1. Intrauterine contraceptive devices (IUCDs) include non-medicated, copper-containing, and hormone-containing devices. 2. Copper IUCDs like CU-T 380A release copper ions that create an inflammatory response and changes in the endometrium to prevent implantation. The levonorgestrel IUCD releases the hormone progestin to suppress the endometrium. 3. IUCDs are highly effective long-acting reversible contraceptives that also provide non-contraceptive benefits like lighter periods. Their failure rates are much lower than other methods. Complications are generally minor.

1. INTRAUTERINE CONTRACEPTIVE
DEVICE

2. CLASSIFICATION
• Non medicated IUCD – (1st GENERATION)
Lippes loop
• Medicated copper containing IUCD- (2ND
GENERATION)
CU-T 380A, Multiload 375, 250
• Hormone containing IUCD- (3RD GENERATION)
LNG IUS, Progestasert

4. Device Description
CU-T 380A contains 380 mm square of copper.
(vertical stem 314mm sq and each arm 33mm sq)
• Copper is radio opaque, additional barium
sulfate is incorporated in the device.
• Device is replaced 10years
• It is used of synecolysis to prevent adhesion
formation after adhesiolysis in Asherman’s
Syndrome

5. Multi load CU-375:
• It has 375 mm sq surface area of copper wire
• No introducer and no plunger
• Replaced every 5 years
Multi load CU-250:
• Emits 60-100mcg of copper per day
• Replaced every 3 years

6. Levonorgestrel Intrauterine system:
• T- shaped with polydimethylsiloxane
membrane around the stem which acts as a
steroid reservoir
• Total amount of LNG is 52mg
• Daily 20mcg is released
• To be replaced every 5 years
• It has many non- contraceptive benefits

7. Mechanism of action
• Biochemical and histological changes in the
endometrium
• Increased tubal motility
• Endometrial inflammatory response
• Copper initiates release of cytokines which are
cytotoxic. Ionised copper prevents blastocyst
implantation through enzymatic interference
• LNG IUS : Suppression of endometrium, scanty
cervical mucus

8. Advantages
• Contraception
• Prevents synechiae formation
• Third generation IUCDs – higher efficacy,
longer action, less expulsion, decreased risk of
ectopic pregnancy, decreased risk of PID
• With LNG IUS- decreased menorrhagia,
dysmenorrhoea, premenstrual tension
syndrome, treatment of endometrial
hyperplasia, endometriosis, adenomyosis

9. Failure rate
PEARL INDEX (pregnancy rate per HWY)
• No method – 85
• Natural method – 25
• Condom (male)- 15
• OC pills- 0.1
• CU- T 380A - 0.8
• LNG 20 – 0.1
• Tubectomy/ Vasectomy - 0.15

10. Contraindications
• Pelvic infammatory disease
• Undiagnosed genital tract bleeding
• Suspected pregnancy
• Distorted uterus
• h/o ectopic pregnancy
• For Cu-T – Wilson’s disease , copper allergy
• For LNG IUS: Hepatocellular disease, Breast Ca,
severe arterial disease
• Not advised in nulliparous patients

11. Time of insertion
• Interval
• Post abortal
• Postpartum
• Post placental delivery (PPIUCD)

12. Method of insertion
• Withdrawal technique

13. Complications
• Immediate: Cramps, syncope, perforation
• Remote: pain, abnormal uterine bleeding,
pelvic inflammatory disease, spontaneous
expulsion, perforation of uterus

14. Indications for removal of IUCD
• Excessive or irregular menstrual bleeding
• Salpingitis
• Perforation of uterus
• Partial expulsion
• Pregnancy with device in situ
• Willing for pregnancy
• Missing thread
• After the life span of the device is over

15. Missing threads
• Causes
• Examination
• USG
• X-ray pelvis AP and lateral view
• Hysteroscopy

18. Pregnancy with IUCD