Contraception Flashcards
IUDs available in UK
Copper intrauterine devices (Cu-IUDs) - highly effective method of contraception or emergency contraception
Levonorgestrel intrauterine devices (LNG-IUDs) -
Mechanism of action of Cu IUD
- Copper effect on:
. On ovum and sperm: inhibition of fertilization - on cervical mucus: inhibits the passage of sperm into the upper reproductive tract
- endometrium: causes an inflammatory response within the endometrium, which could impair implantation.
What is LNG-IUD action
Progestogenic effects on:
- cervical mucus prevent the passage of sperm into the upper reproductive tract
- the endometrium may inhibit implantation
- In some individuals the LNG-IUD will also inhibit ovulation.
Are IUS effective immediately
Cu-IUD - effective immediately following insertion
LNG-IUD - effective 7 days after insertion
Gynecological benefits of IUD
52 mg LNG-IUD helps in management of:
- HMB
- dysmenorrhoea
- endometrial protection as part of HRT
Duration of use of Cu Iud
5-10 years
(Can be extended if inserted over age of 40y)
Duration of use of LNG-IUD
5 years
(If inserted before 45y: extended to 6 y)
(If inserted after 45y: extended to age 55)
Duration of use of LNG-IUD
5 years
(If inserted before 45y: extended to 6 y)
(If inserted after 45y: extended to age 55)
Mirena can be used for how long as a ENDOMETRIAL protection as HRT
5 years (FSRH recommends 6y)
CU IUD failure rate
Typical use: 0.8%
perfect used: 0.6%
LNG IUD failure rate
0.2% (perfect and typical use)
IUC cannot be used by young people, individuals who have never been pregnant and individuals who have never been sexually active. True or False ?
False
When can IUC be inserted post-partum ?
UKMEC 1 - Immediately post-partum within 48 hrs or after 4 wks/28 days - interval insertion
UKMEC 3 - Between 48 hrs - 4 wks
UKMEC in postpartum sepsis ?
4
Should any investigations be done prior to insertion of IUC ?
-STI screening (Current PID, known gonorrhoea infection, symptomatic chlamydial infection, purulent cervicitis are all contraindications to IUC insertion)
Can IUC be inserted in a female with uterine cavity malformations ?
Decision made on individualized basis
According to:
- the degree of distortion
- uterine cavity size
- the accuracy of imaging available
- the indication for use and other suitable alternatives
- the type of device being inserted
- the potential consequence of complications for that particular individual.
How to insert IUD in case of fibroids, distortion or malformations
should be in a specialist setting with access to ultrasound or hysteroscopy
What is Ehlar Danlos Syndrome
connective tissue disorder associated with an increased risk of uterine rupture in pregnancy and/or joint hyperlaxity, both of which may be relevant to IUC procedures
Any CI of IUD with cardiac disease
No
But should require MDT, insertion in hospital settings
Cu-IUD use is not recommended for individuals with which metabolic disorder?
Wilson’s disease
Health risks with IUC use ?
May be an association between hormonal IUDs and breast cancer - however, any potential increased risk appears to be small.
Presence of (or history of) ovarian cysts or PCOS is a contraindication to IUC use?
No
S/E of LNG-IUD
Acne , mood swings, headache, breast tenderness
Emergency contraception
- LNG-IUD
- Ulipristal Acetate
3.Cu IUD
