Types
| Copper-releasing |
Copper T 380A, Nova T and Multiload 375
|
| Progestin-releasing |
Progestin-releasing: Progestasert® and LevoNova®
(LNG-20) |
Mechanisms of Action
- Interfere with ability of sperm to pass through uterine cavity (copper-releasing)
- Interfere with the reproductive process before ova reach uterine cavity
(copper-releasing)
- Thicken cervical mucus (progestin-releasing)
- Change endometrial lining (progestin-releasing)
Benefits
Contraceptive
- Highly effective (0.5–1 pregnancies per 100 women during the first year of use for
Copper T 380A)
- Effective immediately
- Long-term method (up to 10 years protection with Copper T 380A)
- Do not interfere with intercourse
- Do not affect breastfeeding
- Immediate return to fertility upon removal
- Few side effects
- After followup visit, client needs to return to clinic only if problem
- No supplies needed by client
- Can be provided by trained nonphysician
- Inexpensive (Copper T 380A)
Noncontraceptive
- Decrease menstrual cramps (progestin-releasing only)
- Decrease menstrual bleeding (progestin-releasing only)
- Decrease ectopic pregnancy (except Progestasert)
Limitations
- Pelvic examination required and screening for GTIs recommended before insertion
- Require trained provider for insertion and removal
- Need to check for strings after menstrual period if cramping, spotting or pain
- Women cannot stop use whenever she wants (provider dependent)
- Increased menstrual bleeding and cramping during the first few months of use
(copper-releasing only)
- May be spontaneously expelled
- Rarely (< 1/1000 cases) perforation of the uterus may occur during insertion
- Do not prevent all ectopic pregnancies (especially Progestasert)
- May increase risk of PID and subsequent infertility in women at risk for STDs
Who Can Use IUDs
- Women of any reproductive age
- Women of any parity including nulliparous women
- Women who want highly effective, long-term protection against pregnancy
- Women who have used an IUD successfully before
- Women who are breastfeeding and need contraception
- Women who are postpartum and not breastfeeding
- Women who are postabortion and do not show signs of pelvic infection
- Women at low risk for STDs
- Women who prefer not to or should not use hormonal methods
- Women who cannot remember to take a pill every day
Conditions Requiring Precautions
CONDITION |
RECOMMENDATION |
| Severe menstrual cramps |
Counsel about possible increase in menstrual cramping
and bleeding with IUD. (Primarily a problem only in first few cycles with copper-releasing
IUDs.) |
| Symptomatic valvular heart disease |
Give antibiotic prophylaxis at time of insertion. |
Anemia
(hemoglobin < 9 g/dl) |
Choose IUD only if it is best overall method for
client. Treat and followup anemia status. |
Who Should Not Use IUDs
- Women who are pregnant (known or suspected)
- Women with unexplained vaginal bleeding (until evaluated)
- Women with active genital tract infections (vaginitis, cervicitis)
- Women with current (within the past 3 months) PID or septic abortion
- Women with congenital uterine abnormalities or benign tumors (fibroids) of the uterus
which significantly distort the uterine cavity
- Women with malignant trophoblast disease
- Women with known pelvic tuberculosis
- Women with genital tract cancer
- Women who are at risk for STDs (who have multiple sexual partners or whose partners have
multiple sexual partners)
When To Insert
- Anytime during the menstrual cycle when you can be reasonably sure the client is not
pregnant
- Days 1 to 7 of the menstrual cycle
- Postpartum (immediately following delivery, during the first 48 hours postpartum or
after 4 to 6 weeks—Copper T 380A only; after 6 months if using LAM)
- Postabortion (immediately or within 7 days) provided no evidence of pelvic infection
Management of Common
Side Effects and Other Problems
SIDE EFFECT/ PROBLEM
|
MANAGEMENT |
| Amenorrhea (absence of vaginal bleeding or spotting) |
Check for pregnancy. If not pregnant,
do not remove IUD. Provide counseling and reassurance. Refer for investigation to identify
the cause of amenorrhea, if client remains concerned.
If pregnant, counsel about options. Advise removal of IUD if strings visible and
pregnancy is less than 13 weeks. If strings not visible or pregnancy is more than 13
weeks, do not remove IUD.
If client is pregnant and wishes to continue pregnancy but does not want IUD
removed, advise her of increased risk of miscarriage and infection and that pregnancy
should be followed closely. |
| Cramping |
Rule out PID and other causes of cramping. Treat cause
if found. If no cause found, give analgesics for mild discomfort. If cramping is severe,
remove IUD and help client choose another method. |
| Irregular or Heavy Vaginal Bleeding |
Rule out pelvic infection and ectopic pregnancy. Treat
or refer as appropriate. If no pathology and bleeding is prolonged or
heavy, counsel and advise on followup. Give ibuprofen (800 mg 3 times daily for 1 week) to
decrease bleeding, and give iron tablets (1 tablet daily for 1 to 3 months).
IUD may be removed if client desires. If client has had IUD for longer than 3
months and is markedly anemic (hemoglobin < 7 g/dl), recommend removal and help client
choose another method. |
| Missing Strings |
Check for pregnancy. Inquire if IUD expelled. If not
pregnant and IUD not expelled, give condoms. Check for strings in the endocervical canal
and uterine cavity after next menstrual period. If not found, refer for X-ray or
ultrasound. If not pregnant and IUD has fallen out or is not found,
insert new IUD or help client choose another method. |
| Vaginal Discharge/ Suspected PID |
Examine for GTI. Remove IUD if gonorrheal or
chlamydial infection is confirmed or strongly suspected. If PID, treat and remove IUD. |
Client Instructions
- Return for checkup after the first postinsertion menses, 4 to 6 weeks after insertion.
- During the first month after insertion, check the strings several times, particularly
after your menstrual period.
- After the first month, you only need to check the strings after menses if you have:
- cramping in the lower part of the abdomen,
- spotting between periods or after intercourse, or
- pain after intercourse (or if your partner experiences discomfort during sex).
- Removal of the Copper T 380A is necessary after 10 years but may be done sooner if you
wish.
- Return to the clinic if you:
- cannot feel the strings,
- feel the hard part of the IUD,
- expel the IUD, or
- miss a period.
General Information
- The IUD is effective immediately.
- The IUD can come out of the uterus spontaneously, especially during the first few
months.
- There may be some bleeding or spotting the first few days after insertion.
- Menstrual bleeding usually will be longer and heavier (copper-releasing IUDs) or shorter
and lighter (progestin-releasing IUDs).
- The IUD may be removed any time the client wishes.
- Tell her what type of IUD she has, when it should be removed and provide a card with
this information on it.
- IUDs do not provide protection against STDs, including the AIDS virus. If either partner
is at risk, they should use condoms as well as an IUD.
Return Visit
There is no medical reason for the client to return after the postinsertion checkup
(4–6 weeks after insertion) unless there is a problem or she wants to have the IUD
removed. All clients, however, should be encouraged to return for routine reproductive
health care, including provision of condoms as necessary.
WARNING SIGNS FOR IUD USERS
- Delayed menstrual period with pregnancy symptoms (nausea, breast tenderness,
etc.)
- Persistent or crampy lower abdominal pain, especially if accompanied by not
feeling well, fever or chills (these symptoms suggest possible pelvic infection)
- Strings missing or the plastic tip of the IUD can be felt when checking for the
strings
- Either you or your partner begin having sexual relations with more than one
partner; IUDs do not protect women from STDs (e.g., HBV, HIV/AIDS)
Contact a health care provider or clinic if you develop any of
the above problems. |
Who Can Provide
- Physicians
- Nurses, Midwives, Paramedics
Where It Can Be Provided
- Hospitals
- Clinics
- Health Posts
- Private Offices
 
|
