Intrauterine Devices

Background

• 49% of pregnancies are unintended

• Use of IUD: 11.9 percent of women of reproductive age worldwide, but by only 1.5 percent of women in North America

• Not for pregnant, those with PID, anatomically distorted uterus (Table 1 for further contraindications)

• Provide information for a variety of contraceptives

• Lower pregnancy rate despite higher % of ectopic pregnancies from IUD’s make for less overall ectopic pregnancies than other birth control methods.

• Increased risk of PID attributable to time of introduction only

• Copper-releasing device (ParaGard)

  • Prevents sperm transport and mobility

  • Failure rate of 1.26 per 100 woman-years

• Progestin intrauterine system (Mirena)

  • Creates cervical mucus plug and may reduce flow

  • Alters sperm transport and mobility

  • Failure rate of 0.09 per 100 woman-years

• Both alter uterine lining—may prevent implantation

• Low cost: $175 – 500 for visit and insertion

• Reversible

• Last 10 – 12 (ParaGard) and 3 – 5 (Mirena) years

• Non-estrogen based

• Bleeding

• Dysmennorhea

• 2 – 10 % expel IUD in first year

• Strict STD screening prior to insertion

• Preparation of patient (similar to pap smear)

• Cervix fixation with tenaculum

• Sound the uterus, determining position

• Insertion of prepared device

• Trim excess string

• Follow up ultrasound for position

• Wier, E. “Preventing pregnancy: a fresh look at the IUD.” CMAJ. Sept. 16, 2003; 169 (6)

• Johnson, BA. ”Insertion and Removal of Intrauterine Devices.” American Family Physician. Vol 71, Issue 1, Jan 2005.

• Johnson, J. “Intrauterine Devices.” Federation of America. 2005

Category: Gynecology Notes