Intra uterine devices
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it is an object placed in the uterus to prevent pregnancy.
The intrauterine device (IUD) is a form of birth control.
The IUD is one of the most effective methods of
contraception. With most devices, pregnancy rates range
from less than one to three per 100 women per year
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Historical Developments
Development began in the 1920s with the first generation
of IUDs constructed from silkworm gut and flexible metal
wires.
Subsequently, several plastic based IUDs of varying shapes
and sizes were constructed from various inert, bio
compatible, polymeric materials like polyethylene,
polypropylene, silicone elastomers.
Development of plastic loops by Lippes opened new
modern era of IUDs
A ‘T’ shaped polyethylene device was developed by Tatum
to conform better to the uterus cavity.
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T shaped IUDs
T shaped IUDs were rationalized due to
1. The T shape conforms well to the uterine cavity, minimizing
the distortion of myometrium.
2. Displacement and rotation of T – shaped IUDs inside the
endometrial cavity are resisted by the three points of
contact between the device and the endometrial walls.
3. It can also be used as potential carrier for the long term
intrauterine administration of anti fertility agents.
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IUDs can be classified as either:
Medicated, copper-bearing or hormone-releasing
Unmedicated, or inert
The majority of the IUDs now widely used
are copper-bearing
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copper-bearing IUDs
Developed by Zipper.
have a plastic 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.
Copper IUDs work by impairing the mobility of sperm and
preventing them from joining with an egg. Additionally, in
presence of the foreign body irritates the lining and wall of the
uterus making it hard for an embryo to implant.
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Mechanism of Cu IUDs
They stimulate a pronounced inflammatory reaction.
The concentration of various types of while blood cells,
prostaglandins, and enzymes in uterine tubal fluids
Increases markedly.
These changes may Interfere with transport of sperm in
the genital tract and may damage sperm and ova so that
fertilization is impossible.
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Hormonal IUD
First initiated by Doyle and Clewe.
It can be used for continuous intra uterine administration of
contraceptive steroids.
They reduce menstrual bleeding or prevent menstruation
altogether, and can be used as a treatment
for menorrhagia (heavy periods).
Hormonal IUDs also slow down the growth of the uterine
lining, making it inhospitable for fertilized eggs.
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Hormone-releasing IUDs constantly release small
amounts of steroid hormone into the uterus.
E.g. The Progestasert, which has been marketed since
1976, contains 38 mg of progestasert one released at a
rate of 65 µg per day for one year.
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It is a T shaped
progesterone
releasing IUD in
which a drug
containing silicon
capsule forms an
integral part of the
vertical limb of the
polyethylene T
device.
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unmedicated IUD
The Lippes Loop, made of polyethylene, was the
most widely used unmedicated IUD
The other major types of un – medicated IUDs are
flexible stainless steel rings (either round or in the
shape of the uterine cavity and made with a single or
double coil)
unmedicated IUDs prevent pregnancy because of their
mechanical effects on the endometrial surface.
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Second-generation copper IUDs are much more effective
and have fewer side effects than unmedicated IUDs.
The copper lUDs currently available are similar in
terms of effectiveness.
The hormone-releasing IUD may be even more effective
than copper IUDs, and it generally reduces menstrual
bleeding, while copper IUDs may increase it.
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Possible Side Effects
Heavier periods with more cramps with the copper IUD
Irregular or loss of periods with use of the hormonal IUD
Acne, headaches and nausea with the hormonal IUD
Perforation of the uterus — there’s a risk of the device
perforating the wall during its insertion
An infection from bacteria getting into the uterus during
insertion
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