intrauterine contraceptive device
ABBR: IUCD, IUD
An artifact inserted into the uterine cavity to interfere with conception or implantation. Many such devices are impregnated with progestins or copper. IUDs block fertilization and implantation, although the actual mechanism by which IUDs function is unclear. The estimated pregnancy rate is between 0.5% and 3%.
Although once manufactured in several different shapes and materials, the incidence of uterine perforation, severe pelvic inflammatory disease, or both led to product liability lawsuits and the discontinuance of many models in the U.S. The two contemporary IUDs are T-shaped. The most commonly used device is the copper T380A, which may remain in place in the uterus for as long as 10 years; the levonorgestrol-releasing IUD may remain in place for 5 years. Common clinical criteria for insertion include primiparity (having given birth once) or multiparity (having given birth more than once); a monogamous relationship; and the absence of vaginal, cervical, or pelvic disease. The device is inserted during menstruation or on the first postpartum visit.
Because of the increased risk of sexually transmitted infections, the IUD is contraindicated for women who have multiple sexual partners.Patient Care: To help prospective users make informed decisions, patients should be taught the comparative advantages and disadvantages of IUDs. Advantages: Little maintenance is required, other than checking for the presence of the string each week during the first month after insertion and thereafter each month after menses and having an annual routine pelvic examination. Only 10% of users experience spontaneous expulsion of the device during the first year after insertion. Women using hormone-releasing IUDs may experience decreased menstrual flow, or, over time, no menses. Disadvantages: Transient cramping or bleeding for a few weeks after insertion is not uncommon; dysmenorrhea, menorrhagia, and /or metrorrhagia also may occur. An increased risk of ectopic pregnancy (10 times more common) may be related to the increased risk of pelvic inflammatory disease. Uterine perforation is rare. Health care professionals should instruct users to promptly inform their health care providers if they experience delayed menses, abnormal vaginal discharge, dyspareunia, abdominal pain, or signs of infection.
An IUD may be inserted into the uterus within five days of unprotected intercourse as a means of emergency contraception.
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