Intrauterine device, or IUD, is one of the most effective forms of female contraception available today. It is a 30 to 36mm long metal device that can be inserted through the vagina to implant within the uterus.
There are two types of Intra Uterine Devices. The Hormonal IUD, which contains the hormone levonorgestrel, And the Copper IUD, both of which are mainly indicated for female contraception.
For the hormonal IUD, there are three different strengths of levonorgestrel available, 13.5 mg, 19.5 mg, and 52 mg. And the higher dose IUD is also indicated for the treatment of heavy menstrual bleeding and endometrial protection during hormone replacement therapy. The 13.5 mg IUD is approved for use for up to 3 years, while the 19.5 mg and 52 mg IUDs are approved for up to 5 years.
The copper IUD is approved for contraception for up to 10 years. In addition, it is indicated for contraception within 5 days of unprotected sexual intercourse.
Contraindications for both types of IUD include, Pregnancy or suspected pregnancy, Sexually transmitted infection at the time of insertion of the device, Pelvic inflammatory disease, Confirmed or suspected uterine or cervical cancer, Abnormal uterine bleeding, Unremoved previous Intra Uterine Devices, Hypersensitivity to any component of the device, History of septic abortion or history of postpartum endometritis within the last 3 months, And anatomical abnormalities of the uterus that makes insertion of the device difficult.
Specific contraindications for the hormonal IUD include, Confirmed, or suspected breast cancer, Acute liver disease, And benign or malignant liver tumors.
Specific contraindications for the copper IUD include Wilson’s disease, and copper hypersensitivity.
Insertion of an Intra Uterine Device should be performed by an experienced person, usually a doctor. Before inserting the device, pregnancy and above-mentioned other contraindications should be excluded. After insertion, the strings connected to the device should be palpable in the cervix at any time, as you can see in this picture.
IUD can be removed at anytime according to patient’s preference. A patient may request for IUD removal due to following reasons. Desire for pregnancy. Irregular bleeding pattern and heavy vaginal bleeding. Pain and discomfort, which may occur due to displacement of the device. And intrauterine pregnancy.
Complications of IUD include the following. The most common complication is displacement or accidental removal of the IUD after insertion, usually occurring within the first three months. The most concerning complication for a patient is unintended pregnancy. However, it is important to know that this complication of IUD is extremely rare, with a rate less than 1%. Additionally, in a small percentage of patients, there is also a risk of possible uterine perforation when inserting the device. Finally, with both insertion and removal of IUDs, there is a risk of vasovagal symptoms with associated low heart rate. These patients should be managed symptomatically.
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