intra uterine devices

1. Intrauterine Devices (IUDs)

2. • Anatomy of the Uterus: The uterus is a pear-shaped; thick-walled,
muscular organ suspended in the anterior wall of the pelvic cavity.
• It measures normally about 3 inches long and 2 inches wide.
• Fallopian tubes enter its upper portion, one on each side, and the
lower portion of the uterus projects into the vagina.
• The uterine cavity is normally triangular and flattened anterior-
posteriorly.

3. • The wall of the uterus consists of three layers:
• 1. Endometrium: It is the inner coat of the uterine wall and is a mucous
membrane that consists of epithelium lining and connective tissue. There
are two types of arteries:
• Straight arteries: Supplies deeper layer.
• Coiled arteries: Supplies superficial layer.
• 2. Myometrium: It is a thick, muscular middle layer made up of bundles of
interlaced, smooth muscle fibers embedded in connective tissue. It is
subdivided into three ill-defined, intertwining muscular layers containing
large blood vessels of uterine walls.
• 3. Peritoneum: It is the external surface of the uterus, which is attached to
both sides of the pelvic cavity by blood ligaments through which the
uterine arteries cross.

4. Intrauterine Devices (IUDs)
• It is a small object that is inserted through the cervix and placed in
the uterus to prevent pregnancy.
• A small string hangs down from the IUD into the upper part of the
vagina.
• IUDs show pharmacological efficacy for about 1-10 years.
• They work by changing the lining of the uterus and fallopian tubes
affecting the movements of eggs and sperm so that fertilization does
not occur

5. Development of IUDs
• These devices cause more endometrial compression and myometrial distention,
leading to uterine cramps, bleeding, and expulsion of IUDs.
• Researchers developed IUDs in the past 30 years to add antifertility agents to
more tolerated, smaller devices, such as T-shaped devices, to enhance
effectiveness; or anti fibrinolytic agents, such as e-aminocaproic acid and
tranexamic acid to larger IUDs to minimize the bleeding and pain.
• Tatum developed a T-shaped device that would work better with the shape of
the uterus, which forms a T when contracted. This reduced side effects
significantly.

6. • Zipper 1968 added contraceptive metals (Cu) and Doyle and Clewe
developed Progestin releasing IUD.
• This development initiated a new era of R and D for long-term IU
contraception, leading to the generation of recent IUDs-medicated
IUDs.
• Copper-bearing IUDs such as Cu-7 and Progesterone releasing IUDs
such as Progestasert (approved by FDA in 1976) thus evolved.

7. Types of IUDs
• Non-medicated IUDs
• Medicated IUDs
• 1. Non-medicated IUDs:
• These exert their contraceptive action by producing a sterile
inflammatory response in the Endometrium by its mechanical
interaction.
• These do not contain any therapeutic effect. E.g. Ring-Shaped IUDs of
Stainless Steel, Plastic IUDs, Lippes Loop, Dalkon Shield, Saf-T-Coil.

8. • Non- medicated IUD devices are made of plastic or stainless steel
only.
• Lippes loop made of plastic (polyethene) impregnated with barium
sulphate is still used in many parts of the world.
- Lipper’s loops IUD was commonly used from the 1960s to the 1980s.
- This is a plastic double “S” loop, a trapezoid- shaped IUD that closely
fits around the contours of the uterine cavity reducing the incidence
of expulsion.

9. 2. Medicated IUDs: These are capable of delivering pharmacologically
active antifertility agents. E.g. Copper bearing IUDs, Progesterone
releasing IUD.
• There are two types of medicated IUDs:
• Copper bearing IUDs.
• Hormone releasing IUDs: There are two types:
• Progesterone releasing IUD – Progestasert.
• Levonorgesterone IUD – Levonorgestrel releasing device.

11. • Advantages:
• The IUD is one of the most popular contraceptive methods,
especially for long-term reversible contraception, as it can be
easily fitted and removed.
• It is highly effective, with a 98-99% success rate over five years
of IUD use.
• Its action lasts for ten years if it is not removed in between.
• The onset of action is immediate.

12. • It is suitable for lactating women.
• Fertility returns promptly on discontinuation.
• It can be used by women who are on any type
of medication.
• It is not associated with cancer of any organ,
unlike hormonal contraception.
• It is cost-effective.

13. Disadvantages of IUDs
• Menorrhagia is a frequent complaint, as are dysmenorrhoea and
polymenorrhoea. These are the major reasons for IUD discontinuation.
• It does not offer any protection against sexually transmitted infections .
• There is a slight risk (1%) of acquiring a uterine infection during IUD
insertion within 20 days of the procedure.
• Women should be tested for gonorrhea or chlamydia before insertion, and
for any other organism if they so request.
• Fortunately, pelvic infections with the IUD in utero can be treated
adequately without removing the device.
• Expulsion of the IUD may occur especially following or during the periods in
the first three months.

14. • Uterine perforation may occur in 0.1% of women during insertion.
This may manifest as lower abdominal pain. Perforation will require
surgical removal.
• There is a higher risk of ectopic pregnancy if conception occurs with
an IUD in situ, though pregnancies are very rare with this method.
• Nausea, Vomiting, Headache, and Weight gain are some of the side
effects.

15. Applications
• It is used as a contraceptive to prevent pregnancy.
• It can be suitable for use in Hormone Replacement Therapy.
• It can be safely used in women with heavy bleeding to
prevent/control the same.
• In the treatment of fibroids.