Intrauterine contraceptive device is
a device placed within the uterus in order to prevent pregnancy.Intrauterine
contraceptive devices stimulate a non-inflammatory macrophage reaction and this
effect is further enhance by the Copper content of it. In addition the
progesterone releasing variety converts the endometrium unsuitable for
implantation. As the end result sperm transportation in the upper female
genital tract, ovum transport and fertilization are inhibited and implantation
is impaired. These together make intrauterine contraceptive device as a very
efficient method of contraception. But fertilization can occur in the fallopian
tube. Efficacy of the intrauterine
contraceptive device is increased when it is medicated with Copper and/or
progesterone; the surface area is large and proper insertion high up in the
uterus. The efficacy rate of the currently popular intrauterine contraceptive
devices are about 99%. This is suitable for spacing and limitation of family.
Since insertion of intrauterine contraceptive device is difficult in nullipara
this is not suitable for delaying the first child.
Side effects
Abnormal menstrual bleeding, per
vaginal discharge, lower abdominal cramps, back pain and infections leading to
pelvic inflammatory disease are some side effects commonly seen with
intrauterine contraceptive devices. Improper insertion may leads to
perforation of the uterine wall usually at the time of insertion (use pull out
method). Patient with uterine rupture may present with severe abdominal pain
and per vaginal bleeding.Risk of perforation is during post partum when the
uterus is soft. Removal of intrauterine contraceptive device is mandatory in
this event. Ectopic pregnancy is a well
established entry in intrauterine contraceptive device usage. When a patient
complain about abnormal bleeding with abdominal pain while intrauterine
contraceptive device is in situ, it is necessary to exclude ectopic pregnancy.
Contraindications for IUCD
- Known or suspected pregnancy
- Pelvic inflammatory disease
- Heart diseases - valvular or septal lesion
- Abnormal uterine bleeding
- Uterine abnormalities
- Confirmed or suspected malignancy of genital tract
As a routine intrauterine
contraceptive device is perfect to be inserted at the time of menstruation
since it rules out pregnancy, negotiation through cervix is easy and slight
bleeding at the time of insertion goes unnoticed. Post partum intrauterine
contraceptive device should be inserted after 6 weeks from delivery, but now newer
devices are available, which can be inserted immediately after delivery. If the woman gets pregnant while in
intrauterine contraceptive device she should be immediately referred to a
specialist Obstetrician for the removal of intrauterine contraceptive device
and further management.
Woman should be advised on the
following:
- Bleeding per vagina for few days after insertion is normal
- First few menstrual cycles may be abnormal
- Lower abdominal pain and back pain may occur with menstruation. If disturbing can take analgesia.
- Always check for the presence of the thread especially after menstruation. Report to the clinic immediately if the thread is not felt.
The currently used intrauterine
contraceptive devices can keep insitu for about 6-8 years. After insertion the
woman should be reviewed frequently for two visits and later annually.
Post coital contraception with
intrauterine contraceptive device
Intrauterine contraceptive device
inserted within 72 hours of unprotected sexual intercourse can act as contraceptive
method and prevents pregnancy.
