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Intra-Uterine Contraceptive Devices

Introduction:

An intrauterine device, also known as intrauterine contraceptive device or coil, is a small, often T-shaped
birth control device that is inserted into the uterus to prevent pregnancy. IUDs are one form of long-acting
reversible birth control.

Types:

There are two kinds of IUDs

1. Non-Medicated: It is copper-based (commonly referred to as the copper-T, and also known as the
non-hormonal or un-medicated IUD). In addition medicated or bio-active IUD’s release either metal
ions(copper) or hormones(progestogens)
2. Medicated: It is hormone-based medicated IUD.
Both are made up of polyethylene or other polymers

 First generation IUD: The non -medicated or inert IUD is often referred as first generation IUD’s.
 Second Generation: The copper releasing IUD’s is referred as second generation.
 Third Generation: Hormone releasing IUD’s

In India under the National family welfare programme, Cu-T-200B is being used, from 2002, Cu-T-
380 A has been introduced in the programme.

First generation IUD:

The first generation IUD’s comprise the inert or non-medicated devices, usually made of polyethylene or
other polymers. They appeared in different shapes and sizes-loops, spirals, coils, rings, bows. Of all models
Lippies loop is the best known and commonly used device in developing countries.

Lippies Loop:
 It is a double-S shaped device made of polyethylene, a plastic material that is non-toxic reactive and
extremely durable.
 It contains small amount of barium sulphate to allow X-ray observation.
 Loop has attached thread or tail made of fine nylon which project into vagina after insertion.
 Thread is easily felt and is reassurance to the user that the loop is in its place.
 The lippies loop exists in four sizes A,B,C and D. The larger loops(C&D) are more suitable for
multiparous women.
 Higher removal rate due to side effects such as pain, bleeding etc.

Second generation IUD:

A new approach was tried in the 1970’s by adding copper to the IUD. It is found that metallic copper had a
strong anti-fertility effect. Which are easier to fit.
 Commercial copper bearing devices:

1. Copper-7 (Earlier device)

2. Copper-T-200(Earlier device)
3. Cu-T-220C
4. Cu-T-380Aor Ag
5. Nova-T
6. Multi load devices: ML-Cu-250 & Ml-Cu-375

The newer copper IUD’s-Multi load devices and variants of the T device offer the further advantage of
having an effective life of at least 5 years.

Advantages of Copper Devices:

 Lower expulsion rate

 Lower incidence of side effects
 Easier to fit even in nulliparous women
 Increased contraceptive effectiveness
 Effective as post-coital contraceptives, if inserted within 3-5 days of unprotected intercourse.

Third generation IUD:

Third generation IUD’s works on the principle “release of hormone”

The most widely used hormonal device is progestasert, which is a T shaped device filled with 38mg of
progesterone, the natural hormone. It has direct effect on the uterine lining, cervical mucus & possibly on
sperms.

Another hormonal device LNG-20 is a T-shaped IUD releasing 20 mcg of levonorgestrel (a potent
synthetic steroid), it has low pregnancy rate & less number of ectopic pregnancies.

Contraindications:

Absolute: Suspected pregnancy, Pelvic inflammatory diseases, vaginal bleeding of unknown etiology,
cancer of the cervix, uterus or adnexia, pelvic tumours, previous ectopic pregnancy.

Relative: Anemia, menorrhagia, PID, purulent vaginal discharge, distortions of the uterine cavity due to
congenital malformations, fibroids, unmotivated persons.

Timing of Insertion:

 During menstruation or within 10 days of the beginning of a menstrual period, during this period
insertion will be easy because the diameter of the cervical canal is greater at this time.
 Immediate postpartum insertion-first week after delivery but it may lead to perforation, and high
expulsive rate.
 Post puerperal insertion-6 to 8 weeks after delivery.
 Inserted immediately after first trimester abortion.
 IUD insertion after 2 trimester abortion is not recommended due to risk of infection.
Side effects & Complications:
1. Bleeding
2. Pain
3. Pelvic infection
4. Uterine perforation
5. Ectopic pregnancy
6. Expulsion