Intrauterine Contraceptive Devices

Question 1

How effective are intrauterine devices?

Answer 1

99%

Question 2

How does the IUD (copper coil) work?

Answer 2

It causes decreased sperm motility and survival. (possibly due to copper ions)

Question 3

How does the IUS work?

Answer 3

Levonorgestrel prevents endometrial proliferation and causes cervical mucous thickening.

Question 4

After placing in the IUD, when is it effective?

Answer 4

Immediately

Question 5

After placing in the IUS, when is it effective?

Answer 5

After 7 days.

Question 6

What are some potential problems of IUD & IUSs?

Answer 6

1. IUDs make periods heavier, longer and more painful
2. The IUS is associated with initial frequent uterine bleeding and spotting. Later women typically have intermittent light menses with less dysmenorrhoea and some women become amenorrhoeic
3. Uterine perforation
4. The proportion of pregnancies that are ectopic is increased but the absolute number of ectopic pregnancies is reduced, compared to a woman not using contraception
5. Infection
6. Expulsion

Question 7

If Actinomyces-like organisms (ALOs) are seen from a cervical smear what should you do?

Answer 7

Actinomyces-like organisms are a commensal of the female genital tract.

Current advice from the Faculty of Sexual and Reproductive Healthcare suggests IUDs need not be removed if the patient is asymptomatic.

If the patient was symptomatic then IUD removal should be considered along with penicillin therapy

Question 8

What is the advice to give around the chance of infection with an IUD?

Answer 8

There is a small increased risk of pelvic inflammatory disease in the first 20 days after insertion but after this period the risk returns to that of a standard population

Question 9

What advise should you give regarding expulsion and IUDs?

Answer 9

The risk of expulsion is around 1 in 20, and is most likely to occur in the first 3 months

Question 10

What advise should you give about the rate of uterine perforations?

Answer 10

Uterine perforation: up to 2 per 1000 insertions

Question 11

How do IUDs and IUSs affect bleeding differently?

Answer 11

IUDs make periods heavier, longer and more painful

The IUS is associated with initial frequent uterine bleeding and spotting. Later women typically have intermittent light menses with less dysmenorrhoea and some women become amenorrhoeic.