IUCDs
Intrauterine contraceptive have been in use for several decades. The closed devices like Grafenberg ring, and birnberg bow are obsolete now. Open devices like Copper T, Copper 7 and lippes loop were in use in 1980s. ![]()
Commonly used IUCDs in present day practice are:
Cu T 200, Cu T 380 A, Multiload 250, Multiload 350, Progestasert, Levonorgesterel intrauterine device and others.
MECHANISM OF ACTION
Mechanism of antifertility effects of IUCDs is not yet clear.
PROBABLE FACTORS
- It interferes with sperm transportation from the cervix to the fallopian tubes.
- The IUCD inhibits sperm capacitation and survival (speroff et al, 1999).
- It alters the biochemical or cellular composition of uterine fluid or both causing impairment of the viability of gametes.
- The copper ions released from the device interferes with sperm motility and creates a reaction that results in a spermicidal endometrium (Nelson, 2000).
- Progestasert is thought to act through thickening the cervical mucus and rendering it impermeable to sperm.
TIME OF INSERTION
-Interval insertion: Inserted 6 weeks after delivery or abortion. The timing should preferably be within 2 to 3 days of completion of menses. During the period of lactational amenorrhea it should be inserted after ensuring that the women is not pregnant.
-Postabortal or insertion: Insertion immediately following delivery of the placenta. Expulsion rate is high.
- Postpartal: Insertion before the patient is discharged from the hospital following delivery.
COMPLICATIONS
- Cramping pain.
- Syncope following a vasovagal attack.
- Uterine perforation- partial or complete.
- Pelvic infection- infertility.
- Menorrhagia.
- Intermenstrual bleeding.
- Dysmenorrhea.
- Unwanted pregnancy.
- Spontaneous expulsion.
ADVANTAGES
- Provides excellent contraception.
- May be used successfully in lactating women.
- Indicated in women in whom oral contraceptive are contraindicated.
- Can be used over long periods of time.
- Action easily reversible.
- Progesterone IUCDs reduce dysmenorrhea and menorrhagia.
DISADVANTAGES AND CAUTION
- IUCDs do not provide protection against STDs.
- Cannot be used in patients with suspected pelvic infection.
- Best avoided in women having multiple sex partners.
- Menstrual disturbances such as menorrhagia.
- Dysmenorrhea.
- Women with valvular heart disease- risk of bacterial endocarditis.
- Uterine anomalies.
- Previous ectopic pregnancy.
- Women with abnormal Pap smears.
REMOVAL
This may be required because:
- The life span of the IUCD has been completed.
- The patient does not tolerate the IUCD.
- The patient has conceived with the IUCD.
- The IUCD has got displaced downwards.
- The women desires to conceive.
The median time from removal of IUCD to planned pregnancy is 3 months (Nelson, 2000).
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