Intrauterine Device

Essentials

• A copper-releasing IUD is a safe Intrauterine Device for Contraception and effective method of contraception especially for a parous woman living in a faithful, stable relationship.

Advantages of an IUD

• Continuous and successful use of the method is independent of the motivation of the woman Levonorgestrel Intrauterine System Vs. other Forms of Reversible Contraceptives.
• Older women who are smokers can use an IUD.
• An IUD can be used during lactation and it does not affect milk production.
• An IUD can also be used for postcoital contraception Copper Intrauterine Device for Emergency Contraception. In this case it must be inserted within 5 days of unprotected intercourse.

Contraindications of copper IUD use

Insertion of an IUDImmediate Post-Partum Insertion of Intrauterine Devices, Risk of Uterine Perforation in IUD Insertion, Timing of Copper Intrauterine Device Insertion after Medical Abortion, , Interventions for Pain with Intrauterine Device Insertion

• It is not necessary to investigate a Pap smear or infection samples in an asymptomatic woman.
• Insert the IUD preferably during the menstrual flow (within 10 days after the beginning of bleeding). An IUD can be inserted at any phase of the menstrual cycle, as long as the woman is not pregnant. It can also be inserted immediately after abortion Timing of Copper Intrauterine Device Insertion after Medical Abortion, .
• Follow the insertion instructions of the manufacturer and use aseptic technique.
• After insertion, cut the threads to the standard length (2.5-3 cm).
• There is no need for medication Interventions for Pain with Intrauterine Device Insertion or abstinence from intercourse after insertion.
• There is no use in advising the woman to check for the presence of the threads herself.

Disadvantages of an IUD and follow-up

• An IUD may increase bleeding and duration of menses. Increased pain is also possible. Consider changing the IUD if adverse effects appear (an uncorrectly positioned IUD in the uterine cavity may cause problems). About 5 out of 100 IUDs become expelled completely or partially during the first year of use.
• Treat heavy bleeding and pain caused by the IUD with prostaglandin inhibitors Nsaids for Heavy Bleeding or Pain Associated with IUD Use. Nowadays in such situations the IUD is readily changed to a hormone-releasing IUD Hormonal Contraception.
• Although all IUDs tend to descend, total expulsion is rare. It is acceptable for an IUD to descend 2 cm from the fundal position, but an IUD positioned partly or totally in the cervical canal must be changed.
• Sometimes the threads disappear, i.e. they are retracted into the cervical canal. If there is uncertainty about the position of the IUD, ultrasonography can be used to check whether the IUD lies in the uterine cavity. Only a radiograph will, however, provide certainty about whether the IUD is in the abdominal cavity or whether it has been expelled by itself without the woman noticing.
• Bacterial vaginosis Vulvovaginitis as well as Actinomyces on Pap smear Pap (Cervical) Smear and Endometrial Biopsy are found more often in IUD users than in other women. An asymptomatic patient with Actinomyces on Pap smear does not need any intervention. If there is vaginal discharge, remove the IUD and insert a new one after an interval of 2 months.
• If pregnancy occurs with an IUD, remove the IUD as early as possible (in primary care or, if needed, at a hospital outpatient clinic).
• If the IUD has to be removed because of side effects, best time is during the menstruation. While removing the IUD some other time, give the patient postcoital hormonal contraception, if unprotected intercourse has occurred during the previous week.
• Curved uterine forceps and an IUD hook are good instruments for removing of the IUD. If removal is difficult, refer the patient to a hospital outpatient clinic.
• Routine follow-up by a nurse or a doctor is agreed upon at individual discretion, e.g. every 2 or 3 years Contraception: Initiation, Choice of Method and Follow-Up. A follow-up check is naturally always indicated if there are troublesome symptoms associated with the IUD.