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Intrauetrine device

Overview of Intrauterine Device

What is an Intrauterine Device?

It’s an effective long-term contraception method that does not require replacement for long periods and does not interfere with sexual activity. The intrauterine system releases progesterone to prevent pregnancy.

The Technique of Insertion of IUD

The insertion of an IUD is relatively simple and easy. First, a thorough pelvic examination is performed to determine the position and size of the uterus. The presence of any uterine, tubal, or ovarian pathology precludes the insertion of the device. The vagina and cervix are inspected through a speculum. Any vaginal or cervical infection must be treated and cured before a device is inserted. The cervix is grasped with a vulsellum or allis forceps. The device is mounted into the introducer, and the stop on the introducer is adjusted to the length of the uterine cavity. The introducer is then passed through the cervical canal, and the plunger is pressed, which is called the push-in technique. In comparison, the withdrawal technique has less chance of uterine perforation. 

Mechanism of Action:

  • The presence of a foreign body in the uterine cavity renders the migration of spermatozoa difficult.
  • A foreign body within the uterus aggravates uterine contractility through prostaglandin discharge and surges the tubal peristalsis so that the fertilized egg is propelled down the fallopian tube more rapidly than in normal, and it reaches the uterine cavity before the development of chorionic villi.
  • The device causes leukocyte infiltration in the endometrium.
  • Copper T elutes copper, which brings about peculiar enzymatic and metabolic changes in the endometrial tissue, which are ruinous to the proselytism of the fertilized ovum.
  • Progestogen carrying device causes a mutation in the cervical mucus, which hinders sperm penetration and its local action. It also induces endometrial atrophy. It prevents ovulation in about 40%

Uses of IUD:

  •  contraceptive.
  • Postcoital contraception.
  • Excision of uterine septum and Asherman’s syndrome.
  • Hormonal IUD in menorrhagia and dysmenorrhoea.
  • In menopausal women Hormonal replacement therapy
  • It can also be used to counteract endometrial hyperplasia.

Contraindications: 

  • Pregnancy is suspected. 
  • Lower genital tract infection. 
  • Presence of fibroids. 
  • Menorrhagia and dysmenorrhoea. 
  • Heart disease.
  • Scarred uterus.
  • LNG IUD in breast cancer. 
  • Abnormally shaped uterus. 
  • Septate uterus.

Complications:

With the advancements in new devices, acceptability and compliance have been improved. The complications are:

Immediate:

  • Difficulty in insertion.
  • Vasovagal attack.
  • Uterine cramps. 

Early:

  • Expulsion. 
  • Perforation. 
  • Spotting menorrhagia.
  • Dysmenorrhoea. 
  • Vaginal infection. 
  • Actinomycosis. 

Late: 

  • PID – 2 to 5% does not prevent the transmission of HIV.
  • Pregnancy.
  • Ectopic pregnancy. 
  • Perforation. 
  • Menorrhagia. 
  • Dysmenorrhoea.

Misplaced IUD:

The causes if the IUD is not seen are :

The uterus has enlarged through pregnancy. 

Thread has curled inside the uterus. 

Perforation has occurred, or the IUD is buried in the myometrium. 

It has been expelled. 

Plain Radiograph or pelvic ultrasound will show whether the IUD is still inside or it has been expelled. Abnormal shape or location of IUD on radiograph indicates likely perforation.

If you are facing any Gynaecologist problem abnormal vaginal bleeding and are seeking a test and diagnosis, you can consult with Dr Sarah Hussain, the leading Female Gynaecologist in London. Request a call for treatment.