Intrauterine contraceptive devices ( IUCDs)

IUCD is a good method of spacing in women who have born at least one child.

1. Intrauterine
Contraceptive
Devices(IUCDs)
Lavina Belayutham

2. Classification
•Non- medicated IUCDs: Lippes loop
•Medicated copper containing IUCDs :
Cu T-380 A, Multiload – 375, Cu T-200,
Multiload – 250
•Hormone containing IUCDs : Levonorgestrel
intrauterine system (LNG – IUS), progestasert

3. What are the
types of IUCD
that you
know????

9. 1.A 32 year old woman, P2L2 has come to the
hospital for advice on contraception. She is a
model and couldn’t tolerate excessive weight
gain. When asked about her menstrual history,
she says that she soaks through a pad every 2 to
3 hours and she has to get up in the middle of
the night to change her pad. She also has severe
cramps. She said she doesn’t prefer taking pills
because she has never been able to remember
to take a pill daily.

10. What is the best method of contraception?
a)Depot- medroxyprogesterone acetate
b)Progestin- only pill (minipill)
c)Combined oral contraceptive pills
d)Levonorgestrel - IUS

12. 2. A 26 year old woman, G3P3 comes to the
hospital to get a copper T inserted. On
examination, she is found to have ascites and
splenomegaly. Signs of chronic liver disease
were also found. On slit lamp examination :
Would you proceed with the copper T insertion?

13. 3. Lalitha is a married 30-year-old mother of one
infant child. She and her husband both wish to
delay having a second child. Lalitha is
currently breastfeeding. She had an
occurrence of pelvic inflammatory disease
(PID) in her early-20’s. She heard about IUCDs
from a community health worker and has
come to the clinic to learn more about them.
During your meeting, Lalitha wants to learn
more about IUCDs and asks the following
question:

14. a)Is it safe to use
copper IUDs while
breastfeeding?
Why?
Answer : Yes. No hormones.

15. b)Does her previous
history of PID affect
her eligibility for
IUCDs?
Answer : No.

16. Ideal candidate for IUCD
•Normal uterus
•Parous
•Low risk for STD
•Monogamous
•Don’t wish to have baby for few years
•Want to avoid surgical sterilisation
•Willing to check IUCD thread
•Assess – follow up, treatment

18. 1. Pregnancy

19. 2. Abnormalities of uterus resulting in uterine
cavity distortion

20. 3. Acute PID or h/o PID unless there has been a
subsequent uterine pregnancy

21. 4. Postpartum endometritis or infected abortion
in the past 3 months

22. 5. Undiagnosed genital tract bleeding

23. 6.Untreated acute cervicitis, vaginitis, including
bacterial vaginosis, until infection is controlled

24. 7. STIs – current or within 3 months

25. 8. History of ectopic pregnancy

26. 9. Immunosupression

27. Contraindications for copper T
380A
1. Wilson’s Disease

28. 2. Copper allergy

29. Contraindications for LNG-IUS
1. Hepatic tumor or hepatocellular disease

30. 2. Current breast cancer

31. 4. It is now 6 months since Yamuna had her IUD
inserted. During a visit 3 months ago, Yamuna had
complained of a heavy bleeding and cramping during
menses. She was also concerned about the IUD
expulsion. You had examined her and confirmed that
the IUD is still in place and reassured her about the
side effects. Today, she has returned to the clinics and
complains of fever, purulent vaginal discharge, lower
abdominal pain, and pain during sexual intercourse.
She has checked the threads after each menses since
her last visit and had felt them each time.

32. a)What is the likely
cause of Yamuna’s
symptom?

33. Answer : Pelvic Inflammatory
Disease

34. b)Does she need to
have the IUD
removed? Why or
why not?
Answer : Yes. Foci of infection.

35. c)What is your plan
of action?

36. Antibiotics
Ceftriaxone (250mg IM)
+
Doxycycline (100mg bid oral)
for 14 days

37. d)What other
counselling advice
would you offer and
why?

38. Answer :
•Complication if untreated
•Partner also treated
•Abstinence from sexual intercourse until
treatment completed
•Use other contraceptive method

39. 5. Sudha, a P1L1 has had her IUCD for three
months. She is returning to the clinic and
complains that she still has cramping,
especially during menses, and heavy bleeding
during her periods.

40. a)Is heavy bleeding
normal with IUD
use?
Answer : Common (temporary)

41. b)What would you
advise Sudha to do
about her bleeding?

42. Answer :
•Reassure
•Reassure

43. c) What would you
advise Sudha to do
about her cramps?

44. Answer :
•Reassure
•Analgesics
•Underlying cause
•Remove IUCD ( if persists)

45. Complications of IUCD
1.PAIN AND INCREASED MENSTRUAL BLEEDING

46. 2. PELVIC INFECTION(PID)
Risk :
•Low overall
•Higher (first 20 days)
•Extremely rare (> 20 days)
•Gonorrhea/chlamydia
•Similar to risk of PID
in women with
gonorrhea and chlamydia
who are not using IUCD

47. How to reduce the risk of PID?
•Don’t insert IUCD if :
-High risk of STIs
-Clinical symptoms and signs of STI
•Aseptic technique
•Follow-up visit at 3 to 6 weeks

48. 3. Perforations

49. Perforations
•Incidence 1 in 1000
•IUCD, the inserter tube, the sound, or other
gynecological instrument
•Withdrawal technique (less common)
•Postpartum between 72 hours and 6 weeks

50. 4. Expulsions
•During menstruation
•Factors contributing to expulsion :
1.Provider’s skill
2.Age, parity
3.Time since insertion
4.Timing of insertion

51. 5. Intrauterine Pregnancy

52. Intrauterine Pregnancy
•Spontaneous abortion (most common)
•Removed
•Increase risk of preterm labour (if left in place)

53. 6. Ectopic Pregnancy

54. Ectopic Pregnancy
•Risk much lower than noncontraceptive users
•IUCD user pregnant, mostly ectopic
•Lowest rate : copper T 380A, levonorgestrel
IUCD
•Higher rate : progestasert (action limited to
local effect on the endometrium)