INTRAUTERINE CONTRACEPTIVE DEVICE:

 INTRAUTERINE CONTRACEPTIVE DEVICE:

      MECHANISMS:

The primary mechanism of action of the IUD is spermicidal/ovicidal. It is prevent fertilization primarily by interfering with the ability of sperm to survive and to ascend the fallopian tubes, where fertilization occurs. Having a foreign body in the uterus, such as an IUD, causes both anatomical and biochemical changes that appear to be toxic to sperm. When a foreign body is in the uterus, the endometrium reacts by releasing white blood cells, enzymes and prostaglandins; and these reactions of the endometrium appear to prevent sperm from reaching the fallopian tubes. In addition, copper-bearing IUDs release copper ions into the fluids of the uterus and the fallopian tubes, enhancing the debilitating effect on sperm.

     Side effects:

  • Mood changes
  • Acne
  • Headaches
  • Breast tenderness

Advantages:

  1. Allows sexual spontaneity.
  2. Requires no daily attention.
  3. Immediately effective.:
  • Pelvic pain
  • Cramping (copper IUD)
  • Increased bleeding during menstruation (copper IUD)
  • Nausea
  1. Long-lasting.
  2. Not messy.

      Disadvantages:

  1. Does not protect against sexually transmitted infections, including HIV/AIDS.
  2. Insertion and removal require clinic visits.
  3. Can be expelled.
  4. Can cause more difficult menstrual periods.
  5. Possible risk to future fertility.

    Contraindications:

  1. Postpartum between 48 hours and 4 weeks (increased IUD expulsion rate with delayed postpartum insertion).
  2. Benign gestational trophoblastic disease.
  3. Ovarian cancer.
  4. Very high individual likelihood of exposure to gonorrhea or chlamydial STIs.
  5. AIDS (unless clinically well on anti-retroviral therapy).
  6. Pregnancy.
  7. Postpartum puerperal sepsis.
  8. Immediately post-septic abortion.
  9. Before evaluation of unexplained vaginal bleeding suspected of being a serious condition.
  10. Malignant gestational trophoblastic disease.
  11. Cervical cancer (awaiting treatment).
  12. Endometrial cancer.
  13. Distortions of the uterine cavity by uterine fibroids or anatomical abnormalities.
  14. Current PID.
  15. Current purulent cervicitis, chlamydial infection, or gonorrheal STIs.
  16. Known pelvic tuberculosis.

 

 
  

 

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