Intrauterine contraception device

An IUD is ideal for women who want a long-term method of contraception and where regular compliance is not required. IUDs protect against both intrauterine and ectopic pregnancy, but if pregnancy occurs, there is a higher chance than normal that it will be ectopic

Types 1-plastic inert devices (Lippes Loop or Saf-T coil), which often caused significantly heavier and more painful menstrual periods ,These are no longer available, although some women may still have them in situ. Once fitted, they could be left until the menopause.

coil, Dalkon shield

2-copperbearing IUD which are available in various shapes and sizes They cause much less_menstrual disruption than the older plastic devices. Most copper-bearing IUDs are licensed for between 3 and 5 years of use, but many will last longer, possibly up to 10 years. The more copper wire a device has, the more effective it is

Copper-bearing intrauterine devices: Multiload,Copper T 380.

3-Hormone-releasing devices [mirena] have also been developed The levonorgestrel-releasing in trauterinesystem (IUS) has the advantages (and disadvantages) of both hormonal and intrauterine contraception (Table 6.5 ). It is associated with a dramatic reduction in menstrual blood loss and is licensed for contraception and the treatment of menorrhagia

Horrnone-releasing intrauterine devices: progesterone-releasing IUD, levonorgestrel-releasing IUD.

Mode of action 1-All IUDs induce an inflammatory response in the endometrium which prevents implantation. However, 2-copper-bearing IUDs work primarily by a toxic effect on sperm which prevents fertilization. 3-The mirena IUS prevents pregnancy primarily by a local hormonal effect on the cervical mucus and endometrium

Contraindications • Previous PID. • Previous ectopic pregnancy. • Known malformation of the uterus. • Copper allergy (but could use an IUS). *abnormal uterine bleeding *nulliparity

Side effects 1-Menstrual disturbance:menorrhagia & 2ry dysmenorrhea may occur . 2-Expulsion: This is most likely to occur in the first year which may occur sometime without noticing 3-Perforation: Occur at time of insertion in 1.3 /1000 insertions. Routine follow–up 6 weeks after insertion allows most perforations to be detected.

4-Increased risk of pelvic infection in the first few weeks following insertion Although IUDs increase the risk of PID in the first few weeks after insertion, the long-term risk is similar to that of women who are not using any method of contraception 5-pregnancy :if failure occur there is high incidence that pregnancy is ectopic.if intrauterine pregnancy occur there is more risk of abortion ,preterm labour & antepartum hemorrhage

Insertion It is better to be inerted in the first even days of menstrual bleeding so there is no pregnancy & the cervix is soft The cervix is exposed with speculum,Uterine sound is usedto measure length of uterine cavity. The introducer is inserted and the IUD expelled into the cavity then its thread is cut short

Natural family planning This is an extremely important method of contraception worldwide and may e the only one acceptable to some couples for cultural and religious reasons. It involves abstaining from intercourse during the fertile period of the month The failure rates of natural methods of family planning are quite high

The fertile period is calculated by various techniques such as: • changes in basal body temperature, • changes in cervical mucus, • changes in the cervix, • multiple indices, many types of kits available

The lactatinal amenorrhoea method[LAM] it has failure rate of 2% if: *Women who are fully breast – feeding especially at night. *she is amenorrhoeic. *during the first 6 months after child birth.

Barrier methods of contraception Condoms Male condoms are usually made of latex rubber. They are cheap and are widely available . They have been heavily promoted in prevention of the spread of sexually transmitted diseases (STDs), particularly human immunodeficiency virus (HN) and acquired immunodeficiency syndrome (AIDS

Female barriers The diaphragm& cap, are the female barriers They should all be used in conjunction with a spermicidal cream or gel. The effective use of a diaphragm requires careful teaching and fitting. Female barriers offer protection against ascending pelvic infection but can increase the risk of urinary tract infection and vaginal irritation Female condoms made of plastic are also available Spermicidal agents should not be used as a contraceptive method on their own: their main role is to make barrier methods more effective

Coitus interruptus Coitus interruptus, or withdrawal, is widely practised and obviously does not require any medical supervision. Unfortunately, it is not reliable, as pre-ejaculatory secretions may contain millions of sperm and young men often find it hard to judge the timing of withdrawal