Intra-Uterine Device/System

Question 1

What is the mechanism of action of an IUS?

Answer 1

Prevents endometrial proliferation

Question 2

What is the mechanism of action of an IUD?

Answer 2

Decreases sperm motility and survival

Question 3

What is an IUD/IUS?

Answer 3

Devices put into the uterine cavity (copper or progestogen). Thin plastic tubes protrude from cervix which are pulled to remove device.

Question 4

What is the main advantage and disadvantage of the copper IUD?

Answer 4

1. Effective immediately

2. Can cause dysmenorrhoea/menorrhagia

Question 5

How long do copper IUDs last?

Answer 5

5-10 years depending on brand

Question 6

What are the main advantages and disadvantages or the hormonal IUS (Mirena)?

Answer 6

1. Lighter, less painful periods; low systemic side effects; rapid return of fertility after removal; can be used in breastfeeding, obesity, CVD, and hepatic enzyme-inducing drugs.
2. Irregular light bleeding is the main problem

Question 7

What is the process involved in insertion of an IUD/IUS?

Answer 7

1. Screen for STIs
2. Ensure not pregnant, abstain for 3 weeks prior/use reliable contraception (not condoms)
3. IUD can be inserted any time
4. Simple analgesia, eat and drink beforehand
5. Take rest of the day off
6. Follow up after 1st period

Question 8

What is the management for lost threads in an IUD/IUS?

Answer 8

1. Use extra-contraception, exclude pregnancy
2. USS, if not there then pelvic X-ray
3. If present and not due to be changed, leave in situ
4. If extra-uterine - surgical retrieval

Question 9

What are the complications of IUD/IUS?

Answer 9

1. Cervical shock on insertion - tip head, raise legs, IV atropine
2. Expelled device
3. PID infection
4. Perforation
5. Pregnancy more likely to be ectopic if it occurs

Question 10

What are the advantages of IUD/IUS?

Answer 10

1. Extremely safe
2. No need to remember anything
3. IUS causes lighter and less painful periods
4. IUD can be used as emergency contraception

Question 11

What are the absolute contraindications to IUD/IUS?

Answer 11

1. Endometrial/cervical cancer
2. Undiagnosed vaginal bleeding
3. Active/recent pelvic infection (wait 3 months)
4. Current breast cancer (IUS only)
5. Pregnancy

Question 12

What are the relative contraindications to IUD/IUS?

Answer 12

1. Previous ectopic

2. Menorrhagia (IUD only)