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An intra-uterine device (''intra'' meaning ''within'', and ''uterine'' meaning ''of the Uterus '') is a Birth Control device also known as an '''IUD''' or a '''coil''' (this colloquialism is based on the coil-shaped design of early IUDs). It is a device placed in the uterus and is the world's most widely used method of reversible birth control,1 currently used by nearly 160 million women (just over two-thirds of whom are in China where it is the most widely used birth control method, surpassing Sterilization ).2 The device has to be fitted inside or removed from the uterus by a doctor or qualified medical practitioner. It remains in place the entire time pregnancy is not desired. Depending on the type, a single IUD is approved for 5 to 10 years use (the copper T 380A is effective for at least 12 years).3 TYPES OF IUDS There are two broad categories of intrauterine contraceptive devices: inert and Copper -based devices, and hormonally-based devices that work by releasing a Progestogen . In the United States, there are two types of intrauterine contraceptive available; the copper Paragard and the hormonal Mirena . In the U.S. both of these contraceptives are referred to as IUDs.4 In the United Kingdom, the term IUD only refers to inert or copper-containing devices, (seven types of copper-containing IUDs are available in the UK). In the UK, Hormonal Uterine Contraceptives are considered as a separate form of contraception from IUDs, and they are distinguished with the term IntraUterine System or IUS.5 Most non-hormonal IUDs have a plastic T-shaped frame that is wrapped with copper and/or has copper bands. In some IUDs, such as the Nova T 380, the pure copper wire has a Silver core which has been shown to prevent breaking of the wire.6 The arms of the frame hold the IUD in place near the top of the uterus. The GyneFix does not have a T-shape, but rather is a loop that holds several copper tubes. The GyneFix is held in place by a suture to the Fundus Of The Uterus . All copper-containing IUDs have a number as part of their name. This is the surface area of copper (in square millimeters) the IUD provides. EFFECTIVENESS AND MECHANISM OF CONTRACEPTION All second-generation copper-T IUDs have failure rates of less than 1% per year, and cumulative 10-year failure rates of 2-6%.IUDs-An Update. Chapter 2.3: Effectiveness . A large WHO trial reported a cumulative 12-year failure rate of 2.2% for the T 380A ( ParaGard ) (an average failure rate of 0.18% per year over 12 years), equivalent to a cumulative 10-year failure rate of 1.8% following Tubal Ligation . The frameless GyneFix also has a failure rate of less than 1% per year.7 Worldwide, older IUD models with lower effectiveness rates are no longer produced.IUDs—An Update. Chapter 1: Background . The presence of a device in the uterus prompts the release of Leukocyte s and Prostaglandin s by the Endometrium . These substances are hostile to both sperm and eggs; the presence of copper increases this spermicidal effect.89 While the primary mechanism of action of the IUD is spermicidal/ovicidal, post-fertilization mechanisms are believed by some Christian Pro-life physicians to contribute significantly to their effectiveness.10, which cites: :11 Because many pro-life individuals and organizations define fertilization as the Beginning Of Pregnancy , this possible secondary mechanism of action has led some pro-life individuals and organizations to label the IUD an Abortifacient . Some Barrier Contraceptives protect against STDs . Hormonal Contraceptives reduce the risk of developing Pelvic Inflammatory Disease (PID), a serious complication of certain STDs. IUDs, by contrast, do ''not'' protect against STDs or PID.12 13 14 15 16 17 18 19 20 Non Hormonal IUDs are considered safe to use while breastfeeding IUDs while nursing CONTRAINDICATIONS The WHO ''Medical Eligibility Criteria for Contraceptive Use'' and RCOG Faculty of Family Planning & Reproductive Health Care (FFPRHC) ''UK Medical Eligibility Criteria for Contraceptive Use'' list the following as conditions where insertion of a copper IUD is not usually recommended (category 3) or conditions where a copper IUD should not be inserted (category 4):2122 Category 3. Conditions where the theoretical or proven risks usually outweigh the advantages of inserting a copper IUD:
Category 4. Conditions which represent an unacceptable health risk if a copper IUD is inserted:
Adverse reactions have been reported in women with metal allergies, both copper23 and nickel.24 25 An anecdotal report on a LiveJournal community group journal states that the wires wrapped around the T-frame of the ParaGard IUD are nickel wires plated with copper.26 While Nulliparous women (women who have never given birth) are somewhat more likely to have side effects, this is not a contraindication for IUD use. Some doctors prefer to insert the IUD during menstruation to verify that the woman is not pregnant at the time of insertion. However, IUDs may safely be inserted at any time during the menstrual cycle as long as it is reasonably certain the woman is not pregnant.IUDs-An Update. Chapter 3: Insertion . Insertion may be more comfortable if done midcycle, when the cervix is naturally dilated.27 SIDE EFFECTS AND COMPLICATIONS Insertion of the IUD may introduce bacteria into the Uterus . The insertion process carries a small, transient increased risk of Pelvic Inflammatory Disease in the first 20 days following insertion. It is very important that the provider use proper Infection -prevention techniques during insertion.IUDs—An Update. Sidebar: Infection Prevention for IUD Insertion and Removal . Antibiotics should be given before insertion to women at high risk for Endocarditis (inflammation of the membrane lining the heart), but should not be used routinely.IUDs—An Update. Sidebar: Procedures for Providing IUDs . During the placement appointment, the Cervix is dilated in order to sound (measure) the uterus and insert the IUD. Cervix dilation is uncomfortable and, for some women, painful. Doctors often advise women to take Painkillers before the procedure to reduce discomfort, and some will use a local anaesthetic. After IUD insertion, Menstrual Periods are often heavier, more painful, or both - especially for the first few months after they are inserted. On average, menstrual blood loss increases by 20–50% after insertion of a copper-T IUD; increased menstrual discomfort is the most common medical reason for IUD removal.IUDs-An Update. Chapter 2.5: Bleeding and Pain . Complications include expulsion and uterine perforation. Uterine perforation is generally caused by an inexperienced provider and is very rare. Expulsion is more common in younger women, women who have not had children, and when an IUD is inserted immediately after childbirth or abortion. Women should check the string of the IUD at least once per menstrual cycle to verify that it is still in place. The string(s) may be felt by some men during Intercourse . If this is problematic, the provider may cut the strings even with the cervix, so they cannot be felt. Shortening the strings does prevent the woman from checking for expulsion, however. The risk of Ectopic Pregnancy to a woman using an IUD is lower than the risk of ectopic pregnancy to a woman using no form of birth control. However, of pregnancies that do occur during IUD use, a higher than expected percentage (3–4%) are ectopic.IUDs-An Update. Chapter 2.9:Ectopic Pregnancies . Although the pregnancy rate during IUD use is very low (less than 1% per year), it is not a 100% effective method of birth control. If pregnancy does occur, presence of the IUD increases the risk of Miscarriage , particularly during the second trimester. It also increases the risk of Premature Delivery . These increased risks end if the IUD is removed after pregnancy is discovered. Although the Dalkon Shield IUD was associated with septic abortions (infections associated with miscarriage), other brands of IUD are not. IUDs are also ''not'' associated with birth defects or other pregnancy complications.IUDs-An Update. Chapter 2.8: Intrauterine Pregnancy . USE AS EMERGENCY CONTRACEPTION Intrauterine devices can be used as Emergency Contraception to prevent pregnancy up to 5 days after unprotected Sexual Intercourse , or sexual intercourse during which the primary contraception is believed to have failed (e.g. a Condom was used, but it broke). Insertion of a copper-T IUD as emergency contraception is more than 99% effective, making it more effective than Emergency Contraceptive Pills (ECP or 'morning-after pill'). POPULARITY The IUD is the world's most widely used method of reversible birth control, currently used by nearly 160 million women (just over two-thirds of whom are in China where it is the most widely used birth control method, surpassing sterilization). Usage in many countries has been measured by surveys of married women of reproductive age. In this population, IUD use ranges from 5% in Belgium, to 18% in Scandinavia, 30% in Russia and China, and 40% in Kazakhstan.IUDs—An Update. Worldwide Use - Developed Countries . Table 2: Worldwide Use of IUDs . In the U.S., the ParaGard T 380A was approved by the FDA in 1984 and became available for use in 1988. It is still the only copper IUD approved for use in the U.S., and was used by 1.3% of women of reproductive age in a 2002 U.S. survey.28 See Table 56. A wider variety of IUDs is available outside of the U.S. In the U.K., for example, seven brands are available: Flexi-T 300, Multi-Safe 375, Multi-Load Cu 375, Neo-Safe T380, Nova T 380, T-Safe 380A, and GyneFix - also called FlexiGard 330 or CuFix PP330.29 HORMONAL UTERINE DEVICES See Also: IntraUterine System Hormonal uterine devices do not increase bleeding as inert and copper-containing IUDs do. Rather, they reduce menstrual bleeding or prevent menstruation altogether, and can be used as a treatment for Menorrhagia (heavy periods). Although use of IntraUterine Systems results in much lower systemic progestogen levels than other very-low-dose progestogen-only hormonal contraceptives, they might possibly have some of the same side effects. Progestasert was the first hormonal uterine device, developed in 1976IUDs—An Update. Chapter 2: Types of IUDs . and manufactured until 2001. |
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