Contraception:
Bhargavi Goka
Roll no: 2
Moderator- Dr. Kavitha ma’am
Guided by Dr. Deepti ma’am
Dr. Samatha ma’am
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Intrauterine contraceptive devices(IUCD)
• IUCD is an effective, reversible and long term form of contraception.
• The device is commonly made of polyethylene which is lled with barium
sulfate to render the device radiopaque, so that the device can be detected in
pelvis by X ray or ultrasound.
• Types of IUCDs
• Non medicated- First generation IUCD ex- Lippes loop, ota ring
Medicated- Second generation IUCD - copper T
Third generation IUCD - Hormone releasing IUCD
Ex- progestasert and mirena ( levonorgestrel).
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• Advantages of IUCD:
• Cost-effective
• Failure rate < 0.5% with the copper containing device
• Cu T 388 is given free of cost by government of India
• Strong motivation for the use of device is not required unlike OCPs the woman need not
undergo a cumbersome process of remembering to take a pill every day.
• Once inserted the device remains in place for ve years
• IUCDs can be used where OCPs are contraindicated.
• They can be used for emergency contraception
• Medicated IUCD ( Levonorgestrol) is bene cial in abnormal uterine bleeding as it can reduce
menstrual bleeding and Dysmenorrhea.
• It does not interfere with sexual activity.
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• Lippes loop
• It was the rst IUCD introduced in the national family planning program
• Mechanism of action- produce a sterile in ammatory response in th
endometrium by their mechanical action hence uterus becomes hostile to the
sperm and prevents implantation.
• Disadvantages- higher failure rates compared to property or hormonal IUCD.
• Also has shown to cause infertility and sterility big left in the uterus for a long
time.
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Copper T
• 2nd generation copper containing IUCD.
• Mechanism of action- releases copper causes certain enzymatic and metabolic changes in
the endometrial tissue which prevent implantation of the fertilised ovum.
• In these, copper wire with a surface area of 200/ 220/ 250/375/380 mm is wrapped
round the vertical stem of polypropylene frame.
• Ex- copper T 200, copper -7, multiload-375 copper T 380 and Nova T.
• They have an effective life of about 3 to 5 years.
• About 50 µg of copper is release daily into the uterus.
• Nova-T has silver added to the copper wire, increasing its lifespan to 5 years.
• New devices have a pregnancy rate of < 0.5%.
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•Disadvantages-
• A trained medical professional is required for the insertion.
• Chances of expulsion of device
• Risk of perforation of uterus
• Menstrual irregularities ( it takes at least 6 months for regularisation of
cycles).
• Sexually transmitted diseases are not prevented.
• Risk of ectopic pregnancy.
• Pelvic in ammatory disease.
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• Interval of insertion of copper containing IUCD:
Interval insertion - 6 weeks after delivery( postpartum)
During lactation period - during lactation ( do a Urine pregnancy test to
exclude pregnancy)
Post abortal period - wait for 2 weeks till retained products of conception are
expelled from the uterus.
Immediate postpartum and post placental insertion - during LSCS
NVD - < 48 hours ( as
uterus is below the umbilicus and os is open)
Post coital - after 48 hours of coitus.
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• Complications of copper T
Early complications Late complications
Pain during procedure PID - leucorrhea
Vasovagal syncope. Ectopic pregnancy
Perforation Ashermann’s syndrome
TB
Repeated dilatation and curettage
Actinomycosis
Misplaced IUCD
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•Hormonal IUCD: progestasert and mirena
• progestasert - T shaped device carrying 38 mg of protester one in an oil
reservoir in its vertical stem
• It releases 65 mcg of hormone per day.
• Mechanism of action- progesterone released in the uterus forms a thick
plug of mucus at the cervical os which prevents penetration of sperms
• Mirena - contains 52 MG levonorgestrel releases 20mcg/day.
• It is safe in lactation period.
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• Patient selection
1. Low risk of STD
2. Multiparous woman
3. Monogamous relationship
4. Desirous of long-term reversible method of conception, but not yet
desirous of permanent sterilisation
5. Unhappy or unreliable users of oral contraception or barrier
contraception.
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• Indications for removal of IUCDs
1. Pregnancy
2. Acute PID
3. Misplaced IUCD
4. AUB not responding to medical treatment
5. Missing threads
6. Partial expulsion of device
7. One year after onset of menopause.
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ank y !
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Th
ou
