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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