CONTRACEPTION

INTRAUTERINE CONTRACEPTIVE DEVICES (IUCD)

An Intrauterine Contraceptive Devices is a device inserted into the uterine cavity and left for varying periods of time for the purpose of contraception. They are usually made up of polypropylene impregnated with barium sulphate, for visualizing them on x-rays. They are many devices of different design. The commonly used devices are "T" shaped with a horizontal and a vertical arm. The vertical arm has a copper wire wrapped around it and two colored threads at the lower end .These nylon threads (tail) which protrudes through the cervix into the vagina, allows you to check your IUCD whether in place or not .There are hormone-releasing IUCDs available in the market which are suitable for women with special needs.

The frequently used IUD’s are

• Copper T 200 (Cu T-200)
  Available free through government and municipal hospital based programs The effective life span is a minimum of 3 years. However recent studies show it can be used up to 5 years.
• Copper T (Gravigard)
  The effective life span is 3 years. (Approved by USFDA)
• Multi load copper – 250 (ML Cu – 250 ):
  3 years device.
• Multi load Copper – 375 (ML Cu- 375):
  5 years device.

Now days, one of the most frequently used IUD’s in India. They have relatively less side effects and failure rate. It is available in sterilized pack and can be inserted without prior handling, which is of great advantage.

ML Cu –250 has a recommended life span of 3 years.
ML Cu 375 has life span of 5 years.

• Cu -T 380A
• Cu -T 380 Ag
• Cu -T 380S (slim line)

Cu-T 380 A has a life span of 6 years.
Cu-T 380 Ag has a life span of 4 years.
Cu-T 380S has a life span of 2 ½ years.

How does it work?
The presence of the IUD in the endometrial cavity stimulates an in flammatory reaction causing release of large microscopic cells called "macrophages", which are capable of destroying sperm before they can get in to the tube to fertilize the egg. Copper IUD’s are also commonly used as an emergency contraceptive method.
It also prevents the fertilized egg from getting hold on to the inner uterine surface i.e. implantation.( Link to implantation in sexual activity.)   

Failure rate
The IUD is 98% to over 99% reliable in preventing pregnancy. The newer one, like multiloads ML-Cu-250, ML-Cu-375, Cu 7 – 380 A, are highly effective i.e. >99%

What are the advantages?

• The IUD doesn’t require regular supply nor there is any problem of disposal affecting privacy.
• It does not interfere with sex.
• It doesn’t have any systemic side effects.
• It works as soon as it is inserted. The return of fertility following removal is immediate.
• Life risk is minimum and doesn’t increase with age as in oral contraceptives. Link to Disadvantages of O. C. Pills.
• You only have to check the strings of the Cu T once a month. (Post menstrually to know if it’s still in place).

What are the disadvantages and common side effects?

• Some women report that their periods become heavier, longer or more painful. They usually settle down after a couple of months.
• If you are not in a monogamous relationship (i.e. If you or your partner has other sexual partners) you are at risk of developing Pelvic Inflammatory Disease (P.I.D).
• It does not protect you from sexually transmitted diseases. (STD’s)
• It is possible that your womb could push out the IUCD. This is more likely in the first 2- 3 months so it is important to remember to check the IUD, is still in place.
• The pain following insertion of IUD is due to uterine cramps, which usually subsides within a week and is mostly relived by analgesics. If the pain is persistent, you may need to consult the health care professional.
• Some women do get rise in vaginal discharge following insertion, which usually subsides after 1 month. It is associated with pain and fever, consult your health care professional

Hormone releasing IUD’s

Progesterone IUD (progestasert )
The vertical shaft of IUD is fitted with a capsule containing hormone progesterone, which is released in sustained fashion, giving the desired contraceptive effect. Life span is one year.

Levonorgestrol IUD 20 (LNG20, Lernova) (Mirena)
The hormone, Levonorgestrel is released gradually from the capsule. Life span is 5 – 7 years

Advantages

• Hormonal IUD’s are more effective than other IUD’s in relieving cramps.
• Pregnancy and expulsion rates are lower than other IUD’s .
• Amount of bleeding reduces significantly so more suitable for women with heavy periods.

Disadvantages

• Insertion is relatively painful for the patient, as the device is a little bulky.
• Relative increase in number of extrauterine pregnancies is reported for.
• Some women have reported complaints of breast tenderness, ache which, usually settles down within 3 months.
• Irregular bleeding and absence of menses are common with users.
• Infection due to the adhesions inside the uterus that blocks the tubal openings.

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