Intrauterine Devices

IUD Basics - Womb Wonders

Intrauterine Devices (IUDs): Small, T-shaped devices in the uterus for long-term, reversible, highly effective contraception.

• Types:
  • Copper (Cu-IUDs): e.g., CuT 380A.
  • Hormonal (LNG-IUS): e.g., Mirena (levonorgestrel).
• Mechanism (General):
  • Foreign body reaction (sterile inflammation).
  • Sperm incapacitation; impaired ovum transport.
  • Endometrial changes prevent implantation.

⭐ Cu-IUDs offer emergency contraception if inserted within 5 days post-coitus.

Copper IUDs - Copper Champions

• Mechanism: Spermicidal (Cu$^{2+}$ ions); inhibits sperm migration & fertilization; sterile endometrial inflammation impairs implantation.
• Types (India): CuT 380A, CuT 375, Multiload.
• Duration: CuT 380A: 10 years; CuT 375: 5 years.
• Advantages:
  • Highly effective (>99%).
  • Long-acting, reversible.
  • No systemic hormones.
  • Emergency contraception: use within 5 days.
• Disadvantages:
  • ↑ Menorrhagia, dysmenorrhea.
  • Risk of expulsion, perforation (rare).
• Contraindications (Absolute):
  • Pregnancy, active PID, unexplained abnormal vaginal bleeding, current cervical/endometrial cancer.

⭐ CuT 380A is effective for emergency contraception if inserted within 5 days of unprotected intercourse.

Hormonal IUDs (LNG-IUS) - Hormone Heroes

• Mechanism: Local Levonorgestrel (LNG) action:
  • Thickens cervical mucus (sperm barrier).
  • Causes endometrial atrophy/decidualization (inhibits implantation).
  • Inhibits sperm motility & function.
  • Anovulation (in some users, dose-dependent).
• Key Example: Mirena (releases LNG 20 mcg/day), effective for 5-8 years. Other options: Kyleena (5 yrs), Jaydess/Skyla (3 yrs).
• Advantages: Highly effective (failure <0.2%). Significantly ↓ menstrual bleeding & dysmenorrhea. Non-contraceptive benefits: treats heavy menstrual bleeding, endometriosis pain; provides endometrial protection.
• Disadvantages/Side Effects: Irregular bleeding/spotting common initially. Amenorrhea (e.g., Mirena up to 50% by 1 year). Minimal systemic hormonal effects (e.g., acne, mood changes less common).
• Contraindications: Pregnancy, distorted uterine cavity, active/recent PID or STI, current breast cancer, severe liver disease.

⭐ LNG-IUS can reduce menstrual blood loss by up to 90%, making it a first-line therapeutic option for heavy menstrual bleeding.

IUD Procedures - In & Out Safely

• Pre-insertion: Counsel (benefits, risks, alternatives). Screen for contraindications (active PID, pregnancy, distorted uterine cavity, unexplained abnormal uterine bleeding, current breast cancer for hormonal IUDs), STI risk assessment.
• Timing of Insertion:
  • Anytime during menstrual cycle (if reasonably sure not pregnant).
  • Postpartum: Immediate (<10 min of placental delivery), early (<48 hrs), or interval (≥4 weeks).
  • Post-abortion: Immediate (if no infection).
• Insertion Technique: Bimanual exam, cervical cleansing, uterine sounding, IUD insertion. Pain: NSAIDs, paracervical block.

• Follow-up: Check threads after first menses, then annually. 📌 PAINS mnemonic for warning signs: Period late/abnormal, Abdominal pain, Infection exposure (STI), Not feeling well/fever, String missing/shorter/longer.
• Removal Technique: Gentle, steady traction on threads. If difficult, assess for embedment/perforation.

⭐ Copper IUDs (Cu-IUD) can be used as emergency contraception if inserted within 5 days of unprotected intercourse, offering >99% effectiveness.

IUD Complications - Trouble Shooters

• Expulsion: Rate ~2-10% in 1st year. Risks: nulliparity, age <20 yrs, immediate post-abortal/postpartum. Mgmt: Exclude pregnancy, offer new IUD/alternative.
• Perforation: Incidence 1-2/1000. Dx: USG, X-ray. Mgmt: Laparoscopic removal.
• Pelvic Inflammatory Disease (PID): Risk ↑ highest in first 20 days post-insertion. Mgmt: Broad-spectrum antibiotics. Remove IUD if no improvement in 48-72h.
• Missing Threads: Systematic investigation required.

• Pregnancy with IUD in situ: Risks: ↑ectopic, ↑miscarriage, ↑preterm labor. Mgmt: If threads visible & <12 weeks gestation, remove IUD. Counsel on risks if left.

  ⭐ If pregnancy occurs with an IUD, promptly rule out ectopic pregnancy as the relative risk is significantly higher.

• Ectopic Pregnancy: IUDs ↓ overall ectopic risk vs. no contraception. However, if pregnancy occurs with an IUD, a higher proportion are ectopic.

High‑Yield Points - ⚡ Biggest Takeaways

• CuT 380A (Copper IUD) lasts 10 years; LNG-IUS (hormonal) lasts 5 years.
• Copper IUDs: Spermicidal, endometrial inflammation. LNG-IUS: Thickens cervical mucus, thins endometrium.
• Highly effective Long-Acting Reversible Contraception (LARC).
• Rapid return to fertility upon removal.
• PID risk highest in first 20 days post-insertion.
• Contraindications: Pregnancy, active PID, unexplained AUB, uterine distortion.
• Copper IUD effective as emergency contraception within 5 days of unprotected intercourse.