An intrauterine device ( IUD ), also known as intrauterine contraception ( IUCD or ICD ) or coil , is a large, T-shaped birth control device that is inserted into a woman's uterus to prevent pregnancy. IUDs are one form of long-acting reversible birth control (LARC). Among birth control methods, IUDs, along with contraceptive implants, produce the greatest satisfaction among users. One study found that female birth control providers chose the LARC method more frequently (41.7%) than the general population (12.1%).
IUDs are also safe and effective in adolescents and those who previously had no children. Once removed, even after long-term use, fertility returns to normal quickly. Copper devices have a failure rate of about 0.8% while hormone devices (levonorgestrel) fail about 0.2% of the time in the first year of use. By comparison, male sterilization and male condoms have a failure rate of about 0.15% and 15%, respectively. Copper IUD can also be used as emergency contraception within 5 days of unprotected sex.
While copper IUD may increase menstrual bleeding and cause more painful cramps, hormonal IUD may reduce menstrual bleeding or stop menstruation altogether. However, women can spray every day for several months and can take up to three months until there is a 90% decrease in bleeding. Cramps can be treated with NSAIDs. More serious potential complications include expulsion (2-5%) and infrequent uterine perforation (less than 0.7%). The IUD does not affect breastfeeding and may be inserted immediately after delivery. They can also be used immediately after the abortion.
The use of IUDs has increased in the US from 0.8% in 1995 to 5.6% over the 2006-2010 period. The use of IUDs as a form of birth control originated in the 1800s. Previous models known as Dalkon protectors were associated with an increased risk of pelvic inflammatory disease (PID). However, current models do not affect the risk of PID in women without sexually transmitted infections during the time of insertion.
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The types of intrauterine devices available, and their names passed, differ by location.
In the United States, there are two types available:
- Nonhormonal: Copper-containing IUD (ParaGard and others)
- Hormonal: Progestogen-release IUD (Mirena and others)
WHO ATC labeled both copper and hormonal devices as IUDs. In the UK, there are more than 10 types of copper IUD available. In the UK, the term IUD refers only to this copper device. Hyponal intrauterine contraception is considered a different type of contraception and is labeled with the term intrauterine system (IUS).
Non-hormonal
Most copper IUDs have a T-shaped plastic frame that is wrapped with pure electrolytic copper wire and/or has a copper collar (arm). The frame arm holds the IUD near the top of the uterus. The Paragard TCu 380a measures 32 mm (1.26 ") horizontally (over T), and 36 mm (1.42") vertically (T feet). Copper IUD has a first year failure rate from 0.1 to 2.2%. They work by damaging sperm and disrupting their motility so they can not join the eggs. In particular, copper acts as a spermicide in the uterus by increasing the levels of copper ions, prostaglandins, and white blood cells in the uterine and tubal fluids. Increased copper ions in the cervical mucus inhibit motility and sperm viability, prevent sperm from traveling through the cervical mucus, or crush it as it passes. Copper can also alter the lining of the endometrium, but research shows that while this change can prevent implantation of a fertilized egg ("blastocyst"), it can not interfere with one that has been implanted.
The advantages of copper IUD include its ability to provide emergency contraception up to five days after unprotected sex. This is the most effective form of emergency contraception available. It works by preventing conception or implantation but does not affect embryos already planted. It contains no hormones, so it can be used when breastfeeding, and fertility returns quickly after removal. Copper IUDs also last longer and are available in a wider range of sizes and shapes compared to hormonal IUDs. Losses include the possibility of a heavier menstrual period and more painful cramps.
IUDs containing gold or silver also exist. Other forms of IUD include so-called U-shaped IUDs, such as Load and Multiload, and IUDs with no frames holding some hollowcule copper hollow cylindrical beads. It is held in place by a stitch (knot) into the fundus of the uterus. It is mainly available in China, Europe, and Germany. The framed copper IUD is called the IUB SCU300 scroll when it is placed and forms a three-dimensional ball shape. It is based on a nickel titanium alloy memory core. In addition to copper, precious metals and progestogen IUDs; people in China can get copper IUDs with indomethacin. These non-hormonal compounds reduce the severity of menstruation, and these coils are very popular.
Hormonal
Hormonal IUDs (brand names Mirena, Skyla, Kyleena, and Liletta, referred to as intrauterine systems in the UK) work by releasing small amounts of levonorgestrel, progestin. Each type varies in size, number of levonorgestel released, and duration. For example, Mirena and Liletta measure 32x32mm while Skyla and Kyleena are 28x30mm in size. The main mechanism of action is to make the inside of the uterus uninhabitable for sperm. They can also dilute the endometrial lining and potentially impair the implantation but this is not their usual function. Because they dilute the endometrial lining, they can also reduce or even prevent menstrual bleeding. As a result, they are used to treat menorrhagia (heavy menstruation), once the pathological cause of menorrhagia (such as uterine polyps) has been ruled out.
The progestin secreted by a hormonal IUD primarily acts locally; the use of Mirene results in a much lower systemic progestin level than other very low dose progestogen contraceptives.
Mirena is approved for use up to five years in the US, although research supports it for up to seven years. Like Mirena, Kyleena is also approved for up to 5 years but is smaller and releases a little more levonorgestrel. Skyla is even smaller and releases a lower dose of levonorgestrel than Kyleena, but is only approved for up to three years. Liletta is more similar to Mirena in the form and dose of levonorgestrel is released; is currently approved for up to three years of use.
Inert
Inert IUDs do not have bioactive components. They are made of inert materials such as stainless steel (such as stainless steel rings (SSR), flexible steel coil rings that can be damaging to insert through the cervix) or plastic (such as Loop Lippes, which can be inserted through the cervix in the cannula and take the form of trapezium in the uterus ). They are less effective than copper or hormonal IUD, with a side effect profile similar to a copper IUD. Their primary mechanism of action is to induce the reaction of a local foreign body, which makes the uterine environment hostile to both sperm and embryo implantation. They may have higher rates of pregnancy prevention after conception, than before conception, compared to copper or hormonal IUDs.
IUD Inert has not been approved for use in the United States, United Kingdom, or Canada. In China, where IUDs are the most common form of contraception, copper IUD production replaced inert IUD production in 1993. However, in 2008, the most common IUDs used by immigrants who came to Canadian clinics to remove IUDs placed in China were still SSR. Because SSRs do not have strings to remove, this can pose challenges for healthcare providers unfamiliar with IUD types that are not available in their area.
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Insertion and Deletion
It is difficult to predict what women will experience during insertion or removal of the IUD. Some women describe the insertion as a torturous cramp, some as a pinch, and others feel nothing. There are several online videos where women describe their experiences with the installation of IUDs. Substantial pain with inserts requiring active management occurs in approximately 17% of nulliparous women and about 11% of parous women. In such cases, NSAIDs are effective. However, no prophylactic analgesic drug was found to be effective for routine use for women undergoing IUD insertion. During the insertion procedure, your doctor (ObGyn, family doctor, nurse practitioner, etc.) will use the speculum to find your cervix (opening your uterus) and then use an insertion tool to introduce the IUD into your uterus. The insertion device passes through the cervix causing pain during insertion. The procedure itself, if not complicated, should be no more than five to ten minutes. Generally, removal almost does not hurt like insertion because there is no instrument that needs to go through your cervix. This process requires the health care provider to find the cervix with the speculum and then use the ring forceps, which just enter the vagina, to grab the IUD string and then pull the IUD out.
Adverse effects
Regardless of the type of IUD, there are several potential side effects similar to all IUDs. Some of these side effects include changes in patterns of bleeding, expulsion, pelvic inflammatory disease (especially within the first 21 days after insertion), and rarely uterine perforation. A small chance of pregnancy remains after IUD insertion, and when it does occur there is a greater risk of ectopic pregnancy.
IUDs with progestogens provide an increased risk of ovarian cysts, and IUDs with copper provide an increased risk of more severe periods.
The company's menstrual cups recommend that women with IUDs who consider using a menstrual cup should consult their obstetrician before use. There are rare cases where women who use IUDs remove it when removing their menstrual cups, but this can also occur with the use of tampons.
Unlike condoms, IUDs do not protect against sexually transmitted infections.
Mechanism
IUDs primarily work by preventing conception. The progestogen released from the hormonal IUD primarily works by thickening the cervical mucus that prevents sperm from reaching the fallopian tube. Imagine sperm as a driver who wants to get to the destination, eggs, as fast as possible. Without an IUD, they can see where they are headed. However, with an IUD, it is difficult for them to figure out how to reach their final destination. In addition, IUDs can also function by preventing ovulation from happening but this only happens partially. Copper IUDs contain no hormones but the copper ions themselves are toxic to sperm. They also cause the uterus and fallopian tubes to produce fluids containing white blood cells, copper ions, enzymes, and prostaglandins, which are also toxic to sperm. The very high effectiveness of copper-containing IUDs as emergency contraception implies that they can also act by preventing blastocyst implantation.
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History
The history of intrauterine devices dates back to the early 1900s. Unlike IUDs, the initial interuterine device crosses both the vagina and uterus, causing a high rate of pelvic inflammatory disease in a period of time when gonorrhea is more common. The first IUD was developed in 1909 by German physician Richard Richter, of Waldenburg. The tool is made of caterpillar silk and is not widely used.
Ernst GrÃÆ'¤fenberg, another German doctor (after whom the G-spot was named), created the first IUD Ring, the GrÃÆ'¤fenberg ring, made of silver filament. His work was suppressed during the Nazi regime, when contraception was regarded as a threat to Aryan women. She moved to the United States, where her colleagues H. Hall and M. Stone took her job after her death and created a stainless steel Hall-Stone ring. A Japanese doctor named Tenrei Ota also developed a silver or gold IUD called Precea or Pressure Ring.
Jack Lippes helped start increasing the use of IUDs in the United States in the late 1950s. Today, thermoplastics, which can bend for insertion and retain their original shape, become the material used for first generation IUDs. Lippes also designed the addition of nylon monofilament ropes, which facilitate IUD removal. The trapezoidal shape of IUD Loop Lippes became one of the most popular first-generation IUDs. In subsequent years, many different plastic shaped IUDs were found and marketed. These include the famous Dalkon Shield, whose poor design causes bacterial infections and causes thousands of lawsuits. Although Dalkon's shield has been removed from the market, it has a lasting negative impact on the use and reputation of IUDs in the United States. Lazar C. Margulies developed the first plastic IUD using thermoplastics in the 1960s. Innovation allows insertion of the IUD into the uterus without the need to dilate the cervix.
The discovery of a copper IUD in 1960 brought the 'capital' U-shaped design used by most modern IUDs. US physician Howard Tatum determined that the form 'T' would work better with the shape of the uterus, which forms the 'T' when contracted. He estimated this would reduce the rate of IUD expulsion. Together, Tatum and Chilean doctor Jaime Zipper discovered that copper can be an effective spermicide and develop the first copper IUD, TCu200. Improvements by Tatum cause the creation of TCu380A (ParaGard), which is currently preferably a copper IUD.
Hormonal IUDs were also found in the 1960s and 1970s; initially the goal is to reduce the increased menstrual bleeding associated with copper and inert IUD. The first model, Progestasert, was conceived by Antonio Scommengna and was made by Tapani J. V. Luukkainen, but the device lasted only one year of use. Progestasert was produced until 2001. One of the commercially available hormonal IUDs, Mirena, was also developed by Luukkainen and released in 1976. Mirena producer Bayer AG was subjected to several lawsuits over allegations that Bayer failed to warn users that IUDs could penetrate uterus and migrate to other parts of the body.
China
In China, the massive use of IUDs by state health services is part of government efforts to limit birth rates. From 1980 to 2014, 324 million women were injected with IUD after having their first child, in addition to 107 million sterilized by tubal ligation after giving birth to a second child. Women who refuse to lose their government and children's jobs can lose access to public schools. IUDs inserted in this way are modified in such a way that they can not be removed at the doctor's office (which means they are left indefinitely), and surgical removal is usually required. Until the mid-1990s, the country's preferred IUD was a stainless steel ring, which had a higher rate of complications than other IUD types. This gives rise to the idiom "shang huan (pinyin of ??)" meaning "insert loop". Currently, IUDs include T and V forms, the first being the most common and the easiest to remove.
To implement the two-child policy, the government announced the abolition of IUDs paid by the government. Women "allowed to have another child" (see the one-child policy) or "who can not continue to have an IUD for health reasons" get a free removal, others do not.
References
Source of the article : Wikipedia
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