Intrauterine Devices

Question 1

Intrauterine Devices:

Mirens vs Kyleena?

Answer 1

Mirena (LNG 52mg)

• indicated for contraception, HMB, MHT
• 10years of use if for contraception
• 5 years if endometrial protection

Kyleena (LNG 19.5mg)

• indicated for contraception only
• slightly higher failure rates at 5 years
• last 5 years only
• slightly more lighter bleeding than mirena’
• slightly smaller device
• same hormonal side effects as mirena
• possibly less painful insertions

Question 2

Intrauterine Devices:

UKMEC 3-4 for IUDs?

Answer 2

Do not

• insert 48 - 4weeks post partum (increased peforation risk)
• unexplained vaginal bleeding
• active breast cancer (LNG ONLY can use CuIUD)
• decompensated liver cirrhosis, HCC (LNG ONLY can use CuIUD)
• initiate with PID or STI active
• initiate with cervical cancer, endometrial cancer
• significant uterine distortion
• persistent beta hcg
• long QT syndrome
• initiate with IHD/CVA history (LNG ONLY can use CuIUD)
• initiate post transplan/graft
• post septic abortion

Question 3

Intrauterine Devices:

CuIUD important points?

Answer 3

No difference in discontinuation rates than mirena

Can have up to a 50% increase in menstrual losses

Insertion ≥40yo regardless of 5 or 10 year device can remain for 10 years

Question 4

Intrauterine Devices:

How long is the risk of PID increased post IUD insertion?

Answer 4

20 days

Question 5

Intrauterine Devices:

Insertion considerations?

Answer 5

Os size on visual inspection does not relate to insertion difficulty

If any nerves about speculum examination then consider trial of speculum

Analgesia:

• heat pack
• NSAIDs
• topical anaesthesia prior to tenaculum
• paracervical local anaesthetic
• methoxyfluorane