1. INTRAUTERINE DEVICES

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

3. 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

4. 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

6. 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.

7. Cu-T-200B
Nova T

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

9. MULTILOAD 375

10. 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

11. Third generation IUDS:
-Progestasert : T shaped device filled with 38mg of progesterone
-LNG-20: a T shaped IUD releasing 20mcg of levonorgestrel

12. LEVONOGERSTREL IUD

13. PROGESTASERT

14. 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.

15. 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 5 14
Progesterone IUD
2.7
9.3
Levonogestrel IUD
0.2 17

16. 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.

17. 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

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

19. Relative:
-anaemia
-menorrhagia
-history of PID
-purulent cervical discharge
-distortions of the uterine cavity

20. 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.

21. What is the ideal time for insertion and why is follow-up important??

22. Side effects and complications:
-bleeding
-pelvic infection
-uterine perforation
-pregnancy
-ectopic pregnancy
-expulsion
-fertility after removal
-cancer and teratogenesis
-mortality
-pain