The document discusses intrauterine devices (IUDs). It describes the anatomy of the uterus and explains that IUDs are small objects inserted through the cervix into the uterus to prevent pregnancy. There are two main types - non-medicated IUDs made of plastic or stainless steel, and medicated IUDs that deliver drugs like copper or progesterone. IUDs are highly effective birth control but can increase bleeding or cramping.

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.