1. IUCDs can be non-medicated like the Lippes Loop or medicated with copper or hormones. Common copper IUCDs include T-380 and T-200 while the LNG-IUS releases levonorgestrel. 2. Copper IUCDs prevent pregnancy primarily by interfering with sperm motility and survival while also preventing implantation. The LNG-IUS thickens cervical mucus and thins the uterine lining. 3. Medical eligibility criteria from WHO categorizes conditions as having no restrictions, generally able to use with additional care, or not recommended due to risks outweighing benefits for IUCD use. Proper training is required for insertion and removal to avoid risks.

1. IUCDs INSERTION AND REMOVAL

2. Classification
• Non-medicated IUCDs: lippes loop
• Medicated copper containing IUCDs: Cu T-380,Cu T-200,
multiload-375,
multiload-250
• Hormone containing IUCDs:levonorgestrel intrauterine
system(LNG-IUS), progestasert

3. Types of IUCDs

4. Lippes Loop
• Inert device made of polyethylene or other polymers, appeared
in different shapes and sizes-loops, spirals, coils, rings and bows.
• Types: according to size could be A, B, C and D, D being the largest.
• Larger the size, greater the antifertility effect and a lower expulsion
rate but a lower continuation rate due to side-effects like pain and
bleeding.
First generation IUCD

6. Second Generation IUCDs
• Earlier devices: Cu-7Cu
T-200
• Newer devices:
(Variants of T device)
T Cu-200 ,BT Cu-380A
(currently provided under
the National Family Welfare
program
Nova T: (Multiload
devices)ML-Cu-250 ML-Cu-
375

7. Third Generation IUCDs
• These are hormonal – available on a limited scale)
• Progestasert : T shaped device filled with 8mg of Progesterone,
releasing 65mcg daily
LNG (Mirena) T shaped IUCD releasing Levonorgestrel - More
potent

8. Mechanism of Action
• Copper-bearing IUCDs, such as the Copper T 380A, act
primarily by preventing fertilization (Rivera et al. 1999).
• Copper ions decrease sperm motility and function by altering
the uterine and tubal fluid environment, thus preventing sperm
from reaching the fallopian tubes and fertilizing the egg.
• The device also stimulates foreign body reaction in the
endometrium that releases macrophages and prevents
implantation.

9. MEDICAL ELIGIBILITY CRITERIA (MEC):
• WHO system - 4 CATEGORIES
• CATEGORY 1: Can use IUCD with no restriction
1.lactational amenorrhoea
2.post menstrual insertion
3. immediately after 1st trimester abortion
4. more than 6 weeks postpartum provided no
infection

10. 5.Benign ovarian tumors/ uterine fibroids not distorting the
cavity
6. Genital infection with mild nonpurulent discharge
7.Women with a h/o ectopic pregnancy
8. As emergency contraception

11. CATEGORY 2: ( can generally use IUCD- the advantages outweigh
the risks; additional follow up and care needed.
• Less than 20 yrs of age / nullipara
• Immediately following 2nd trimester abortion
• Less than 48 hrs postpartum provided no infection
• Anatomical abnormalities that makes insertion difficult eg.
Cervical stenosis
• At risk for STI other than gonorrhea / chlamydia (eg.
Herpes, syphilis, trichomoniasis) should be treated and
inserted

12. • Past h/o PID without subsequent pregnancy
• HIV infected
• Complicated valvular heart diseace (RHD/ artificial
shunts)
• With anemia
• 1st and 2nd degree UV prolapse
• Rectovaginal fistula

13. CATEGORY 3: Use of IUCD is not recommended
(risks outweigh benefits)
• Heavy menstrual bleed, endometriois, dysmenorrhoea
• 48 hrs to less than 6 weeks postpartum
• Benign trophoblastic disease
• Purulent cervical discharge
• 3rd degree UV prolapse
• Vesicovaginal fistula

14. CATEGORY 4: should not use IUCD
• Pregnant women
• h/o puerperal sepsis/ septic abortio
• Malignant trophoblastic disease
• Anatomical abnormalities that distort uterine cavity
• Pelvic TB

15. Timing of the Insertion
• Within seven days of the beginning of last menstrual period or
anytime during the menstrual cycle provided the service provider is
reasonably sure that woman is not pregnant.
• Immediately or within 48 hours after delivery (by a provider who is
trained in inserting IUCDs during this time) or more than 6 weeks
post partum.
• Concurrently with 1st trimester medical termination of pregnancy.
• After 1st menstrual period following spontaneous/medical/second
trimester abortion
• In a woman with Lactational Amenorrhea provided pregnancy can
be ruled out.
• Within 5 days of unprotected sex as an emergency contraception

22. Advantages
• No adverse systemic effects
• Long acting
• Reversible Immediate return of fertility
• Reduced chance of intrauterine and ectopic pregnancies with
LNg-IUS

23. Limitations
• Pelvic examination before IUCD insertion is mandatory as
against other spacing methods.
• Requires a skilled provider for insertion and removal of the
device.
• Does not protect against STIs/ HIV
• Cannot be inserted in the women who currently have active
RTI/STI
• It has chance of expulsion