Intrauterine contraceptive device Flashcards
What is the IUCD? How does it work?
Plastic shapes with copper winding and a plastic thread for a tail
Prevent fertilisation by reducing sperm motility and survival, preventing sperm penetration of cervical mucus
What is the intrauterine system? How does it work?
Mirena - carries lenogestrel
Local effect - reversible endometrial atrophy - prevents endometrial proliferation - making implantiatno less likely and periods lighter and less painful
Thus also used in menorrhagia
Describe insertion of IUCD
Screen for STD prior to insertion
Can be inserted at any time as long as not pregnant
Effective immediately
Advise taking simple analgesia prior to insertion and warm her this may cause cramps
Teach how to feel the threads and ask to check after each period
When are IUS effective?
After 7 days
What are problems with IUCDs?
- May be expelled by a uterus which is nulliparous or distorted - 1 in 20
- Associated with PID up to 21d following insertion
- May cause dysmenorrhoea and manorrhagia
- Risk of ectopic pregnancy is 1:20 if she becomes pregnant
- Risk fo uterine perforation 2 per 1000
What are contraindications to IUCD?
Pregnancy Current pelvic infection/STI Pelvic inflammatory disease Allergy to copper Wilson's disease Heavy/painful periods Trophoblastic disease Gynae malignancy Abnormal uterine bleeding
When should IUCD be removed?
At menopause remove after 2 years amenorrhoea if <50, 1 years amenorrhoea if >50
If desired, start alternative contraception prior to removal
How long does Mirena coil last?
5 years
Which can be used for emergency contractions
IUCD
What are advantages of IUCD/IUS?
Very effective
Fertility returns to normal as soon as it is removed
Can be fitted at any stage of the cycle
Can be used by women who are breastfeeding
Can be used in most women for whom the COCP is contraindicated
Mirena coil often produces lighter, less painful periods
Copper coil is suitable for women who do not want hormonal contraception
What are disadvantages of IUCD/IUS?
No protection against STIs
Risk of ascending or iatrogenic infection
Risk of uterine perforation at fitting
Risk of body expelling IUD/IUS
Copper coil may make periods heavier and more painful
Most likely by adjustment period of irregular bleeding
Insertion of coil can be painful
Risk of ectopic
Increased risk of seizures in epileptics
When can copper IUD be inserted?
Any point during menstrual cycle
After first or second trimester abortion
From 4 weeks postpartum
hat is the most common side effect of IUS within first 6 months??
In the first 6 months following insertion of the intrauterine system, irregular bleeding is a common side effect. Eventually, most women using the IUS become oligomenorrhoeic or amenorrhoeic
When can women stop contraception?
After 1 year of amenorrhoea if > 50yo
AFter 2 years of amenorrhoea if < 50yo