INTRAUTERINE DEVICES

Types of UDs: First generation IUDs: non medicated Second generation : copper containing Third generation : hormone releasing

In 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 loop Double shaped device Made up of polyethylene Contains small amount of barium sulphate to allow X-ray examination Has a tail made up of nylon Exists in four sizes A,B,C,D

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

Cu-T-200B Nova T

Earlier devices: - Copper 7 - Copper T-200 Newer devices a. Cu-T-220 C Cu-T-380A Nova T Multiload Cu 250,375

MULTILOAD 375

Advantages: Low expulsion rate Lower incidence of side effects eg.pain and bleeding Easier to fit in nulliparous women Better tolerated by nullipara Increased contraceptive effectiveness Effective as post coital contraceptive

Third 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: device Preganancy rate% Expulsion rate% Removal rate % Lippes loop 3 12-20 12-15 Cu-7 2-3 6 11 TCu-200 8 TCu-380A 0.5-0.8 5 14 Progesterone IUD 1.3-1.6 2.7 9.3 Levonogestrel IUD 0.2 17

Change 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 insert Insertion takes place only few minutes Inexpensive Contraceptive effect is reversible Virtually free of systemic metabolic side effects associated with hormonal pills. Highest continuation rate

Contraindications a. absolute Suspected pregnancy Pelvic inflammatory diseases Vaginal bleeding Cancer of cervix, uterus Previous 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