What are intrauterine contraceptive devices (IUCDs or IUDS)?
These are objects are placed inside the uterus in order to prevent
pregnancy. There is evidence that a variety of devices have been used for
more than two thousand years. In modern clinical practice, widespread use
followed the first International Conference in New York in 1962 when the Lippes
loop (IUCD) was introduced.
How popular are Intrauterine Contraceptive Devices?
A survey in 1991 found that 5% of women in the UK chose this method. Currently there are more than 100 million women using
IUCDs worldwide.
Why is copper used in Intrauterine Contraceptive Devices)?
Early IUCDs were inert, being made of plastic. With the exception of the LNG-IUS (Mirena),
intrauterine contraceptive devices are now contain copper. Copper IUCDs have replaced inert
intrauterine contraceptive devices as they can be smaller and therefore less likely to cause symptoms, notably pain and bleeding problems. Smaller copper
IUCDs can be at least as effective as larger inert intrauterine contraceptive
devices.
How effective are intrauterine contraceptive devices?
The quoted range of failure is 0.3-2.0 per hundred woman years this range is for non-hormonal devices. The LNG-IUS is the most effective female contraception currently available (Q13.6).
How do intrauterine contraceptive devices work?
The IUCDs work in a number of ways. All intrauterine contraceptive devices produce an inflammatory response in the fluid of the genital tract that largely prevents fertilisation. Copper, increases this inflammatory response and it is toxic to sperm (spermicidal) and the early embryo. The amount of copper entering the body from copper containing
IUCDs is believed to be of no significance as there is very little increase in blood levels of copper. Most of the copper is lost through the fluid in the uterus which passes into the vagina. The LNG-IUS causes the endometrium to be thin so that it is not capable of sustaining embryo implantation. It also results in the cervical mucus being impenetrable to sperm.
For some, the question of how the IUCD prevents pregnancy is critical. As inert and copper
intrauterine contraceptive devices are effective partly after fertilisation they may not be acceptable in some cultures. The Mirena (LNG-IUS
Mirena) functions almost entirely by preventing fertilisation.
Recommended Book:
Contraception Today: A Pocketbook for Primary Care Practitioners
Are intrauterine contraceptive devices appropriate for adolescents and women who
have never been pregnant?
There are only a few studies on the use of IUDs in
adolescents. IUDs are a safe and effective long-term contraceptive method. IUDs
are underutilized in the United States, especially by adolescents. Because
adolescents contribute disproportionately to the epidemic of unintended
pregnancy, IUDs should be considered as a first-line contraceptive choice
regardless of parity.
The
levonorgestrel-releasing intrauterine system (Mirena -LNG IUS) is a
particularly good choice for adolescents because of associated noncontraceptive
benefits such as decreased menstrual bleeding,
dysmenorrhea and pain associated
with endometriosis. There is a clear
need for further studies in the use of the IUD among adolescents. Can I conceive if my
intrauterine contraceptive device is removed and I use alternative contraception?
If intercourse has taken place within seven days before IUCD removal conception could occur as there may be sperm or an early embryo in the genital tract.
When should I have my intrauterine contraceptive device fitted?
Many doctors prefer to insert an IUCD during a period as the cervix is more open and there is little chance of a current pregnancy. There is, however, a greater chance of expulsion (the uterus squeezes the device back out) if a device is introduced early in the cycle. It would seem that the best time for insertion is just after the period.
The technique for introducing a T380 IUCD is provided by Durbin.
What happens after I have my intrauterine contraceptive device fitted?
There may be some bleeding and pain, which generally settle within a few days. Mild analgesics such as paracetamol may be required.
How quickly will an intrauterine contraceptive device be effective?
Contraception is immediate, but it is advisable to wait one or two weeks before having intercourse.
Can I use tampons if I have and intrauterine contraceptive device fitted?
External sanitary wear is preferable for a week after an IUCD has been introduced, but subsequently internal tampons are fine.
Can any medication interfere with the function of my intrauterine
contraceptive device?
Steroids reduce inflammatory response and could lead to failure of the
intrauterine contraceptive device. There are no problems with other medications.
How should my intrauterine contraceptive device be monitored?
To ensure that the device has not been expelled, you should check that the threads of the
IUCD are still present after each period. You should see your doctor if you experience irregular bleeding, pelvic pain or excessive discharge.
Most doctors would recommend a pelvic examination within a few weeks of insertion of your
IUCD. Most expulsions occur during the first few periods and a further check six months later seems appropriate. Subsequently an annual pelvic examination can be recommended.
What are the benefits of Intrauterine Contraceptive Devices?
This method provides:-
- Highly effective inexpensive and reversible method of contraception.
- No hormone treatment is involved (except with the LNG-IUS).
- It is always present providing continuous contraception.
- side effects are minimal.
- There is no evidence of increased risk of cancer.
What problems could I have from my intrauterine contraceptive device?
- The chances are that you will be happy with an intrauterine contraceptive
device although, as with anything in life, problems do occasionally arise.
- Your IUCD could result in pelvic pain, irregular vaginal bleeding and heavier periods.
The intrauterine contraceptive device is one form of birth control that can be associated with heavy
periods.
-
The device may be expelled by the uterus and, if you are not aware that this has happened, you could inadvertently have unprotected intercourse with the possibility of pregnancy.
- Copper IUCDs are associated with a risk of pelvic infection (Q 20.2).
- Very rarely, the device may perforate the uterus and end up inside the abdomen (one in a thousand chance).
What are the risks if a pregnancy occurs in the presence of an
intrauterine contraceptive device?
Should a pregnancy occur:
- miscarriage and infection are more likely. If the IUCD is left in place the risk of miscarriage is increased even beyond three months. Whilst there is a chance of miscarriage in association with removing the device, the balance of risks is such that if possible, the
intrauterine contraceptive device should be removed early in the pregnancy. If the pregnancy is to be terminated, the
IUCD can be removed at the same time.
- although overall pregnancy rates are low, there is a slightly higher percentage of ectopic pregnancies (pregnancy outside the uterus,
Q12.23) than would otherwise be expected.
- there is no evidence of an increased risk of foetal abnormality.
What is pelvic actinomycosis?
Pelvic actinomycosis is a chronic low grade pelvic infection due to organisms called actinomyces. Typically, there may be pelvic symptoms, and clinical examination or pelvic ultrasound shows a swelling in the pelvis. Invariably there is an
IUCD present unless it has recently been removed. The diagnosis is often made from tissue samples taken at surgery. Pelvic actinomycosis should respond to antibiotics (usually penicillin) taken over several months.
How often should intrauterine contraceptive devices be changed?
Modern copper intrauterine contraceptive devices are approved for between three and ten years.
How quickly would my fertility return after my intrauterine
contraceptive device is removed?
Fertility returns immediately to pre-existing levels as soon as your
intrauterine contraceptive device is removed. There is no medical advantage in waiting before trying for a pregnancy.
Despite small sample size of studies investigating impact of intrauterine contraceptive devices on subsequent fertility, the results are consistent and reassuring on high pregnancy rates, and a normal distribution of pregnancy outcomes. There are limited data on return of fertility after usage of medicated intrauterine contraceptive devices- more studies are warranted among women who have used hormone-releasing intrauterine contraceptive devices.0801
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