INTRAUTERINE

CONTRACEPTIVE
DEVICE (IUD)
 TYPES

 Inert intrauterine device

 Copper releasing IUD

 Hormone releasing IUD

 MECHANISM OF ACTION
1) Presence of foreign body

 Migration of spermatozoa difficult

 Cellular and biochemical reaction in
endometrial fluid ⃰
 Sterile inflammatory response- leucocyte
mobilization ⃰

⃰ Spermicidal and prevent implantation

 MECHANISM OF ACTION…
2) IUD

 Provokes uterine contractions

 Increases tubal peristalsis

Fertilized egg is propelled down before

endometrium is ready for implantation
 MECHANISM OF ACTION…
3) Copper containing device cause
increased
 Copper ions
in endometrial
 Enzymes
and tubal fluid
 Prostaglandins

 Macrophages

Impair sperm function and fertilization

 MECHANISM OF ACTION…
4) Progesterone containing device

 Thickens cervical mucus

 Decidualization of endometrium
 INERT IUD

 Lippes loop
Most tried & was widely used
Available in four sizes
Push out type

 Saf-T-coil
Available in 3 size
Withdrawal type
 INERT IUD

 Chinese single coil ring

 Mahua ring
No tails
High failure rate
 Ota ring
 Copper containing IUD…

Cu T 200 (Gynae T)
1st medicated IUD
Life span – 4 years
 Polypropylene impregnated with barium
sulphate and 120 mg of 0.25 mm copper
wire wound around vertical limb
 Exposed copper wire area 200 sq mm
 Copper containing IUD…

 Copper T 220C

 Cooper 7 (Gravigard)

Life span 3 years

 Copper containing IUD…
Nova Cu T 200

Modified Cu T 200 with silver core

Life span 5 years
 Copper containing IUD…
 Multi-load Copper 250 & ML Cu 375
Available in sterilized packs
Life span : 3 & 5 years

 Copper T 380A, Cu T 380Ag, Cu T 380S

Life span : 6, 4, 21/2 Years
 Copper containing IUD…
COPPER T 380 A
 T shaped
 314 sq mm Cu wire on vertical stem
PLUS
 33 sq mm Cu on transverse stems each
 Effective up to 10 years
 Hormone releasing IUD
 Mirena

52 mg levonorgestrel
20mcg hormone/day
Life span 5 years
 Hormone releasing IUD
 Progesterone IUD

38 mg of progesterone
Deliver 65 mcg progesterone/day
Reduces blood loss
Life span 1 year
 Hormone releasing IUD
ADVANTAGES
 Reduces blood loss
Used in anemics and DUB
 Reduces pain and dysmenorrhoea
Used in endometriosis and adenomyosis
 Beneficial effects in fibroids
 CONTRAINDICATIONS

 Acute pelvic infections

 Uterine fibroids
 Anomalies of uterus
 Classical caesarean section
 Genital malignancy
 Menorrhagia and metrorhagia
 CONTRAINDICATIONS

 Dysmenorrhoea
 Cervical stenosis
 Severe anaemia
 Wilson’s disease
 Immunosuppressive therapy
 Relative Contraindications

 Previous ectopic pregnancy

 Heart disease
 Lower genital tract infection
 Nulliparity
 Timing of Insertion

 Postmenstrually
 Post-coital
 Post-abortal
 Post-partum
 Lactation
Procedure
 Procedure
 Withdrawal technique

 Uterocervical length measured

 Plunger adjusted

 Inserter with device inserted through

cervix
 Indications for removal
 Expiry
 Pelvic pain or cramps
 Abnormal or excessive bleeding
 Acute pelvic inflammation
 Displacement of IUD
 Pregnancy
 Menopause
 Advantages
 Easy motivation
 No interference with sexual act
 Cost effective
 No systemic effects
 Immediate return of fertility
 Effective
 Disadvantages

 Trained personnel for insertion and

removal

 Insertion painful

 Complications
 Complications

 At the time of insertion

 Immediate complications

 Delayed
 Complications
 Pain
 Perforation
 Expulsion
 Increased bleeding
 Vaginal discharge
 Infection
 Ectopic pregnancy
 Follow-up

 After next menstruation

 3 months

 Annually
 IUD with pregnancy
 Increased risk of abortion / septic abortion,
preterm delivery

 No increase in teratogenicity

 Remove device

 Termination of pregnancy if patient opts

for
 IUD with pregnancy

If patient wants to continue

 Remove the Cu T if easy

 Can be left behind if removal is difficult

 Missing threads

 Expulsion
 Thread may have drawn back
 Perforation
 Tail may have separated
 Pregnancy and thread moving up with
enlarging gravid uterus
 Missing thread…

 Transvaginal ultrasound

 Plain X-ray abdomen AP & lateral view

 Missing thread…
Device within uterus

 Can be removed with Shirodkar’s forceps

or artery forceps
OR
 Hysteroscopic guided removal
 Missing thread…
Within peritoneal cavity

 Retrieval laparoscopically or by
laparotomy

 As copper can lead to adhesion formation

and intestinal obstruction
 Non contraceptive benifits
 Following excision of uterine septum and
Asherman syndrome

 Hormonal IUD
 DUB

 Adenomyosis

 HRT