34. Intrauterine Contraceptive Devices

Summary

This video script provides an in-depth discussion on intrauterine contraceptive devices (IUDs), covering their types, mechanisms of action, and lifespan. It compares first, second, and third-generation IUDs, focusing on copper and hormonal IUDs like Mirena. The script explains how copper IUDs prevent pregnancy by causing inflammation in the uterus, while hormonal IUDs work by altering the endometrial environment and thickening cervical mucus. It also addresses complications such as bleeding, pain, pelvic inflammatory disease, and the rare occurrence of ectopic pregnancies. The script concludes with guidance on IUD use, contraindications, and management in specific situations.

Takeaways

• 😀 IUDs are classified into three generations: first, second, and third, based on the materials and mechanisms they use.
• 😀 First-generation IUDs are non-medicated and made from inert substances, such as the Lippes loop.
• 😀 Second-generation IUDs contain copper, like the Copper T 380A, which causes inflammation in the uterus and prevents implantation.
• 😀 Third-generation IUDs are hormonal and release progesterone, like Mirena, which alters the endometrial lining and cervical mucus.
• 😀 Copper IUDs release copper to create a hostile environment in the uterus, preventing both fertilization and implantation.
• 😀 Hormonal IUDs release progesterone, causing decidualization of the endometrium and thickening the cervical mucus to prevent sperm movement.
• 😀 Copper T 380A is the most commonly used IUD worldwide, effective for up to 10 years.
• 😀 Mirena, a hormonal IUD, is effective for 5 years and is often used for controlling heavy menstrual bleeding.
• 😀 Inserting IUDs can increase the risk of pelvic inflammatory disease (PID), so it should be done in a sterile environment to minimize infection risks.
• 😀 Common complications of IUDs include bleeding, pain, expulsion, perforation, and, in rare cases, ectopic pregnancy.
• 😀 If pregnancy occurs with an IUD in place, there is a 30% chance it will be ectopic. The IUD may need to be removed if accessible without harming the pregnancy.

Q & A

What are the three generations of intrauterine contraceptive devices (IUDs)?

The three generations of intrauterine contraceptive devices (IUDs) are: first generation (non-medicated, inert substances like Lippe's loop), second generation (copper-containing IUDs like Copper T380A), and third generation (hormonal IUDs like Mirena that contain progesterone).

What is the main difference between first generation and second generation IUDs?

First generation IUDs are non-medicated and made of inert substances, while second generation IUDs contain copper, which is essential for their contraceptive mechanism.

How do copper-containing IUDs prevent pregnancy?

Copper-containing IUDs cause a mild inflammation in the endometrium, which prevents the implantation of a fertilized egg. Additionally, copper may hinder sperm movement towards the egg, preventing fertilization.

What is the mechanism of action of hormonal IUDs like Mirena?

Hormonal IUDs release progesterone, which leads to decidualization of the endometrium (making it unsuitable for implantation) and thickening of the cervical mucus, preventing sperm from entering the uterus. In some cases, they also inhibit ovulation.

What is the lifespan of different IUDs?

The lifespan of different IUDs varies: the Copper T380A (second generation) lasts up to 10 years, Mirena (third generation) lasts up to 5 years, and Progestasert (another hormonal IUD) lasts for 1 year.

What are the risks associated with the insertion of IUDs?

Risks associated with IUD insertion include pelvic inflammatory disease (PID), perforation of the uterine wall, expulsion of the device, and increased menstrual bleeding or pain.

What is the most common infection seen with copper-containing IUDs?

The most common infection seen with copper-containing IUDs is Actinomyces infection, not pelvic inflammatory disease (PID) or Chlamydia.

What are the absolute contraindications for using an IUD?

Absolute contraindications for using an IUD include pelvic inflammatory disease, cervical or endometrial cancer, uterine anomalies, unexplained vaginal bleeding, Wilson's disease, and copper allergy.

How is the Copper T380A IUD identified?

The Copper T380A IUD is identified by its T-shape, with copper wrapped around the arms and stem. It releases 50 micrograms of copper daily to induce mild inflammation in the uterus.

What should be done if a woman becomes pregnant while using an IUD?

If a woman becomes pregnant while using an IUD, the pregnancy should be monitored. If the IUD is accessible and in a safe location, it may be removed. However, if the device is in the funnel region, it should not be removed to avoid complications. There is a 30% chance that the pregnancy may be ectopic.