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Intrauterine

Contraception

Copper T 380A (Paragard®)
Levonorgestrel-Releasing Intrauterine
System (Mirena®)

Intrauterine Contraception • Paragard™ (TCu380A) • Mirena™(levonorgestr el.releasing IUS) – Copper IUD – Local Progestin – Use up to 10 years – Use up to 5 years – Heavier periods – No hormonal side effects – Lighter periods • Irregular for 3-6 months – Some systemic effects .

Copper-releasing IUDs: Mechanism • Mass effect. 1998 . like plastic IUDs • Copper alters uterine and tubal fluid – Hinders spermatozoa function / motility • Inhibits fertilization – Not an abortifacient Hatcher.

2000 .Progestin-releasing IUDs: Mechanism • Impairs spermatozoa motility / function • Inhibits conception – Unable to recover fertilized ova – Not an abortifacient • Thickens cervical mucus • Atrophy of endometrium • Impairs tubal motility • 85% of women are ovulatory Lahteenmaki.

Levonorgestrel-releasing IUS • Releases 20 mcg per day of Levonorgestrel • Hormonal side effects are rare • Endometrial concentrations 200800x higher than in blood Lähteenmäki et al. Steroids 2000 .

High effectively Effective after planting Long. 3.advantage 1. 2. 4.term ptotection no disturbance on sexual contact .

Menstrual irregularities Long menstruation and a lot of Spotting Disminorhea . 3. 4. 2.disadvantage 1.

Wanted to use a long term contraception 3. or breastfeeding 4. Are postpartum. Women at productive age 2.indication 1. Young and nulliparous women should be counseled on expulsion risk . post-abortion.

Reproduction tract infection 4. Unidentified vaginal bleeding 3. Abnormal uteri 5.pregnancy 2. Cancer .contra indication 1.

Some pain and cramping First few days: .Light bleeding and mild cramping First few month: .Common side effects During insertion: .Intermenstrual bleeding and/or cramping .Heavier or prolonged menstrual bleeding .

Progestin IUDs – side effects • Hormonal side effects are rare & not more common than in general population • Nonetheless. they are reasons given for discontinuation • No weight gain .

Signs of possible complications .Irregular bleeding and/or open every cycle--------dislocation or perforation .Fever. chills. unusual vaginal discharge-----infection .Severe bleeding or abdominal cramping 3-5 days post insertion---perforation infection .

Shorter . partial expulsion.Pain during intercourse-----infection. longer or missing strings----partial or complete expulsion. . perforation.Signs of possible complications continued . expelled IUD----pregnancy (uterine or ectopic) . .Missed period. other sign of pregnancy. perforation.

if no infection .Timing of IUD Insertion Interval insertion: .Any time during menstrual cycle if women is not pregnant and has signs of infection Post partum insertion: .Immediately after vaginal or cesarean delivery if no infection or hemorrhage (within 48 hours. or delay 6 weeks postpartum) Post abortion insertion (first trimester) .immediately.

Decontaminate instrument .Infection Prevention Procedure - Wash hands Wear sterile gloves Carefully disinfect vagina and cervix Use sterile IUD and sterile or highlevel disinfected aquipment .Safely dispose of contaminated waste .

Sound uterus .Inspect vaginal and cervix .Insert IUD .Disinfect vagina and opening to cervix .IUD insertion Steps .Perform bimanual exam .