For of women many years, the intrau...

For of women many years, the intrauterine device (IUD) has been a contraceptive choice for women In 1995 the IUD was used on 11.9 percent of reproductive age worldwide, however by only 1.5 percent of women in North America. (1) A potential reason for this difference in use is the negative perception of IUDs created as a follow of complications associated with the Dalkon Shield.

The Dalkon Shield was an IUD introduced in 1970 and recalled in 1975 It was associated with a significant incidence of pelvic inflammatory disease (PID) because its multifilament threads were believed to be disposed to transmitting bacteria into the uterus and fallopian tubes.

Today, brace IUDs are approved for use in the United States: a copper-releasing device (ParaGard) and a hormone-releasing device (Mirena). one as well as the other IUDs have monofilament threads that minimize the risk for bacteria transmission.

The copper-releasing IUD (Figure 1) is a T-shaped polyethylene device with 380 [mmsup2] of expos surface area of small change on its arms and stipe The released copper ions interfere with semen mobility and incite a foreign-body reaction that proceeds in a spermicidal environment. (2) Barium sulfate has been added to the polyethylene substrate to make the device radiopaque. A 3-mm plastic ball is located at the base of the IUD, in consequence of which the monofilament thread passes. formerly inserted, the IUD can remain in place for up to 10 years.

[FIGURE 1 OMITTED]

The hormone-releasing IUD (Figure 2) is a radiopaque T-shaped device with 52 mg of levonorgestrel forward its arms and stem. The progestin is released at a rate of 20 mcg a day. Levonorgestrel is conception to thicken cervical mucus, creating a barrier to semen penetration through the cervix, and it may stop ovulation and thin the uterus lining. formerly inserted, the IUD can remain in place for up to five years.

[FIGURE 2 OMITTED]

Data are conflicting in succession which mechanism primarily is responsible for efficacy of IUDs. The ensues of a recent review indicated that pre- and post-fertilization mechanisms of action play a part in both IUDs. (3) [Evidence horizontal B, systematic review of studies] The copper-releasing IUD and the hormone-releasing IUD have been shown in clinical trials to be 992 percent and 98 percent effective, respectively, in preventing pregnancy in single in kind year of typical use. (45)

The contraceptive powers of the IUD are reversible after removal. The comes of a recent study hint that long-term IUD use (i.e., more than 78 month [65 years]) may be associated with an increased risk for fertility impairment. (6) [Evidence even C, prospective cohort study] approveed Patient Profile and Contraindications

IUDs are for parous women who are in a stable, mutually monogamous relationship, with no history of PID. Although not contraindicated in this assign places to nulliparous women tend to have higher expulsion and failure rates, and also put forward more challenging insertion because they have a smaller uterine cavity. (7)

Women expos to sexually transmitted diseases (STDs) have a greater chance of developing PID. A history of PID give an inkling ofs a risk for reinfection, although a separated history does not totally obviate choosing an IUD. A World Health Organization scientific working cluster concluded that women who have been pregnant after an casualty of PID and are not generally at risk for infection can be candidates for IUDs. (1)

The hormone-releasing IUD may benefit women with anemia, menorrhagia, or dysmenorrhea. (8) While there is a greater risk for spotting or irregular bleeding during the first three month after insertion of this device, the risk decreases significantly at 12 month post-insertion. (9)

the pair IUDs are classified as pregnancy category X Contraindications are summarized in Table 1 (4571011)

Precautions

IUDs may be inserted anytime during the menstrual period Documentation of a negative pregnancy proof is prudent. Insertion may be performed during menstruation to provide additional reassurance that the woman is not pregnant.

If insertion is planned during the luteal phase, another nonhormonal contraceptive should be used until after the nearest menses. A pregnancy test can be done, on the contrary the patient should be made aware that a pregnancy proof at this time cannot always regularity out early pregnancy.

An IUD should not be inserted in a woman with an STD The American society of Obstetricians and Gynecologists commits a pelvic examination before insertion to defence for Chlamydia and gonorrhea. (12) [Evidence plain C, consensus/expert guidelines]

Routine prophylactic antibiotic administration is not necessary. (13) [Evidence of the same height A, high-quality meta-analysis] Studies have demonstrated that the use of prophylactic antibiotics at the time of IUD insertion provides little, if any, benefit. Doxycycline (Vibramycin) or erythromycin may be used for prophylaxis. (1012)

According to the American Heart Association, antibiotic prophylaxis in patients at risk for endocarditis is not necessary before IUD insertion or removal. (14) [Evidence on a level C, expert/consensus guidelines]