Copper T & DMPA notes

1. Cu-T
1) Cu T-200 B: 215 sq mm of Cu wire,contains 124 mg of Cu,Cu lost @ 50 ug/24 hrs,to be
removed after 4 yrs.
2) Cu T 200 :carries 200sq.mm Cu wire,containing 120 mg Cu,to be removed after 3 yrs.
3) Cu T 380 A: 380 sq. mm Cu wire,314 sq.mm around the stem and 33 sq.mm on each
horizontal sleeve
4) Multiload Cu 250: to be replaced every 3 yrs
5) Multiload 375: 375 sq.mm Cu wire around its vertical stem,to be replaced every 5 yrs
Time of insertion:
a)Interval – preferably 2-3 daysafter period is over,effectively upto 10 days post
period,anytime during lactational amenorrhoea.
b)Postabortal: Immediately foll. Termination of pregnancy by S&E/D&E.Addl.
advantage of preventing uterine synaechiae.
c)Postpartum: Insertion can be done before discharging pts. from hospital.Because of
high rate of expulsion,it is preferable to withhold insertion for 6 weeks when the uterus
will be involuted to near normal size.
d)Postplacental delivery:Insertion immediately foll. delivery of the placenta could be
done,but the expulsion rate is high.
Complications:
Immediate:
 Cramp like pain
 Syncopal attack
 Partial or complete perfor;ation
Remote:
 Pain

2.  Abnormal menstrual bleeding
 Pelvic infection
 Spontaneous expulsion
 Perforation of the uterus
 Pregnancy
Indications for removal:
 .Persistent excessive regular or irregular
 Flaring up of salpingitis
 Perforation of the uterus
 Partial expulsion of the IUD
 Pregnancy occurring with the device in-situ
 Woman desirous of a baby
 Missing thread
 One year after menopause
 When effective lifespan of the device is over
Advantages of IUD:
 Inexpensive & reversible
 Simplicity in techniques of insertion and most cost effective
 Prolonged contraceptive protection after insertion (5-10yrs) and suitable for rural
population of developing countries
 Suitable for hypertensives,breastfeeding women and epileptics
 Reversibility to fertility is prompt after removal.
Disadvantages of IUD:
 Requires motivation
 Limitation in its use
 PID,pelvic pain,heavy periods
 Risk of ectopic pregnancy

3. DMPA
-i.m. administration in either deltoid or gluteus
-150mg every 3 months or 300mg every 6 months
Depo-Sub Q provera 104 contains 104 mg of DMPA,given s.c. over ant. Thigh or
abdomen,suppresses ovulation for 3 months.
Advantages: 1.eliminates regular medication eg.OCPs
2.can be used safely during lactation
3.no oestrogen related side effects
4.Menorrhagia,dysmenorrhea reduced.
5.Protective against endometrial cancer
6. Can be used as interim contraception before vasectomy becomes effective
7.reduction in PID,endometriosis,ectopic pregnancy,ovarian cancer
8.non contraceptive benefits- salpingitis, endometrial cancer, iron def. anaemia, sickle cell
problems,endometriosis
Disadvantages:
Failure rate for DMPA –(0-0.3)HWY
Chance of irregular bleeding and occasional phase of amenorrhoea
Return of fertility after discontinuation is usually delayed for several months
Loss of Bone Mineral Density with long term use of Depo-provera
Weight gain
Headache
Contraindications: Women with high risk factors for Osteoporosis