The document provides a comprehensive overview of intrauterine devices (IUDs), including their types, mechanisms of action, insertion procedures, contraindications, and complications. It outlines the differences between copper and hormonal IUDs, their benefits, non-contraceptive uses, and potential side effects. Additionally, the document discusses guidelines for insertion timing, removal, and follow-up care, emphasizing the safety and effectiveness of IUDs as a contraceptive method.

1. DR ANITA RAMESH
PROFESSOR,OBGY
VBMC,KURNOOL

2.  What is IUD?
 TYPES
 MECHANISM OF ACTION
 TIMING OF INSERTION
 CONTRAINDICATIONS
 METHODS OF INSERTION
 PROCEDURE OF INSERTING COPPER
IUD/MULTILOAD/MIRENA
 PROCEDURE OF REMOVAL OF IUCD
 COMPLICATIONS & MANAGEMENT
 INDICATIONS FOR IUCD REMOVAL
 ADVANTAGES
 NONCONTRACEPTIVE BENEFITS OF HORMONAL
IUCDs
 DISADVANTAGES OF HORMONAL IUCDs

3.  Most commonly used contraceptive
worldwide
 IUDs have a small plastic frame which has to
be inserted into the uterine cavity
 Safe,effective & reversible method of
contraception
 They have failure rate of less than 1%

5.  Inert(non
medicated)
1. Lippies loop
2. SAF T Coil
3. Grafenberg coil
 Bioactive/Medicat
ed
1. Cu IUDs
2. Hormonal(proges
terone)

6.  BIOACTIVE
1. Cu7,Cu 250(3yrs)
2. Multiload
375(5yrs)
3. Cu T 380
A(PARAGARD)(10y
rs)
 HORMONAL
1. Progestasert(Iyr)
2. LNG IUD(7 yrs)
3. Skyla(3yrs)
4. Gynefix

9. COPPER IUD

13.  It is a T shaped polyethyelene device 32mm
long &32mm wide.It comes in a package with
single use inserter.A monofilament
polyethylene thread is attached to a loop at
the base of the stem.
 T shaped body has barium sulphate for
visualisation on X Ray
 LNG is dispersed in a silicon reservoir on the
stem
 It has 52 mg of LNG releasing 20mcg/day
after insertion.VERY LOW DOSE IS RELEASED
COMPARED TO OC PILLS

17. Newer
IUDs(Gynefix/Skyla)
GYNEFIX

19.  Biochemical & Histological reactions
Nonspecific inflammatory reaction
which affects the
1. Functioning & viability of gametes
2. Prevents fertilization
3. Reduces chance of implantation
4. Release PGs which r toxic to sperms
5. Macrophages cause phagocytosis of
sperms

20.  Endometrial INFLAMMATORY RESPONSE
decreases sperm transport & ability to meet
the ovum
 Cu devices…Ionised copper has antifertility
effect by impairing blastocyst implantation.
Cu ions release cytokines which r cytotoxic
Cu ions impede sperm transport & viability in
the cervical mucus

21. 1. SUPPRESS the endometrium
2. Cervical mucus become thick & scanty(impedes
sperm motility)
3. Causes Anovulation & Insufficient luteal phase
activity
4. Decreases tubal motility
5. Stimulates GLYCODELIN A which inactivates
sperms
Periods are short,light & less painful.Useful in
AUB,FIBROID,ADENOMYOSIS,ENDOMETRIOSIS

22. INTERVAL >6 weeks of delivery
Insert day 3-5 days of periods
POST ABORTAL Immediately after D & E
EMERGENCY Cu T 380 A(within 72 hrs of
unprotected coitus)
IMMEDIATE POSTPARTUM Postplacental(within 10 mins of
placental delivery
Intraceaserean
Within 48 hrs of delivery
Extended postpartum/anytime
after 6 weeks

23.  Pregnancy ruled out
 Cervix partially open(no paracervical block
needed)
 Pain mixed with menstrual cramps

24. Postinsertion
menorrhagia/dysmenorrhea may be
there for 3 months
She has to feel the threads
occassionally
During 1st period of insertion,check
the pads for expulsion
Follow up if periods are missed
Regular follow up as advised

25.  First FU after periods
 Later on every 6 months
 Later on yearly

26.  Pregnancy
 Undiagnosed vaginal bleeding
 Acute pelvic infection in last 3 mnths
 Distorted uterine cavity
 Severe dysmenorrhea
 Known/suspected uterine/cervical neoplasia
 Ppartum/Post abortal endometritis in last 3 mnths
 STIs
 Molar pregnancy
 Cu IUDs :Cu allergy/Wilson s disease
 LNG IUS:hepatic tumour/hepatocellular disease OR current
breast disease OR severe arterial disease

27.  PUSH METHOD
 WITHDRAWAL METHOD

30.  complete history/Per speculum & Pelvic Examination.
 OPD Procedure
 Empty bladder
 Patient in lithotomy position
 Load the Cu t 250 using no touch technique
 The genital area cleansed with savlon/betadine
 Bimanual exam for uterine position
 Measure the UCL by uterine sound
 Adjust the guard on the inserter tube to the UCL
 Insert plunger into the inserter
 Introduce the IUD into the uterine cavity.

31.  The horizontal arms should sit at the fundus
 Once the inserter with IUD touches the fundus
(guard/flangeat the external os),the inserter
tube along with the plunger are gently
withdrawn together causing release of horizontal
arms
 The threads are cut 1 to 2 cms from the external
os

33.  Applicator with device is taken out of sealed
packet
 Pushed through the os into the uterine cavity
upto fundus
 Applicator is withdrawn releasing the IUD

35.  The vertical stem is thicker
 May need cervical dilatation/mild local
analgesia
 Slider is adjusted to pull the mirena into the
inserter tubeUCL measured & flange adjusted
 UCL measured & flange adjusted
 Mirena inserted into the uterine cavity
 The slider is advanced backward to release
the IUD.

37.  Patient empties the bladder
 Lithotomy position
 Speculum introduced
 Cervix held with vulsellum
 Threads are visualised & caught with artery
forceps & IUD pulled out
 Shown to the patient

38.  IMMEDIATE COMPLICATIONS
 REMOTE COMPLICATIONS

39. CRAMP LIKE PAIN ANALGESICS
SYNCOPAL ATTACK PROPER SIZE IUD
PARTIAL/COMPLETE
PERFORATION
FAULTY INSERTION TECHNIQUE

40. • PAIN PROPER SIZE DEVICE
• ABNORMAL UTERINE BLEEDING
(menorrhagia/more
duration/intermenstrual
spotting)
Counselling
Tranaxemic acid 500mg TID
NOT THERE WITH LNG IUS(60%
reduction of bleeding & 50% have
amenorrhea)
• PID Don’t insert if pt has any
infective vaginal discharge
Asepsis during insertion
• SPONTANEOUS EXPULSION 5%
More with postabortal or
postpartum insertions
Check during periods
Feeling of threads
• PERFORATION OF UTERUS
1:1000
Uncommon with withdrawal
technique
Examination
X Ray with sound
USG
HYSTEROSCOPY

44. USG TO DIAGNOSE MISPLACED IUD
NORMAL USG MISPLACED IUD

45. WITHIN CAVITY OUTSIDE CAVITY
Cu T hook removal Laparoscopy
Curette Laparotomy
Artery forceps
Hysteroscopy NOTE:Cu T causes intense
inflammatory reaction
surrounding structureswith

47.  LOWEST with paragard/LNG IUS
 Risk of ECTOPIC PREGNANCY is there
 If insitu it can lead to Abortion,Preterm
labour,Sepsis,Placenta
previa,Abruption,LBW & Malformations
WHAT TO DO?
1. Thread visible:Remove the device
2. Thread not visible:Counsel & do
termination/Continuation

48.  Desiring pregnancy
 Effective lifespan of IUD is over
 Missing threads
 Perforation
 Persistent vaginal discharge
 Pregnancy with IUD insitu
 Persistent excessive bleeding/dysmenorrhea
 One year after menopause

49.  Reduction in the risk of endometrial &
cervical cancer
 LNG IUS can be used as a fertility sparing
treatment of early stage endometrial Ca
 Safe & as effective as sterilisation procedure
 As an alternative treatment for
MENORRHAGIA,AUB,ADENOMYOSIS,SMALL
FIBROIDS & ENDOMETRIOSIS

50.  Safe & highly effective
 Long term protection
 Economical
 Simple insertion/removal technique
 No systemic side effects9HT,breast feeding &
epileptics)
 Immediate return to fertility after removal
 No repeated costs /repeated visits
 High continuation rates & user satisfaction
 Apart from contraception,it is also used post
adhesiolysis of Ashermanns syndrome(without
copper)

51.  Cu T 380 A,mirena,multiload 375
 Higher efficacy with lower pregnancy rates
 More longer duration of action
 Lower expulsion rates
 Risk of ectopic pregnancy is reduced
 Risk of PID,anaemia is reduced
 LNG IUD..Benefits
AUB,anaemia,endometriosis,dysmenorrhea,PID &
higher satisfaction
 Hormonal IUD has no effect on carbohydrate Or
lipid metabolism,cagulation Or liver functions.

52.  Expensive
 Not supplied by govt in India
 Amenorrhea(5%)…return to normal menses
occurs after removal
 Malpositioning may cause
pregnancy/expulsion
 Minor side effects of LNG..acne,depression
and mood change,breast tenderness,nausea
& headache,slight spotting daily during early
weeks