vagina.
The thread can be felt by the patient.

Types of IUCDs

Non medicated : lippes loop

Medicated IUCD (bioactive) :
contain metal copper. eg: Cu T-200, Cu T-380 A, Multiload-250, Multiload-375

Hormone containing IUCD: release progesterone (progestasert) or levonorgestrel (LNG-IUD)


Mechanism of action of IUCD:

1.Presence of a foreign body in the uterine cavity makes it difficult for the spermatozoa to migrate.

2.foreign body leads to prostaglandin release – provokes uterine contractility and increases tubal motility – fertilized ovum is propelled down the fallopian tube more rapidly and reaches the uterine cavity before the development of chorionic villi and hence it is unable to implant.

3.the device causes leucocytic infiltration in the endometrium. So. the macrophages engulf the fertilized egg if it enters the endometrial tissue.

4.Copper brings about enzymatic and metabolic changes in the endometrial tissue which is not conducive for implantation of the fertilized ovum.

5. Progestogen carrying devices:
•cause alteration in cervical mucus, which prevents sperm penetration,
•cause endometrial atrophy,
•prevent ovulation in 40 % cases.


Indications of IUCD

1.Contraception
2.Emergency contraceptive (postcoital contraception)
3.After excision of uterine septum, Asherman syndrome
4.Hormonal IUCD (Mirena) can be used in women with menorrhagia and dysmenorrhea
5.As a hormone replacement therapy in menopausal women.
6. In a woman on tamoxifen for breast cancer
7.In case of endometrial hyperplasia, Mirena can be used to counteract it.


Contraindications of IUCD

1.suspected pregnancy
2.previous ectopic pregnancy
3.severe anemia
4.fibroid
5.pelvic inflammatory diseases
6.uncontrolled diabetes (because of increased chances of pelvic infection)
7.heart disease (risk of infection)
8.Avoid LNG IUCD in breast cancer
9.Avoid copper T in menorrhagia and dysmenorrhea
10.Avoid use in unmarried and nulliparous women because of risk of PID and tubal infertility.
11.abnormally shaped uterus, septate uterus
12.scarred uterus


Complications

Immediate
Difficulty in insertion
Vasovagal attack
Uterine cramps

Early
Expulsion
Perforation
Spotting, menorrhagia
Dysmenorrhea
Vaginal infection
Actinomycosis

Late
PID
Pregnancy (failure rate of IUCD: 1-3/HWY)
Ectopic pregnancy
Perforation
Menorrhagia
Dysmenorrhoea


Advantages of IUCD

1.it is coital independent
2.one time motivation required, gives protection for a long period of time
3. cost effective
4.does not cause reduced fertility after removal
5.no systemic ill effects, unlike oral contraceptives
6.no adverse effects on lactation.


Disadvantages of IUCD

1.a medical or paramedical personnel is required to screen and insert the IUCD
2.it has complications


Note:

Copper T IUCD

-can be inserted within 5 days of intercourse
-cheap
3 -5 yrs long-lasting
failure rate: 0.1%

Mrunali Gondane

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