[27] Contraception - IUD/IUS

Question 1

What are the IUD and IUS?

Answer 1

Long-acting reversible contraceptive devices that are fitted inside the uterus

Question 2

What does the intrauterine device refer to?

Answer 2

The copper coil

Question 3

What is the primary mechanism of the copper coil?

Answer 3

It releases copper, which makes the uterus an unfavourable environment for sperm

Question 4

What is the secondary mechanism of the copper coil?

Answer 4

It is thought to create an endometrial inflammatory reaction, inhibiting implantation if fertilisation has already occurred

Question 5

What does the intrauterine system refer to?

Answer 5

Levonorgesterel-releasing coils

from now on I’m just going to call it hormonal coil which i don’t think is technically right but you know what i mean and i can’t spell that word

Question 6

Give an example of a levonorgestrel-releasing coil

Answer 6

Mirena coil

Question 7

How does the hormonal coil work?

Answer 7

• Thins endometrium, preventing plantation

- Thickens cervical mucus, inhibiting sperm movement through cervix

Question 8

How effective are the IUD and IUS?

Answer 8

99%

Question 9

When in the menstrual cycle can the IUD and IUS be fitted?

Answer 9

Any point

Question 10

How long after insertion does the copper coil provide contraception?

Answer 10

Immediately after insertion

Question 11

How long after insertion does the hormonal coil provide contraception?

Answer 11

Immediately if fitted within first 7 days of menstrual cycle, otherwise after 1 week

Question 12

How long does the procedure to fit a IUD/IUS take?

Answer 12

20 mins

Question 13

What is done before the procedure to fit a IUD/IUS?

Answer 13

Bimanual examination and speculum examination

Question 14

Why is a bimanual examination performed before the procedure to fit a IUD/IUS?

Answer 14

To assess normal uterine anatomy

Question 15

Why is a speculum examination performed before the procedure to fit a IUD/IUS?

Answer 15

To visualise the cervix

Question 16

Describe the procedure to fit a IUD/IUS?

Answer 16

A cervical dilator/sizer is assed through the cervix, and a small plastic T-shaped device is pushed through the cervix into the uterus, where it remains. The strings attached to the IUD/IUS are then cut, so they remain in the vagina

Question 17

What should a woman be advised to do regarding the strings of a IUD/IUS?

Answer 17

Periodically check to ensure the device has not been expelled

Question 18

What should be done 2 weeks before the IUD/IUS is fitted?

Answer 18

A STI screen

Question 19

Why should a STI screen be performed 2 weeks before the IUD/IUS is fitted?

Answer 19

As recent exposure to STI is an absolute contraindication

Question 20

Who is the IUS/IUD particularly suited to?

Answer 20

Women who often miss pills, or who want long-lasting birth control

Question 21

Other than contraception, what are the additional indications for the IUD?

Answer 21

Emergency contraception

Question 22

When is the IUD effective as emergency contraception?

Answer 22

If fitted within 5 days of unprotected sex

Question 23

Other than contraception, what are the additional indications for the IUS?

Answer 23

• First line treatment for heavy menstrual bleeding

- Second line treatment for dysmenorrhoea

Question 24

What are the contraindications to the IUD/IUS?

Answer 24

• Infection
• Current pregnancy/up to 4-weeks postpartum
• Uterine structural abnormalities
• Current gynaecological malignancy
• Current unexplained vaginal bleeding

Question 25

What is an additional contraindication specific to the IUD?

Answer 25

Allergy to copper

Question 26

What infections are contraindications to the IUD/IUS?

Answer 26

• History of pelvic inflammatory disease
• Recent exposure to STI
• Recent infection of uterus

Question 27

Give 2 examples of infections of the uterus

Answer 27

• Septic abortion

- Post-partum endometritis

Question 28

Give an example of a uterine structural abnormality?

Answer 28

Bicornuate uterus

Question 29

What are the additional contraindications for the IUS?

Answer 29

• Current DVT or PE
• Current liver disease
• History of breast cancer

Question 30

What are the advantages of the IUD/IUS?

Answer 30

• Very effective
• Fertility usually returns as soon as removed
• Can be fitted at any stage of cycle
• Can be used in (most) women in whom the COCP is contraindicated

Question 31

What are the advantages specifically of the Mirena coil?

Answer 31

Often produces lighter, less painful periods

Question 32

What are the advantages specifically of the copper coil?

Answer 32

Suitable for women who do not want hormonal contraception

Question 33

What are the disadvantages of the IUD/IUS?

Answer 33

• No protection against STIs
• Risk of ascending and iatrogenic infection
• Risk of uterine perforation at time of fitting
• Risk of body expelling IUD/IUS
• Most likely will be ‘adjustment period’ after insertion of coil
• Insertion may be painful
• Although risk of pregnancy is lower, higher risk that any pregnancy will be ectopic
• Increased risk of seizures in epileptic at time of dilatation

Question 34

What does the ‘adjustment period’ to the coil consist of?

Answer 34

Irregular bleeding for up to 6 months

Question 35

What are the disadvantages of the copper coil specifically?

Answer 35

May make periods heavier and more painful