Intrauterine contraceptive devices Flashcards

1
Q

Intrauterine contraceptive devices

Effectiveness

A

Intrauterine contraceptive devices comprise both conventional copper intrauterine devices (IUDs) and levonorgestrel-releasing intrauterine systems (IUS, Mirena). The IUS is also used in the management of menorrhagia

Mode of action:

  • IUD: primary mode of action is prevention of fertilisation by causing decreased sperm motility and survival (possibly an effect of copper ions)
  • IUS: levonorgestrel prevents endometrial proliferation and causes cervical mucous thickening
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2
Q

Intrauterine contraceptive devices

IUD is effective immediately following insertion
IUS can be relied upon after 7 days

Potential problems

A

Potential problems:

  • 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
  • uterine perforation: up to 2 per 1000 insertions
  • 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
  • infection: 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
  • expulsion: risk is around 1 in 20, and is most likely to occur in the first 3 months
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