Intrauterine Device (IUD)

Question 1

Briefly describe the mechanim of action of the intrauterine device (IUD)

Answer 1

• The primary mode of action of copper intrauterine devices (Cu-IUDs) is via the toxic effects of copper on the ovum and sperm, preventing fertilization.
• In addition, alterations in the copper content of cervical mucus may inhibit penetration by sperm, and inflammatory reactions within the endometrium may prevent implantation, should the ovum be fertilized. Consequently, the Cu-IUD can work immediately after insertion.

Question 2

What are the indications of IUD?

Answer 2

• Contraception (including emergency)

Question 3

What is the most common regime of IUD?

Answer 3

• Used perfectly→ 0.6% of women will conceive within the first year of use due to method failure
• Used typically→ 0.8% of women will conceive within the first year of use due to method failure or user failure

Question 4

What is the efficacy of IUD?

Answer 4

• Used perfectly→ 0.2% of women will conceive within the first year of use due to method failure
• Used typically→ 0.2% of women will conceive within the first year of use due to method failure

Question 5

What are the advantages of the IUD?

Answer 5

• Very safe and effective
• Effective immediately after insertion and can be used for emergency contraception
• Long-term contraception→ only needs to be replaced every 5–10 years
• Sex need not be interrupted.
• There are no hormonal side effects.
• Immediately reversible→ normal fertility returns as soon as it is removed
• Cu-IUD can be used:
  
  • With breastfeeding
  • 4 weeks postpartum
  • Immediately following surgical or medical termination of pregnancy
  • By women of any age and can be continued through the menopause
• There are no drug interactions
• May be associated with a reduced risk of endometrial and cervical cancer

Question 6

What are the disadvantages of the IUD?

Answer 6

• An internal pelvic examination, prior to insertion of the copper intrauterine device (Cu-IUD) is needed to check that it is suitable
  
  • There may be pain or discomfort for a few hours after insertion; this can be treated with an analgesic such as paracetamol or ibuprofen.
• Some bleeding or spotting may occur immediately after the Cu-IUD is inserted
• Some women experience severe cramps and pain beyond the first 3–5 days after insertion
• A trained healthcare provider must remove the device
• Does not protect against STIs
• Adverse effects such as unscheduled bleeding may be experienced in the first 3–6 months of using the Cu-IUD

Question 7

What are the side effects of the IUD?

Answer 7

• Pain on insertion
• Unscheduled bleeding

Question 8

What are the risks of the IUD?

Answer 8

• Perforation of the wall of the uterus
• Expulsion
• Pelvic inflammatory disease (PID)
• Ectopic pregnancy

Question 9

Briefly describe how to assess a woman for the IUD

Answer 9

• Exclude pregnancy → if pregnancy is possible, do not insert IUS
• Check the UK Medical Eligibility Criteria
• Assess the woman’s risk of STIs
  
  • If appropriate, advise testing, promote safer sex and/or refer for sexual health counselling
• If the woman has unexplained vaginal bleeding that suggests an underlying medical condition (such as bleeding between her periods or after sexual intercourse)→ do not insert the LNG-IUS until the cause of bleeding has been diagnosed

Question 10

What are the contra-indication of the IUD?

Answer 10

• Pregnancy
• Pelvic inflammatory disease (PID)
• Sexually transmitted infection (STI)
• Significantly distorted uterine anatomy.
• Unexplained vaginal bleeding

Question 11

How often does the IUD have to be replaced?

Answer 11

7-12 years (depending on the brand used)