Intrauterine Contraception

Copper T 380A (Paragard®)

Levonorgestrel-Releasing Intrauterine System

(Mirena®)
 Intrauterine Contraception
• Mirena™(levonorgestrel-
• Paragard™ (TCu380A) releasing IUS)

– Copper IUD – Local Progestin

– Use up to 10 years – Use up to 5 years

– Heavier periods – Lighter periods

• Irregular for 3-6
months
– No hormonal – Some systemic effects
side effects
 Copper-releasing IUDs:
Mechanism

• Mass effect, like plastic IUDs

• Copper alters uterine and tubal fluid
– Hinders spermatozoa function / motility

• Inhibits fertilization
– Not an abortifacient

Hatcher, 1998
 Progestin-releasing IUDs:
Mechanism
• Impairs spermatozoa motility / function
• Inhibits conception
– Unable to recover fertilized ova
– Not an abortifacient
• Thickens cervical mucus
• Atrophy of endometrium
• Impairs tubal motility
• 85% of women are ovulatory
Lahteenmaki, 2000
 Levonorgestrel-releasing IUS

• Releases 20 mcg per

day of Levonorgestrel
• Hormonal side effects
are rare
• Endometrial
concentrations 200-
800x higher than in
blood

Lähteenmäki et al. Steroids 2000

 advantage
1. High effectively
2. Effective after planting
3. Long- term ptotection
4. no disturbance on sexual contact
 disadvantage
1. Menstrual irregularities
2. Long menstruation and a lot of
3. Spotting
4. Disminorhea
 indication
1. Women at productive age
2. Wanted to use a long term contraception
3. Are postpartum, post-abortion, or
breastfeeding
4. Young and nulliparous women should be
counseled on expulsion risk
 contra indication
1.pregnancy
2. Unidentified vaginal bleeding
3. Reproduction tract infection
4. Abnormal uteri
5. Cancer
 Common side effects
During insertion:
- Some pain and cramping
First few days:
- Light bleeding and mild cramping
First few month:
- Heavier or prolonged menstrual bleeding
- Intermenstrual bleeding and/or cramping
 Progestin IUDs
– side effects

• Hormonal side effects are rare & not more

common than in general population
• Nonetheless, they are reasons given for
discontinuation
• No weight gain
 Signs of possible complications
- Severe bleeding or abdominal cramping 3-5
days post insertion---- perforation infection
- Irregular bleeding and/or open every cycle-----
---dislocation or perforation
- Fever, chills, unusual vaginal discharge-----
infection
 Signs of possible complications
continued
- Pain during intercourse-----infection,
perforation, partial expulsion.
- Missed period, other sign of pregnancy,
expelled IUD-----pregnancy (uterine or
ectopic)
- Shorter , longer or missing strings----- partial
or complete expulsion, perforation.
 Timing of IUD Insertion
Interval insertion:
- Any time during menstrual cycle if women is not
pregnant and has signs of infection
Post partum insertion:
- Immediately after vaginal or cesarean delivery if
no infection or hemorrhage (within 48 hours, or
delay 6 weeks postpartum)
Post abortion insertion (first trimester)
- immediately, if no infection
 Infection Prevention Procedure
- Wash hands
- Wear sterile gloves
- Carefully disinfect vagina and cervix
- Use sterile IUD and sterile or high-level
disinfected aquipment
- Decontaminate instrument
- Safely dispose of contaminated waste
 IUD insertion Steps
- Inspect vaginal and cervix
- Perform bimanual exam
- Disinfect vagina and opening to cervix
- Sound uterus
- Insert IUD