The document discusses intrauterine drug delivery systems (IUDs), including their types, mechanisms of action, and potential side effects. It distinguishes between hormonal and non-hormonal IUDs and explains how they prevent pregnancy, their effectiveness, and associated risks. Additionally, it addresses common questions and evaluation methods for IUDs in clinical practice.

1. INTRA-UTERINE DRUG
DELIVERY SYSTEM
Submitted by- Prachi Pandey, Rahul Pal
Submitted to- Nimisha ma'am

2. IntrauterineDrug Delivery System
An IntraUterine System (IUS) or IntraUterine Drug Delivery
System (IUDDS) is a small object that is placed inside the
uterus above the endometrium and is active or medicated
when it contains a therapeutic agent. This system is a
combination of drug/device that slowly releases the active
ingredient.

3. UTERUS

4. Intrauterine Devices
An intrauterine device (IUD), also known as intrauterine
contraceptive device (IUCD or ICD) or coil, is a small, often T-
shaped birth control device that is inserted into the uterus to
prevent pregnancy. IUDs are one form of long-acting
reversible birth control (LARC).

5. Types of IUDs
The types of intrauterine devices available, and
the names they go by, differ by location. In the
United States, there are two types available:
1-Nonhormonal: Copper-containing IUD (Last 10
years)
2-Hormonal: Progestogen-releasing IUD (Last 5
years)

6. Hormonal Intra
uterine device
Non-Hormonal
uterine device

7. Non-Hormonal
Most copper IUDs have a T-shaped frame that is wound around with pure
electrolytic copper wire and/or has copper collars (sleeves). The arms of the
frame hold the IUD in place near the top of the uterus. The Paragard TCu
380a measures 32 mm (1.26") horizontally (top of the T), and 36 mm (1.42")
vertically (leg of the T). Copper IUDs have a first-year failure rate ranging
from 0.1 to 2.2%. They work by damaging sperm and disrupting their motility
so that they are not able to join an egg. Specifically, copper acts as a
spermicide within the uterus by increasing levels of copper ions,
prostaglandins, and white blood cells within the uterine and tubal fluids. The
increased copper ions in the cervical mucus inhibit the sperm's motility and
viability, preventing sperm from traveling through the cervical mucus, or
destroying it as it passes through.

8. Hormonal
Hormonal IUDs (referred to as intrauterine systems in the UK) work by releasing a
small amount of levonorgestrel, a progestin. Each type varies in size, amount of
levonorgestrel released, and duration. The primary mechanism of action is making
the inside of the uterus uninhabitable for sperm. They can also thin the
endometrial lining and potentially impair implantation but this is not their usual
function. Because they thin the endometrial lining, they can also reduce or even
prevent menstrual bleeding. As a result, they are used to treat menorrhagia
(heavy menses), once pathologic causes of menorrhagia (such as uterine polyps)
have been ruled out.
The progestin released by hormonal IUDs primarily acts locally; use of Mirena
results in much lower systemic progestin levels than other very-low-dose
progestogen only contraceptives.

9. Adverse Effects
Regardless of IUD type, there are some potential side effects that are similar for all IUDs. Some
of these side effects include bleeding pattern changes, expulsion, pelvic inflammatory disease
(especially in the first 21 days after insertion), and rarely uterine perforation. A small
probability of pregnancy remains after IUD insertion, and when it occurs there's a greater risk
of ectopic pregnancy.
IUDs with progestogen confer an increased risk of ovarian cysts, and IUDs with copper confer
an increased risk of heavier periods.
Menstrual cup companies recommend that women with IUDs who are considering using
menstrual cups should consult with their gynecologists before use. There have been rare cases
in which women using IUDs dislodged them when removing their menstrual cups, however,
this can also happen with tampon use.
Unlike condoms, the IUD does not protect against sexually transmitted infections.

10. Some questions which may come to
mind
Q1-Is it safe to have an intrauterine device during
breastfeeding
A1-No
Q2-If some one has pelvic inflamatory disease it may effect in IU
devices
A2-No
Q3- Can it prevent sexual transmitted diseases
A3- No

11. Evaluation
Ultrasonography serves as first-line imaging
for the evaluation of IUD position in patients
with pelvic pain, abnormal bleeding, or absent
retrieval strings.

12. The symptoms of an infection
lower abdominal pain
vaginal discharge, possibly with a foul odor
pain when urinating
painful intercourse
a fever
irregular menstruation

13. As per Japroep.s et al. 2014, a retrospective evaluation of
the intrauterine devicesuggest overall good long-term
performance with IUD insertion, with minimal
complaints or adverse outcomes.