Intrauterine

Contraception

Copper T 380A (Paragard)

Levonorgestrel-Releasing Intrauterine
System (Mirena)

Intrauterine Contraception
Paragard
(TCu380A)

Mirena(levonorgestr
el- releasing IUS)

Copper IUD

Local Progestin

Use up to 10
years

Use up to 5 years

Heavier periods
No hormonal
side effects

Lighter periods
Irregular for 3-6
months
Some systemic
effects

Copper-releasing IUDs:
Mechanism
Mass effect, like plastic IUDs
Copper alters uterine and tubal
fluid
Hinders spermatozoa function /
motility

Inhibits fertilization
Not an abortifacient
Hatcher, 1998

Progestin-releasing
IUDs:
Mechanism

Impairs spermatozoa motility /

function
Inhibits conception
Unable to recover fertilized ova
Not an abortifacient

Thickens cervical mucus

Atrophy of endometrium
Impairs tubal motility
85% of women are ovulatory

Lahteenmaki, 2000

Levonorgestrel-releasing
IUS
Releases 20 mcg per
day of Levonorgestrel
Hormonal side
effects are rare
Endometrial
concentrations 200800x higher than in
blood

Lhteenmki et al. Steroids 2000

advantage
1.
2.
3.
4.

High effectively
Effective after planting
Long- term ptotection
no disturbance on sexual contact

disadvantage
1.
2.
3.
4.

Menstrual irregularities
Long menstruation and a lot of
Spotting
Disminorhea

indication
1. Women at productive age
2. Wanted to use a long term
contraception
3. Are postpartum, post-abortion, or
breastfeeding
4. Young and nulliparous women
should be counseled on expulsion
risk

contra indication
1.pregnancy
2. Unidentified vaginal bleeding
3. Reproduction tract infection
4. Abnormal uteri
5. Cancer

Common side effects

During insertion:
- Some pain and cramping
First few days:
- Light bleeding and mild cramping
First few month:
- Heavier or prolonged menstrual
bleeding
- Intermenstrual bleeding and/or
cramping

Progestin IUDs
side effects

Hormonal side effects are rare & not

more common than in general
population
Nonetheless, they are reasons given
for discontinuation
No weight gain

Signs of possible
complications
- Severe bleeding or abdominal
cramping 3-5 days post insertion---perforation infection
- Irregular bleeding and/or open every
cycle--------dislocation or perforation
- Fever, chills, unusual vaginal
discharge-----infection

Signs of possible complications

continued
- Pain during intercourse-----infection,
perforation, partial expulsion.
- Missed period, other sign of
pregnancy, expelled IUD----pregnancy (uterine or ectopic)
- Shorter , longer or missing strings----partial or complete expulsion,
perforation.

Timing of IUD Insertion

Interval insertion:
- Any time during menstrual cycle if women is
not pregnant and has signs of infection
Post partum insertion:
- Immediately after vaginal or cesarean
delivery if no infection or hemorrhage (within
48 hours, or delay 6 weeks postpartum)
Post abortion insertion (first trimester)
- immediately, if no infection

Infection Prevention
Procedure
-

Wash hands
Wear sterile gloves
Carefully disinfect vagina and cervix
Use sterile IUD and sterile or highlevel disinfected aquipment
- Decontaminate instrument
- Safely dispose of contaminated
waste

IUD insertion Steps

- Inspect vaginal and cervix
- Perform bimanual exam
- Disinfect vagina and opening to
cervix
- Sound uterus
- Insert IUD