Gynecology Book

http://www.fpnotebook.com/

Intrauterine DeviceAka: IUD, Paragard, Copper T-380A IUD, Progestasert, Mirena

Advertisement

  1. Contraindications
    1. Nulliparity
    2. Sexually Transmitted Disease history
    3. Multiple Partners
    4. Undiagnosed Abnormal Uterine Bleeding
    5. Unresolved abnormal Pap Smear
    6. Active genitourinary infection
    7. Uterine abnormality
    8. History Ectopic Pregnancy (relative contraindication)
    9. Wilson's Disease or copper allergy (Copper-T IUD)
  2. Risks
    1. Pelvic Inflammatory Disease
    2. Tubal Infertility
      1. Cohort Study (n=4185)
        1. Primary (Nulliparous) Tubal Infertility Risk
          1. Dalkon Shield relative risk: 3.3
          2. Lippes Loop or Saf-T-Coil relative risk: 2.9
          3. Copper-T IUD relative risk: 1.6
          4. Having only one sexual partner: No increased risk
        2. Secondary (Multiparous) Tubal Infertility Risk
          1. Copper-T IUD relative risk: 1.5 (not significant)
          2. Non-Copper IUD relative risk: 2.8
      2. References
        1. Cramer (1985) N Engl J Med 312(15):941
  3. Adverse Effects
    1. First 3 months after IUD insertion
      1. Perception of vaginal infection
      2. Changes in menstrual flow (30%)
        1. Dysmenorrhea or prolonged flow
        2. Results in 10-15% discontinuation in first year
        3. Reduced with NSAIDs taken 2-3 days with flow onset
    2. Pelvic Inflammatory Disease risk
      1. Risk increases in first 20 days
      2. Risk is <1 per 1000 insertions
      3. Use of prophylactic antibiotics not warranted
    3. Expulsion in first 2 months
      1. Days 1-5: 5% expulsion rate
      2. Days 6-12: 3% expulsion rate
      3. Days >12: 2% expulsion rate
  4. Types
    1. Copper T-380A IUD (Paragard): 10 year copper device
      1. First year failure rate: 0.7%
      2. Cumulative ten year failure rate: 2.1%
      3. Recent studies indicate efficacious 12 years
      4. Reduces Ectopic Pregnancy rate significantly
      5. Barium impregnated
    2. Mirena: 5 year Progesterone (Levonorgestrel) device
      1. First year failure rate: 0.1%
        1. Of pregnancies, 50% will be ectopic
        2. Better efficacy than Copper-T IUD
      2. Polyethylene-barium T-shape 52 mg Levonorgestrel
      3. Releases 20 mcg/day of Levonorgestrel
      4. Progesterone adverse effects may occur
        1. Headache
        2. Acne Vulgaris
      5. Conception occurs for 80% within 12 months of removal
      6. Mechanism (Primarily spermicidal)
        1. Thins endometrium and thickens Cervical Mucus
        2. Inhibits sperm movement and function
        3. May also suppress Ovulation
      7. Reduces Menstrual Bleeding
        1. Consider for Dysfunctional Uterine Bleeding
        2. Irregular bleeding may occur in first 6 months
        3. Amenorrhea at one year of use if common (20%)
    3. Progestasert: 1 year Progesterone device
      1. First year failure rate: 2%
      2. Ethylene/vinyl acetate T-shape 38 mg Progesterone
      3. Higher rate of ectopic compared with Copper IUD
      4. Less bleeding complications
      5. Progesterone adverse effects may occur
  5. Indications for Prophylactic Antibiotics on insertion
    1. Routine prophylaxis no longer indicated
    2. Prior indications for antibiotic prophylaxis
      1. History of Bacterial Vaginosis
      2. Difficult insertion
      3. SBE Prophylaxis (not indicated in IUD insertion)
  6. Procedure
    1. See IUD Insertion
  7. References
    1. (2001) Med Lett Drugs Ther 43(1096):7
    2. Andersson (1994) {a 8072} 49:56
    3. French (2000) Br J Obstet Gynaecol 107:1281
    4. Herndon (2004) Am Fam Physician 69(4):853

Intrauterine Devices (C0021900)

Definition (MSH)Contraceptive devices placed high in the uterine fundus with a string extending from the device through the cervical as into the vagina. (UMDNS, 1999)
Definition (NCI)A device usually made of plastic or metal, inserted into the uterus to prevent conception. IUCD can be a coil, loop, triangle, or T in shape; its material can be impregnated with a pharmaceutical agent. The primary action of all IUCDs is the induction of a foreign-body reaction within the endometrium. This sterile inflammatory process is toxic to gametes, primarily spermatozoa, and effectively prevents viable sperm from passing into the fallopian tubes. The copper-bearing device has an independent toxic effect on spermatozoa. The progestin-releasing devices produce changes in endometrial architecture and function that reduce the potential for implantation of a fertilized egg. The progestin effect on the cervical mucus also reduces the penetrability of sperm.
ConceptsMedical Device (T074)
EnglishIntrauterine Contraceptive Device, Intrauterine Contraceptive Devices, Intrauterine Device, Intrauterine Devices, IUCD, IUD, IUDs
Spanishdispositivo intrauterino, dispositivo intrauterino anticonceptivo, DIU
CreditsDerived from the NIH UMLS (Unified Medical Language System)


Mirena (C0591811)

ConceptsSteroid (T110) , Pharmacologic Substance (T121)
EnglishBerlex Brand of Levonorgestrel, Levonorgestrel Berlex Brand, Mirena, Schering Brand 1 of Levonorgestrel
CreditsDerived from the NIH UMLS (Unified Medical Language System)


Progestasert (C1515395)

ConceptsSteroid (T110) , Pharmacologic Substance (T121) , Hormone (T125)
EnglishProgestasert
CreditsDerived from the NIH UMLS (Unified Medical Language System)



Navigation Tree