Intrauterine device

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 a woman's uterus to prevent pregnancy. IUDs are one form of long-acting reversible birth control (LARC). Among birth control methods, IUDs, along with contraceptive implants, result in the greatest satisfaction among users. One study found that female family planning providers choose LARC methods more often (41.7%) than the general public (12.1%).levonorgestrellevonorgestrellevonorgestrel-Prevents ovulation at times -Emergency contraception-Lighter periods after 3 months; some users experience amenorrheaMechanism of actionThe contraceptive action of all IUDs is mainly in the intrauterine cavity. Ovulation is not affected, and the IUD is not an abortifacient.58–60 It is currently believed that the mechanism of action for IUDs is the production of an intrauterine environment that is spermicidal.Nonmedicated IUDs depend for contraception on the general reaction of the uterus to a foreign body. It is believed that this reaction, a sterile inflammatory response, produces tissue injury of a minor degree but sufficient to be spermicidal. Very few, if any, sperm reach the ovum in the fallopian tube.The progestin-releasing IUD adds the endometrial action of the progestin to the foreign body reaction. The endometrium becomes decidualized with atrophy of the glands.65 The progestin IUD probably has two mechanisms of action: inhibition of implantation and inhibition of sperm capacitation, penetration, and survival.Mechanism of actionCopper-releasing IUCsWhen used as a regular or emergency method of contraception, copper-releasing IUCs act primarily to prevent fertilization. Emergency insertion of a copper IUC is significantly more effective than the use of ECPs, reducing the risk of pregnancy following unprotected intercourse by more than 99%.2,3 This very high level of effectiveness implies that emergency insertion of a copper IUC must prevent some pregnancies after fertilization.Emergency contraceptive pillsTo make an informed choice, women must know that ECPs—like the birth control pill, patch, ring, shot, and implant,76and even like breastfeeding77—prevent pregnancy primarily by delaying or inhibiting ovulation and inhibiting fertilization, but may at times inhibit implantation of a fertilized egg in the endometrium. However, women should also be informed that the best available evidence indicates that ECPs prevent pregnancy by mechanisms that do not involve interference with post-fertilization events.ECPs do not cause abortion78 or harm an established pregnancy. Pregnancy begins with implantation according to medical authorities such as the US FDA, the National Institutes of Health79 and the American College of Obstetricians and Gynecologists (ACOG).80Ulipristal acetate (UPA). One study has demonstrated that UP can delay ovulation.81... Another study found that UPA altered the endometrium, but whether this change would inhibit implantation is unknown.82p. 122:Progestin-only emergency contraceptive pills. Early treatment with ECPs containing only the progestin levonorgestrel has been show to impair the ovulatory process and luteal function.83–87p. 123:Combined emergency contraceptive pills. Several clinical studies have shown that combined ECPs containing ethinyl estradiol and levonorgestrel can inhibit or delay ovulation.107–110How does EC work?In 2002, a judicial review ruled that pregnancy begins at implantation, not fertilisation.8 The possible mechanisms of action should be explained to the patient as some methods may not be acceptable, depending on individual beliefs about the onset of pregnancy and abortion.Copper-bearing intrauterine device (Cu-IUD). Copper is toxic to the ovum and sperm and thus the copper-bearing intrauterine device (Cu-IUD) is effective immediately after insertion and works primarily by inhibiting fertilisation.9–11 A systematic review on mechanisms of action of IUDs showed that both pre- and postfertilisation effects contribute to efficacy.11If fertilisation has already occurred, it is accepted that there is an anti-implantation effect,12,13Levonorgestrel (LNG). The precise mode of action of levonorgestrel (LNG) is incompletely understood but it is thought to work primarily by inhibition of ovulation.16,17Ulipristal acetate (UPA). UPA’s primary mechanism of action is thought to be inhibition or delay of ovulation.2 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 a woman's uterus to prevent pregnancy. IUDs are one form of long-acting reversible birth control (LARC). Among birth control methods, IUDs, along with contraceptive implants, result in the greatest satisfaction among users. One study found that female family planning providers choose LARC methods more often (41.7%) than the general public (12.1%). IUDs are safe and effective in adolescents as well as those who have not previously had children. Once an IUD is removed, even after long-term use, fertility returns to normal rapidly. Copper devices have a failure rate of about 0.8% while hormonal (levonorgestrel) devices fail about 0.2% of the time within the first year of use. In comparison, male sterilization and male condoms have a failure rate of about 0.15% and 15%, respectively. Copper IUDs can also be used as emergency contraception within 5 days of unprotected sex. Although copper IUDs may increase menstrual bleeding and result in painful cramps, hormonal IUDs may reduce menstrual bleeding or stop menstruation altogether. However, women can have daily spotting for several months and it can take up to three months for there to be a 90% decrease in bleeding. Cramping can be treated with NSAIDs. More serious potential complications include expulsion (2–5%) and rarely perforation of the uterus (less than 0.7%). IUDs do not affect breastfeeding and can be inserted immediately after delivery. They may also be used immediately after an abortion. The use of IUDs has increased within the United States from 0.8% in 1995 to 7.2% from the period of 2006 to 2014. The use of IUDs as a form of birth control dates from the 1800s. A previous model known as the Dalkon shield was associated with an increased risk of pelvic inflammatory disease (PID). However, current models do not affect PID risk in women without sexually transmitted infections during the time of insertion. The types of intrauterine devices available, and the names they go by, differ by location. In the United States, there are two types available: The WHO ATC labels both copper and hormonal devices as IUDs. In the United Kingdom, there are more than 10 different types of copper IUDs available. In the United Kingdom, the term IUD refers only to these copper devices. Hormonal intrauterine contraception is considered to be a different type of birth control and is labeled with the term intrauterine system (IUS). 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. Copper can also alter the endometrial lining, but studies show that while this alteration can prevent implantation of a fertilized egg ('blastocyst'), it cannot disrupt one that has already been implanted. Advantages of the copper IUD include its ability to provide emergency contraception up to five days after unprotected sex. It is the most effective form of emergency contraception available. It works by preventing fertilization or implantation but does not affect already implanted embryos. It contains no hormones, so it can be used while breastfeeding, and fertility returns quickly after removal.Copper IUDs also last longer and are available in a wider range of sizes and shapes compared to hormonal IUDs. Disadvantages include the possibility of heavier menstrual periods and more painful cramps. IUDs that contain gold or silver also exist. Other shapes of IUD include the so-called U-shaped IUDs, such as the Load and Multiload, and the frameless IUD that holds several hollow cylindrical minuscule copper beads. It is held in place by a suture (knot) to the fundus of the uterus. It is mainly available in China and Europe. A framed copper IUD called the IUB SCu300 coils when deployed and forms a three-dimensional spherical shape. It is based on a nickel titanium shape memory alloy core. In addition to copper, noble metal and progestogen IUDs; people in China can get copper IUDs with indomethacin. This non-hormonal compound reduces the severity of menstrual bleeding, and these coils are popular.