The main benefits of IUDs are (1) a high level of Adding a reservoir of a progestin to the vertical arm

effectiveness, also increases

(2) a lack of associated systemic metabolic effects,
and (3) the
need for only a single act of motivation for long-term
use.
With experience, correct high-fundal insertion occurs
more frequently, and there is a lower incidence of
partial or complete
expulsion.
the effectiveness of the T-shaped devices. With the
LNGIUS,
about 20 mcg LNG is released into the endometrial
cavity
each day. This amount is sufficient to prevent
pregnancy by
thickening the cervical mucus and preventing the
transport of
sperm into the endometrial cavity and tubes

MECHANISMS OF ACTION
All intrauterine devices induce a local inflammatory
The failure rates associated with IUDs are reaction of
comparable to those the endometrium, and the cellular and humoral
achieved with surgical sterilization. Thus, the IUD is components
especially expressed in the tissue and the fluid fill the uterine
suited for older parous women who wish to prevent cavity to create
further pregnancies. an environment that is toxic to sperm, so fertilization
The high effectiveness of IUDs make them of the
appropriate ovum does not occur. Although this sterile
choices for women of all ages. inflammatory reaction
is the only mechanism in inert devices, medicated
IUDs
The devices developed and initially used in the containing either copper or levonorgestrel produce
1960s were made of a plastic, polyethylene, additional local
impregnated with barium effects that increase their efficacy in preventing
sulfate to make them radiopaque. In the 1970s, in pregnancy.
order to
diminish the frequency of the side effects of
increased uterine The sterile inflammatory products accumulate
bleeding and pain, smaller plastic devices covered throughout the
with copper uterine lumen and penetrate the cervix and probably
were developed and widely utilized. the fallopian
tubes. This affects the function and viability of
gametes
The copper T 380A IUD is the only copper-bearing at many levels, preventing fertilization and lowering
IUD currently marketed the chances
in the United States, but the Multiload CU 375 is of survival of any embryo that may be formed, before
widely used it reaches
in Europe. the uterus. In addition, copper impedes sperm
transport and viability
in the cervical mucus.
At the scheduled

time of removal, for women desiring continued Thus,

contraceptive protection, the principal mechanism of action of the copper T
the device can be removed and another inserted 380A IUD is
during the to interfere with sperm action, preventing fertilization
same office visit. of the
ovum.
Less inflammation occurs within the uterus of LNG-
IUS users, but the potent
progestin effect thickens cervical mucus to impede
sperm
penetration and access to the upper genital track.
insertion should be treated with reassurance and
supplemental oral
iron, as well as systemic administration of one of the
prostaglandin
synthetase inhibitors during menses.

Mefenamic acid ingested in a dosage of

500 mg three times a day during the days of
On removal of the IUD, the inflammatory reaction
menstruation has
and other changes rapidly disappear. Resumption of
been shown to reduce MBL significantly in IUD
fertility following
users. If excessive
IUD removal is prompt and occurs at the same rate as
bleeding continues despite this treatment, the device
resumption of fertility following discontinuation of
should
the barrier
be removed.
methods of contraception.

Although uncommon, one of the potentially serious

TIME OF INSERTION
complications
25913 Family Planning
associated with IUD use is perforation of the uterine
Although it is widely believed that the optimal time
fundus.
for insertion
Perforation always occurs at the time of insertion.
of an IUD is during the menses, there are data
indicating that the
IUD can be safely inserted on any day of the cycle
provided the
woman is not pregnant. INFECTION IN THE NONPREGNANT IUD USER
In the 1960s, despite great concern among clinicians
that use of
Uterine Bleeding the IUD would markedly increase the incidence of
The majority of women discontinuing this method of salpingitis,
contraception or PID,
do so for medical reasons. Nearly all the medical
reasons accounting
for removal of copper IUDs involve one or more An IUD should not be inserted into a woman
types who may have been recently infected with gonococci
of abnormal bleeding: heavy or prolonged menses or or
intermenstrual Chlamydia trachomatis. Insertion of the device will
bleeding. The heavy bleeding may be produced by transport
a premature and increased rate of local release of these pathogens from the cervix into the upper genital
prostaglandins tract,
brought about by the presence of the intrauterine where the large number of organisms may overcome
foreign body, the host
as this increase is seen with both inert and copper defense and cause salpingitis.
IUDs. The
stimulation of uterine contractions by excessive
levels of prostaglandins
may prolong the duration of the menstrual flow, which are listed as contraindications to
which IUD insertion in the United States: (1) pregnancy or
is significantly longer in women wearing copper suspicion
IUDs than in of pregnancy, (2) acute PID, (3) postpartum
normally cycling women. endometritis or
infected abortion in the past 3 months, (4) known or
suspected
uterine or cervical malignancy, (5) genital bleeding
excessive bleeding in the first few months following of unknown
IUD
origin, (6) untreated acute cervicitis, and (7) a
previously
inserted IUD that has not been removed.