IUC Guideline Flashcards
How many mcg/day initial release rate for each coil?
52mg is 20mcg day
19.5mg is 17.5mcg day
13.5mg is 14mcg day
Which one coil is licensed for 8 years contraception?
Mirena-not the other 52mg
When do nice recommend lng iud for hmb?
No underlying pathology
Adenomyosis
Fibroids if not distorting cavity and <3cm
What is main mode of action of Cu IUD?
Pre implantation toxic effect ovum and sperm
(Also cervical mucus and endometrium effects)
What is main mode action lng iud?
Cervical mucus
(Also endometrium and ovulation in some)
What effect do LNG iud have on HPO axis?
Little effect.
Serum estradiol normal.
Most still ovulate (>75% with 52mg-almost all with lower doses)
What is ukmec for any iud <20 yo
2- increased rate expulsion/painful insertion
What should you consider in Tran-men with insertion IUD
Effect on bleeding/cramps
Testosterone
1.teratogenic so LARC good
2. atrophy-consider vaginal e2 2/52 prior to insertion
What are contraindications to insertion iud at delivery?
PROM
PPH
sepsis
Who has highest risk perf?
BF
<36 weeks postnatal
Both individually increase the risk
What are rules re insertion post EMA?
If expulsion not confirmed (ie at home) must confirm no ongoing pregnancy first by
1. Low Sensitivity PT >2 weeks after miso
2.scan at any time
Iuc in GTD-when might you consider insertion before hcg normalised?
Cu IUD EC (ukmec 3 if falling hcg)
When is BMI relevant to IUD insertion?
Ukmec 2 if> 30 and additional CV RF
What ukmec is insertion IUD with cavity distortion?
3
If do use US or hyst guidance
IUD at time ablation what’s the issue?
Not an issue really at insertion
Removal may be tricky may need to be done at hyst if initial attempt fails
What’s the issue with IUD at interval after ablation?
Individualise.
USS by specialist immediately prior and insertion specialist
US-homogenous triple stripe endometrium normal cavity no harmatometra suggest patent cavity.
What to consider post lletz if IUD removed?
Any need for EC?
Bridge
If not immed replaced delay till cx healed approx 4-6 weeks
In what circumstance would you consider prophylactic abx for gc/ct prior to coil fit?
If emergency EC IUD cannot be delayed and:
Asymptomatic contact of known GC/C4
Symptoms of gc/C4 but tests not back
What ukmec are
Asymptomatic chlamydia and GC prior to fit?
GC is Ukmec 4-unacceptable risk
C4 is ukmec 3 if asymptomatic could treat on day of insertion…but UKMEC 4 if symptomatic.
Apart from GC/C4 what is the only other incidental infection you should treat if detected prior to insertion?
Group A strep-TSS
Treat bv/tv/thrush but no need to delay insertion
Mgen not included in this ukmec but ideally treat first as can cause PID
What do you advise re steroid and IUD insertion in adrenal insufficiency?
D/W their dr but….
General rule:
Double dose glucocorticoid 1hr prior
Procedure in am
Double dose next 24hrs
Mineralocorticoid no adjustment
If inhaled steroids >800mcg or oral >10mg may need to increase dose to cover stress also 24 hours pre and post
What is risk of Vasovagal at iud insertion?
2%
Which coils might contain silver?
Cu IUD (may also contain nickel, gold)
Jayden’s and kyleena have silver ring
If someone is on warfarin can I do their coil?
If suitable then as long as target INR is <3.5 and stable no need to omit dose crack on
What about DOAC/antiplatelets/LMWH can I insert coil?
Yes don’t omit doses
Try to time with lowest drug levels
What do haemophilia guidelines say about coil for HMB?
Go for it
What to tell people about breast cancer risk and lng iud
Small but statistically significant increased risk breast cancer for current or recent lng-iud pre menopausal women
Similar to other HC
Risk BC very small under 50 so absolute risk very low
What are criteria to reasonably exclude pregnancy for coil insertion?
D1-5 or <d21 post partum or <5 days abortion/mc/gtd
No sex since LMP/pregnancy
Sex >21 days ago negative PT
Consistent contraception use
LAM
When switching to CU and LNG IUD who needs cover 7 days?
Cu-no one
LNG-unless d1/5 (6,7 SPC) or method using in date and has cervical mucus effect that IUD can just maintain….7 days cover needed
Note: If removing either coil no sex 7 days before
1. May not be able to replace
2. For lng if switch to cu need 7 days to become effective post insertion (could be viable sperm from week with cu iud, could ovulate)
CHC to LNG what are rules re cover after insertion in
1. Week 2-3+
2. Week 1 or after d1 HFI
- No cover needed (ovulation will be inhibited until lng kicks in)
- If no sex insert and use condoms/abstain, run cocp 7 days
If sex then run cocp 7 days
Similar rules DRSP POP (d8-24 are the no cover days)
What drugs must you have available?
Adrenaline 1:10,000 pre-filled 10ml (1mg) this is the IV/IO arrest dose
Atropine 500/600mcg iv/im 2 doses
O2
Are all coils MRI safe?
Current Uk ones yes
But if inserted abroad careful as eg stainless steel not safe and must be removed prior
What should you consider new pelvic pain post coil?
?perf (check threads)
? Ectopic (do PT)
What to do if IUC and pregnant?
Scan to confirm ectopic or not
<12 Remove if easy to remove regardless plans, advise if left in greater risk of eg septic abortion/ptl/mc
If not easy to remove/>12 judgement
??risk virillisation lng…little known
What is risk of infection post insertion?
<1% highest in first 3/52
Is actinomyces an important pelvic infection?
Very rare. Commensal associated with long term IUC. If becomes pathogenic….
Pain
D/C
IMB
Fever
Need high dose long term abx
Send coil for culture (ensure other STI eliminated)
What should you confirm in removing malpositioned IUC?
Any sex last 7 days? If possible defer….
If not consider EC/Pt at 21 days
If ? Expulsion what imaging?
USS
Abdo/pelvis x ray or CT
If inserting coil for gynae reasons and prev expulsion what could you consider?
Insert after d1-8
+-Suppress menses
(Eg inserted for HmB)
How long should you wait after perforation before reinsertion?
6 weeks-suggest in service with USS
What is prevalence of non visible threads?
18% standard (1.4-18)
30% post nvd
50% post cs
Who should you report broken arm/lost sheath to?
MHRA
