1. Session I: Characteristics of IUDs
Copper-Bearing Intrauterine Devices (IUDs)
Session I: Characteristics of IUDs
Illustration credit: Salim Khalaf/FHI
Copper T 380A

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.
Suggested script:
The learning objectives for this module are based on input from various stakeholders <insert who provided input: participants, supervisors, health officials>.
The objectives of this module are as follows: By the end of this training session, participants will be able to: <click the mouse to advance through the objectives, reading each objective aloud >.

3. Copper IUDs: Key Points for Providers and Clients
5/25/2012
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 copper 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).
Adapted from WHO’s Decision-making tool for family planning clients and providers.

4. Copper IUDs: Key Points for Providers and Clients
5/25/2012
Very safe
Copper 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.
Adapted from WHO’s Decision-making tool for family planning clients and providers.

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
Copper T-380A
Multiload 375

6. Levonorgestrel IUDs (LNG-IUD)
A T-shaped plastic device that steadily releases a small amount of the hormone levonorgestrel each day
Insertion/removal procedure similar to copper IUDs
Slightly more effective than copper IUDs
Shorter duration of use: 3-5 years, depending on brand
Work by preventing sperm from fertilizing an egg
Different side effects: lighter/no bleeding and hormonal side effects (such as headaches)
Typically less available and more expensive than copper IUDs
Fully covered under a different module
This slide is only to introduce LNG-IUD to trainees. As the LNG-IUD becomes more available, providers are more likely to hear of it or have a client ask about it. Being able to differentiate it from the copper IUD is valuable. The side effect profile and MEC recommendations are relatively different from the copper IUD due to the LNG-IUD being a hormonal method. Full discussion of these is beyond the scope of the copper IUD TRP module. A full module on LNG-IUD is being developed and should become available in late 2018 or early 2019.

7. Effectiveness of IUDs
In this progression of effectiveness, where would you place copper IUDs?
Implants
Male Sterilization
Female Sterilization
Progestin-only Injectables
Combined Oral Contraceptives
Male Condoms
Standard Days Method
Female Condoms
Spermicides
More effective
Copper IUDs
Less effective

8. Relative Effectiveness of Family Planning Methods
# of unintended pregnancies among
1,000 women in 1st year of typical use
No method
850
Withdrawal
220
Female condom
210
Male condom
180
Pill 90
Injectable 60
IUD (Copper/ LNG-IUD)
8 / 2
Female sterilization 5
Vasectomy
1.5
Implant
0.5
Source: Trussell J., Contraceptive Failure in the United States, Contraception 83 (2011) , Elsevier Inc.

9. Copper IUDs: Mechanism of Action
Prevents fertilization by:
Impairing the viability of the sperm
Interfering with movement of the sperm
Source: Ortiz, 1996

10. Copper IUDs: Characteristics
Safe and highly effective
Require no user action
Long-acting (up to 12 years)
Rapid return to fertility
No systemic effects
Have health benefits
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
Source: CCP and WHO, 2018.

11. 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
Rate in women using no contraception is 65 in 10,000
May help protect against cervical and endometrial cancer

12. Possible Side-Effects
Copper IUD
If a woman chooses this method, she may have some side-effects. They are not usually signs of illness.
After insertion:
Other common side-effects:
Some cramps for several days
Longer and heavier periods
Bleeding or spotting between periods
Some spotting for a few weeks
Adapted from WHO’s Decision-making tool for family planning clients and providers.
More cramps or pain during periods
May get less after a few months

13. 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