Intrauterine contraceptive device

FOR MBBS & OBG students

1. INTRAUTERINE CONTRACEPTIVE DEVICE

2. CLASSIFICATION Non medicated IUCD – (1 st GENERATION) Lippes loop Medicated copper containing IUCD- (2 ND GENERATION) CU-T 380A, Multiload 375, 250 Hormone containing IUCD- (3 RD GENERATION) LNG IUS, Progestasert

3. Device Description CU-T 380A contains 380 mm square of copper. (vertical stem 314mm sq and each arm 33mm sq) Copper is radio opaque, additional barium sulfate is incorporated in the device. Device is replaced 10years It is used of synecolysis to prevent adhesion formation after adhesiolysis in Asherman’s S yndrome

4. Multi load CU-375: It has 375 mm sq surface area of copper wire No introducer and no plunger Replaced every 5 years Multi load CU-250: Emits 60-100mcg of copper per day Replaced every 3 years

5. Levonorgestrel Intrauterine system: T- shaped with polydimethylsiloxane membrane around the stem which acts as a steroid reservoir Total amount of LNG is 52mg Daily 20mcg is released To be replaced every 5 years It has many non- contraceptive benefits

6. Mechanism of action Biochemical and histological changes in the endometrium Increased tubal motility Endometrial inflammatory response Copper initiates release of cytokines which are cytotoxic . Ionised copper prevents blastocyst implantation through enzymatic interference LNG IUS : Suppression of endometrium , scanty cervical mucus

7. Advantages Contraception Prevents synechiae formation Third generation IUCDs – higher efficacy, longer action, less expulsion, decreased risk of ectopic pregnancy, decreased risk of PID With LNG IUS- decreased menorrhagia , dysmenorrhoea , premenstrual tension syndrome, treatment of endometrial hyperplasia, endometriosis, adenomyosis

8. Failure rate PEARL INDEX ( pregnancy rate per HWY) No method – 85 Natural method – 25 Condom (male)- 15 OC pills- 0.1 CU- T 380A - 0.8 LNG 20 – 0.1 Tubectomy / Vasectomy - 0.15

9. C ontraindications Pelvic infammatory disease Undiagnosed genital tract bleeding Suspected pregnancy Distorted uterus h/o ectopic pregnancy For Cu-T – W ilson’s disease , copper allergy For LNG IUS: Hepatocellular disease, Breast Ca, severe arterial disease Not advised in nulliparous patients

10. Time of insertion Interval Post abortal Postpartum Post placental delivery (PPIUCD)

11. Method of insertion Withdrawal technique

12. C omplications Immediate: Cramps, syncope, perforation Remote: pain, abnormal uterine bleeding, pelvic inflammatory disease, spontaneous expulsion, perforation of uterus

13. Indications for removal of IUCD Excessive or irregular menstrual bleeding Salpingitis Perforation of uterus Partial expulsion Pregnancy with device in situ Willing for pregnancy Missing thread After the life span of the device is over

14. Missing threads Causes Examination USG X-ray pelvis AP and lateral view Hysteroscopy

15. Pregnancy with IUCD