What are intrauterine contraceptive devices?
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 IUCDs - 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 IUCDs (Intrauterine Contraceptive Devices)?
Early IUCDs were inert, being made of plastic. With the exception of the LNG-IUS (Mirena), IUCDs are now contain copper. Copper IUCDs have replaced inert IUCDs 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 IUCDs.
How effective are IUCDs (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 IUCDs work?
The IUCDs work in a number of ways. All IUCDs 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 IUCDs 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 Can I conceive if my IUCD 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 IUCD 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 IUCD 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 IUCD 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 IUCD 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 IUCD?
Steroids reduce inflammatory response and could lead to failure of the IUCD. There are no problems with other medications.
How should my IUCD 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 IUCDs (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 IUCD?
- The chances are that you will be happy with an IUCD although, as with anything in life, problems do occasionally arise.
- Your IUCD could result in pelvic pain, irregular vaginal bleeding and heavier periods.
The IUCD 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 IUCD?
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 IUCD 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 IUCDs be changed?
Modern copper IUCDs are approved for between three and ten years.
How quickly would my fertility return after my IUCD is removed?
Fertility returns immediately to pre-existing levels as soon as your IUCD 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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