Intrauterine system and device Flashcards
MoA of intrauterine copper device (IUD)
- release of copper → uterus becomes unfavourable environment to sperm
- creates endometrial inflammatory reaction → implantation is inhibited (if fertilisation has already occurred)
MoA of intrauterine system (IUS)
Levonorgestrel realising coil
- endometrium becomes thinner → implantation is prevented
- cervical mucus becomes thicker → sperm movement through the cervix is prevented
Example of IUS (1)
Mirena® coil
When do IUS and IUD can be fitted in terms of time of menstrual cycle?
Anytime, but…
- IUD (copper) → provides contraception straight away/at any time during menstrual cycle
- IUS → only effective straight away, if fitted within 7 days of a start of menstrual cycle (if not, need to use condoms for 7 days)
How long, after insertion, does it take for IUD and IUS to offer its contraceptive effects?
- IUD (copper) → provides contraception straight away/at any time during menstrual cycle
- IUS → only effective straight away, if fitted within 7 days of a start of menstrual cycle (if not, need to use condoms for 7 days)
Describe a procedure of a coil insertion
- procedure takes 20 minutes
- STIs screen performed 2 weeks before an insertion → recent STI exposure is absolute contraindication for a coil
- Bimanual exam performed → to assess anatomy
- Speculum is inserted to visualise the cervix
- Cervical dilator/sizer is passed through the cervix
- A small, plastic T-shaped device is then pushed through the cervix into the uterus
- The strings attached to (IUS/IUD) are cut → so they remain in the vagina *
*so women can check from time to time if the device is in the right place
What do we need to ensure before a coil insertion?
STIs screen performed 2 weeks before an insertion → recent STI exposure is absolute contraindication for a coil
Additional indications for IUS (Mirena coil)
Apart from contraception:
- used as 1st line for heavy menstrual bleeding
- used as 2nd line treatment for dysmenorrhoea (but not licensed for that use)
Extra contraceptive use of IUD (copper coil)
Used as regular contraception and:
- useful as emergency contraception → if fitted in within 5 days of an unprotected sex
Absolute contraindications for fitting of IUS or IUD (8)
- Hx of pelvic inflammatory disease
- recent STIs exposure
- recent infection of the uterus
- current pregnancy or up to 4- weeks postpartum
- uterine structural abnormalities
- current gyn malignancy
- current unexplained vaginal bleed
- allergy to copper (IUD only)
Contraindication for IUS insertion only
(not the ones common with IUD)
Similar to other progesterone contraceptives
- current DVT or PE
- current liver disease
- Hx of breast ca
Advantages of the coils
- very effective form of contraception
- fertility returns to normal immediately after removal
- can be fitted at any stage of the cycle
- can be used while breastfeeding
- can be used in most women in whom COCP are contraindicated
- Mirena coil produces lighter and less painful periods
- copper coil is suitable for women who do not want to use hormonal contraception
Disadvantages of the coils
- No protection against STIs
- Risk of ascending or iatrogenic infection
- Risk of uterine perforation at the time of fitting
- Risk of the body expelling the IUD/IUS
- The copper coil may make periods heavier and more painful
- There will most likely be an “adjustment period” after insertion of the coil which may consist of irregular bleeding for up to 6 months
- Insertion of the coil can be painful
- Although the risk of pregnancy is lower, there is a higher risk that any pregnancy will be ectopic
- Increased risk of seizures in epileptics at the time of cervical dilation
