Obstetrics and Gynecology - A.M. Gromova 2000

Modern family planning methods
Modern methods of contraception
Intrauterine devices (IUDs)

IUDs are among the most widespread contraceptive Methods used by over 70 million women worldwide.

Modern intrauterine contraceptives are categorized into inert ones, made of polyethylene with barium sulfate added for radiopacity, and medicated ones, which contain copper and gestagens.

Currently, there are over 50 Different types of IUDs. Their MECHANISM OF ACTION is similar yet not fully defined. It is believed that the presence of an IUD in the Uterus increases the synthesis of Prostaglandins, which enhance uterine tone and accelerate fallopian tube peristalsis, causing the zygote to move to the uterus more quickly. Implantation becomes impossible due to the lack of preparation of the endometrium and trophoblast. There is also the aseptic inflammation theory, according to which IUDs cause inflammatory Changes in the endometrium, thereby preventing implantation, enhancing the phagocytosis of spermatozoa by macrophages, and inhibiting sperm migration. IUDs cause enzymatic disorders in the endometrium, thus disrupting implantation. Copper ions in copper-bearing IUDs have a spermato- and ovotoxic effect. Gestagen-releasing IUDs promote endometrial atrophy, inhibit its secretory transformations, and thicken cervical mucus.

Inert-type IUDs, represented by the Lippes Loop, are practically no longer used due to their ban by a WHO regulation in 1986.

Copper-bearing IUDs are made of polyethylene with The addition of barium sulfate and feature copper wire wound around a vertical axis. Representatives of such IUDs include TCu-380A, TCu-220, TCu-200Ag, TCu-380Ag, and Multiload Cu-375.

The Pearl index for such IUDs ranges from 1.0 to 1.3, while for the Multiload type, it does not exceed 1.0. The lifespan of intrauterine contraceptives ranges from 3 to 5 years depending on their type. It should be noted that due to the presence of IUD threads in the cervical canal, the integrity of the cervical barrier is compromised, creating conditions for infection penetration and a decrease in local Immunity in women. Currently, it is recommended to shorten the duration of IUD use to three years.

The gestagens in gestagen-releasing IUDs exert a local effect on the endometrium, fallopian tubes, and the mucous membrane of the cervix. Ovulation is preserved in almost 75% of women using them. Representatives of such IUDs include Progestasert, which contains 38 mg of progesterone and releases 65 mcg of gestagen per day, and Levonorgestrel-20 (Levonova, Mirena), which releases 20 mcg of levonorgestrel per 24 hours. The contraceptive efficacy of gestagen-releasing IUDs is 1.0–2.9.

Traditionally, IUDs are inserted during the last days of menstruation, but insertion is also permissible on any day of the cycle once Pregnancy is ruled out, 6 weeks after uncomplicated delivery (only the TCu-380A IUD), or immediately following an Artificial abortion or within 7 days if there are no signs of pelvic inflammatory disease.

Disadvantages of intrauterine Contraception include the potential onset of menometrorrhagia, an increased risk of Ectopic Pregnancy, and The Development of Inflammatory Diseases of the internal reproductive Organs. Such contraception should not be recommended for women with menstrual irregularities, signs of genital tract infections (colpitis, cervicitis), cervical erosion, congenital anomalies or benign uterine tumors (fibroids), within 3 months after an acute flare-up of pelvic inflammatory disease, or for women with multiple sexual partners.

Upon the onset of any gynecological disease, the IUD must be removed. If the IUD is removed after 5 years of use, Curettage of the uterine cavity is indicated.