IUD & IUS Flashcards
What is the difference between the IUD & IUS?
intrauterine system (LNG-IUS):
- describes the levonorgestrel intrauterine system
- this contains progestogen that is slowly released into the uterus
intrauterine device (Cu-IUD):
- describes the copper coil
- creates a hostile environment for pregnancy
How does removal of a coil affect fertility?
fertility returns to normal as soon as the device is removed
What are the contraindications to coil fitting?
- pelvic inflammatory disease / infection
- pelvic cancer
- unexplained vaginal bleeding
- immunosuppression
- uterine cavity distortion (e.g. fibroids)
- pregnancy
What test must be performed prior to insertion of a coil?
screening for chlamydia + gonorrhoea
- performed in all women at higher risk
- i.e. under 25 years
What is involved in the insertion of a coil?
- bimanual is performed to check the position + size of uterus
- speculum is inserted to fit the device
- forceps are used to stabilise the cervix during insertion
- BP + HR should be recorded before and after insertion
What may women experience after insertion of a coil?
temporary crampy period type pain
- NSAIDs can be used to help with discomfort after the procedure
How should women be followed up following insertion of the coil?
- they should be taught to feel the strings to ensure the coil remains in place
- they should be seen 3-6 weeks after insertion to check the threads
What are the risks relating to insertion of the coil?
- bleeding
- pain on insertion
- vasovagal reactions (syncope / bradycardia / arrhythmias)
- uterine perforation
- PID (especially in first 20 days)
-
expulsion of the coil
- risk is highest in the first 3 months
What advice is given to women about contraception and removal of the coil?
- women must use condoms for 7 days PRIOR to removal of the coil
- they should also use condoms for the first 7 days after insertion if the coil was not inserted during their menstrual cycle
What 3 things must be excluded when the threads cannot be palpated?
- expulsion
- pregnancy
- uterine perforation
What 3 things must be excluded when the threads cannot be palpated?
- expulsion
- pregnancy
- uterine perforation
What advice is given to women when they can’t find their coil strings?
use extra contraception (i.e. condoms) until the coil is located
What is the first line investigation when coil strings cannot be palpated?
ultrasound
- this can be used to confirm the correct placement of the IUD within the uterine cavity
What may be performed when the IUD cannot be seen on USS?
pelvic XR:
- this looks for the coil elsewhere in the abdomen / peritoneal cavity after uterine perforation
- hysteroscopy / laparoscopic surgery may be required depending on the location of the coil
How long can the copper coil be left in for?
What are the uses of this IUD?
- depending on the device, it can be left in for 5-10 years
- it can be used as emergency contraception being inserted up to 5 days after UPSI
When is the copper IUD contraindicated?
Wilson’s disease
- a genetic condition resulting in the build-up of copper in the organs
How does the copper IUD work?
- copper is toxic to the ovum and sperm
- it also enters the endometrium to make it less accepting of implantation
- the copper IUD does NOT contain any hormones
What are the benefits to using the Cu-IUD?
- it can be inserted at any time during the menstrual cycle and is effective immediately
- reliable contraception
- does not contain hormones so can be used in women with VTE risk or history of hormone-related cancers
- may reduce risk of endometrial + cervical cancer
What are the drawbacks to using the Cu-IUD?
- can cause heavy / Intermenstrual bleeding
- may cause pelvic pain
- does not protect against STIs
- increased risk of ectopic pregnancy
- IUDs can occasionally fall out
What are the 4 types of IUS?
Mirena:
- effective for 5 years for contraception
- licensed for use for menorrhagia & HRT
- only licensed for 4 years use for HRT
Levosert:
- effective for 5 years for contraception
- licensed for use for menorrhagia
Kyleena:
- effective for 5 years
Jaydess:
- effective for 3 years
!! these all contain levonorgestrel !!
How does the LNG-IUS work?
it releases levonorgestrel (progestogen) into the local area:
- thickening of the cervical mucus
- altering of the endometrium to make it less accepting of implantation
- it inhibits ovulation in a small number of women
When should the LNG-IUS be inserted?
- it can be inserted up to day 7 of the menstrual cycle without the need for additional contraception
- if inserted after day 7, condoms should be used for 7 days after insertion
What are the benefits to using the LNG-IUS?
- can make periods lighter / stop altogether
- can improve dysmenorrhoea / endometriosis-related pain
- no effect on bone mineral density (unlike Depo)
- no increase in thrombosis risk (unlike COCP)
- can be used in obese patients (unlike COCP)
- additional uses for HRT and in menorrhagia
What are the drawbacks of the LNG-IUS?
- can cause spotting / irregular bleeding
- may cause pelvic pain
- does not protect against STIs
- increased risk of ectopic pregnancies
- increased risk of ovarian cysts
- IUS can occasionally fall out
- systemic absorption causes side effects of acne, headaches + breast tenderness
What advice is given to women about bleeding following insertion of the LNG-IUS?
- irregular bleeding is common after insertion
- it should have settled within the first 6 months
- if problematic bleeding continues, further investigations are required
- pregnancy test
- sexual health screen
- cervical screening
What may be prescribed to help with problematic bleeding following LNG-IUS insertion?
- COCP** can be taken in addition to the LNG-IUS for **3 months
- this should help to settle problematic bleeding
What is discovered incidentally during cervical screening in women with a coil?
actinomyces-like organisms (ALO)
- these do not require treatment unless symptomatic
- if the woman has pelvic pain / abnormal bleeding, removal of the coil is considered
