[27] Contraception - IUD/IUS Flashcards
What are the IUD and IUS?
Long-acting reversible contraceptive devices that are fitted inside the uterus
What does the intrauterine device refer to?
The copper coil
What is the primary mechanism of the copper coil?
It releases copper, which makes the uterus an unfavourable environment for sperm
What is the secondary mechanism of the copper coil?
It is thought to create an endometrial inflammatory reaction, inhibiting implantation if fertilisation has already occurred
What does the intrauterine system refer to?
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
Give an example of a levonorgestrel-releasing coil
Mirena coil
How does the hormonal coil work?
- Thins endometrium, preventing plantation
- Thickens cervical mucus, inhibiting sperm movement through cervix
How effective are the IUD and IUS?
99%
When in the menstrual cycle can the IUD and IUS be fitted?
Any point
How long after insertion does the copper coil provide contraception?
Immediately after insertion
How long after insertion does the hormonal coil provide contraception?
Immediately if fitted within first 7 days of menstrual cycle, otherwise after 1 week
How long does the procedure to fit a IUD/IUS take?
20 mins
What is done before the procedure to fit a IUD/IUS?
Bimanual examination and speculum examination
Why is a bimanual examination performed before the procedure to fit a IUD/IUS?
To assess normal uterine anatomy
Why is a speculum examination performed before the procedure to fit a IUD/IUS?
To visualise the cervix
Describe the procedure to fit a IUD/IUS?
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
What should a woman be advised to do regarding the strings of a IUD/IUS?
Periodically check to ensure the device has not been expelled
What should be done 2 weeks before the IUD/IUS is fitted?
A STI screen
Why should a STI screen be performed 2 weeks before the IUD/IUS is fitted?
As recent exposure to STI is an absolute contraindication
Who is the IUS/IUD particularly suited to?
Women who often miss pills, or who want long-lasting birth control
Other than contraception, what are the additional indications for the IUD?
Emergency contraception
When is the IUD effective as emergency contraception?
If fitted within 5 days of unprotected sex
Other than contraception, what are the additional indications for the IUS?
- First line treatment for heavy menstrual bleeding
- Second line treatment for dysmenorrhoea
What are the contraindications to the IUD/IUS?
- Infection
- Current pregnancy/up to 4-weeks postpartum
- Uterine structural abnormalities
- Current gynaecological malignancy
- Current unexplained vaginal bleeding
What is an additional contraindication specific to the IUD?
Allergy to copper
What infections are contraindications to the IUD/IUS?
- History of pelvic inflammatory disease
- Recent exposure to STI
- Recent infection of uterus
Give 2 examples of infections of the uterus
- Septic abortion
- Post-partum endometritis
Give an example of a uterine structural abnormality?
Bicornuate uterus
What are the additional contraindications for the IUS?
- Current DVT or PE
- Current liver disease
- History of breast cancer
What are the advantages of the IUD/IUS?
- 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
What are the advantages specifically of the Mirena coil?
Often produces lighter, less painful periods
What are the advantages specifically of the copper coil?
Suitable for women who do not want hormonal contraception
What are the disadvantages of the IUD/IUS?
- 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
What does the ‘adjustment period’ to the coil consist of?
Irregular bleeding for up to 6 months
What are the disadvantages of the copper coil specifically?
May make periods heavier and more painful
