Intrauterine contraceptive device

Question 1

What is the IUCD? How does it work?

Answer 1

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

Question 2

What is the intrauterine system? How does it work?

Answer 2

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

Question 3

Describe insertion of IUCD

Answer 3

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

Question 4

When are IUS effective?

Answer 4

After 7 days

Question 5

What are problems with IUCDs?

Answer 5

1. May be expelled by a uterus which is nulliparous or distorted - 1 in 20
2. Associated with PID up to 21d following insertion
3. May cause dysmenorrhoea and manorrhagia
4. Risk of ectopic pregnancy is 1:20 if she becomes pregnant
5. Risk fo uterine perforation 2 per 1000

Question 6

What are contraindications to IUCD?

Answer 6

Pregnancy
Current pelvic infection/STI
Pelvic inflammatory disease
Allergy to copper
Wilson's disease
Heavy/painful periods
Trophoblastic disease
Gynae malignancy
Abnormal uterine bleeding

Question 7

When should IUCD be removed?

Answer 7

At menopause remove after 2 years amenorrhoea if <50, 1 years amenorrhoea if >50

If desired, start alternative contraception prior to removal

Question 8

How long does Mirena coil last?

Answer 8

5 years

Question 9

Which can be used for emergency contractions

Answer 9

IUCD

Question 10

What are advantages of IUCD/IUS?

Answer 10

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

Question 11

What are disadvantages of IUCD/IUS?

Answer 11

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

Question 12

When can copper IUD be inserted?

Answer 12

Any point during menstrual cycle
After first or second trimester abortion
From 4 weeks postpartum

Question 13

hat is the most common side effect of IUS within first 6 months??

Answer 13

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

Question 14

When can women stop contraception?

Answer 14

After 1 year of amenorrhoea if > 50yo

AFter 2 years of amenorrhoea if < 50yo