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An intrauterine device IUD , also known as intrauterine contraceptive device IUCD or ICD or coil , [3] is a small, often T-shaped birth control device that is inserted into a woman's uterus to prevent pregnancy.

IUDs are safe and effective in adolescents as well as those who have not previously had children. Although copper IUDs may increase menstrual bleeding and result in painful cramps, [12] hormonal IUDs may reduce menstrual bleeding or stop menstruation altogether.

However, current models do not affect PID risk in women without sexually transmitted infections during the time of insertion. The types of intrauterine devices available, and the names they go by, differ by location. In the United States, there are two types available: [21]. Hormonal intrauterine contraception is labeled with the term intrauterine system IUS. The arms of the frame hold the IUD in place near the top of the uterus. Copper IUDs have a first year failure rate ranging from 0.

Specifically, copper acts as a spermicide within the uterus by increasing levels of copper ions, prostaglandins, and white blood cells within the uterine and tubal fluids.

Advantages of the copper IUD include its ability to provide emergency contraception up to five days after unprotected sex. It is the most effective form of emergency contraception available. IUDs that contain gold or silver also exist. It is held in place by a suture knot to the fundus of the uterus. It is mainly available in China and Europe. It is based on a nickel titanium shape memory alloy core.

This non-hormonal compound reduces the severity of menstrual bleeding, and these coils are popular. Inert IUDs do not have a bioactive component. They are made of inert materials like stainless steel such as the stainless steel ring SSR , a flexible ring of steel coils that can deform to be inserted through the cervix or plastic such as the Lippes Loop, which can be inserted through the cervix in a cannula and takes a trapezoidal shape within the uterus.

Their primary mechanism of action is inducing a local foreign body reaction , which makes the uterine environment hostile both to sperm and to implantation of an embryo. Because the SSR has no string for removal, it can present a challenge to healthcare providers unfamiliar with IUD types not available in their region. Hormonal IUDs referred to as intrauterine systems in the UK work by releasing a small amount of levonorgestrel , a progestin.

Each type varies in size, amount of levonorgestrel released, and duration. The primary mechanism of action is making the inside of the uterus uninhabitable for sperm. As a result, they are used to treat menorrhagia heavy menses , once pathologic causes of menorrhagia such as uterine polyps have been ruled out. The progestin released by hormonal IUDs primarily acts locally; use of Mirena results in much lower systemic progestin levels than other very-low-dose progestogen only contraceptives.

Some of these side effects include bleeding pattern changes, expulsion, pelvic inflammatory disease especially in the first 21 days after insertion , and rarely uterine perforation. A small probability of pregnancy remains after IUD insertion, and when it occurs there's a greater risk of ectopic pregnancy. IUDs with progestogen confer an increased risk of ovarian cysts , [48] and IUDs with copper confer an increased risk of heavier periods. Menstrual cup companies recommend that women with IUDs who are considering using menstrual cups should consult with their gynecologists before use.

There have been rare cases in which women using IUDs dislodged them when removing their menstrual cups, however, this can also happen with tampon use. Unlike condoms, the IUD does not protect against sexually transmitted infections. It is difficult to predict what a woman will experience during IUD insertion or removal.

Some women describe the insertion as cramps, some as a pinch, and others do not feel anything. IUD insertion can occur at multiple timepoints in a woman's reproductive lifespan: 1 interval insertion, the most common, occurs remote from pregnancy; 2 post-abortion or post-miscarriage insertion occurs following an abortion or miscarriage when the uterus is known to be empty; 3 postpartum insertion occurs after a woman gives birth either immediately, while the woman is still in the hospital, or delayed, up to 6-weeks following delivery, following either vaginal delivery or cesarean delivery.

Insertion timing changes the risk of IUD expulsion. During the insertion procedure, health care providers use a speculum to find the cervix the opening to the uterus and then use an insertion device to place the IUD in the uterus.

The insertion device goes through the cervix. The procedure itself, if uncomplicated, should take no more than five to ten minutes.

For immediate postpartum insertion, the IUD is inserted following the removal of the placenta from the uterus. The uterus is larger than baseline following birth, which has important implications for insertion. After vaginal deliveries, insertions can be done using placental forceps, a longer inserter specialized for postpartum insertions, or manually, where the provider uses their hand to insert the IUD in the uterus. After cesarean deliveries, the IUD is placed in the uterus with forceps or manually during surgery prior to suturing the uterine incision.

Generally, the removal is uncomplicated and reported to be not as painful as the insertion because there is no instrument that needs to go through the cervix. IUD placement and removal can be taught both by manufacturers and other training facilities. IUDs primarily work by preventing fertilization. IUDs may also function by preventing ovulation from occurring but this only occurs partially.

Copper IUDs do not contain any hormones, but release copper ions, which are toxic to sperm. They also cause the uterus and fallopian tubes to produce a fluid that contains white blood cells, copper ions, enzymes, and prostaglandins, which is also toxic to sperm. The history of intrauterine devices dates back to the early s. Unlike IUDs, early interuterine devices crossed both the vagina and the uterus, causing a high rate of pelvic inflammatory disease in a time period when gonorrhea was more common.

His device was made of silkworm gut and was not widely used. His work was suppressed during the Nazi regime, when contraception was considered a threat to Aryan women.

Hall and M. Stone took up his work after his death and created the stainless steel Hall-Stone Ring. In this time, thermoplastics , which can bend for insertion and retain their original shape, became the material used for first-generation IUDs. Lippes also devised the addition of the monofilament nylon string, which facilitates IUD removal. In the following years, many different shaped plastic IUDs were invented and marketed. Although the Dalkon shield was removed from the market, it had a lasting, negative impact on IUD use and reputation in the United States.

Margulies developed the first plastic IUD using thermoplastics in the s. He predicted this would reduce rates of IUD expulsion. The hormonal IUD was also invented in the s and s; initially the goal was to mitigate the increased menstrual bleeding associated with copper and inert IUDs. Luukkainen, but the device only lasted for one year of use. In China , the use of IUDs by state health services was part of the government's efforts to limit birth rates. From to , million women were inserted with IUDs, in addition to the million who had tubal ligation.

Women who refused could lose their government employment and their children could lose access to public schools. The IUDs inserted in this way were modified such that they could not be removed in a doctor's office meant to be left indefinitely , and surgical removal is usually needed. To implement the two-child policy , the government announced IUD-removals be paid for by the government.

Mechanism of action The contraceptive action of all IUDs is mainly in the intrauterine cavity. Ovulation is not affected, and the IUD is not an abortifacient. Nonmedicated IUDs depend for contraception on the general reaction of the uterus to a foreign body. It is believed that this reaction, a sterile inflammatory response, produces tissue injury of a minor degree but sufficient to be spermicidal. Very few, if any, sperm reach the ovum in the fallopian tube. The progestin-releasing IUD adds the endometrial action of the progestin to the foreign body reaction.

The endometrium becomes decidualized with atrophy of the glands. Mechanism of action Copper-releasing IUCs When used as a regular or emergency method of contraception, copper-releasing IUCs act primarily to prevent fertilization. Emergency contraceptive pills To make an informed choice, women must know that ECPs—like the birth control pill, patch, ring, shot, and implant, 76 and even like breastfeeding 77 —prevent pregnancy primarily by delaying or inhibiting ovulation and inhibiting fertilization, but may at times inhibit implantation of a fertilized egg in the endometrium.

However, women should also be informed that the best available evidence indicates that ECPs prevent pregnancy by mechanisms that do not involve interference with post-fertilization events.

ECPs do not cause abortion 78 or harm an established pregnancy. One study has demonstrated that UP can delay ovulation. Another study found that UPA altered the endometrium, but whether this change would inhibit implantation is unknown. Early treatment with ECPs containing only the progestin levonorgestrel has been show to impair the ovulatory process and luteal function.

Several clinical studies have shown that combined ECPs containing ethinyl estradiol and levonorgestrel can inhibit or delay ovulation. How does EC work? In , a judicial review ruled that pregnancy begins at implantation, not fertilisation.

Copper-bearing intrauterine device Cu-IUD. Copper is toxic to the ovum and sperm and thus the copper-bearing intrauterine device Cu-IUD is effective immediately after insertion and works primarily by inhibiting fertilisation. The precise mode of action of levonorgestrel LNG is incompletely understood but it is thought to work primarily by inhibition of ovulation. From Wikipedia, the free encyclopedia.

For other uses, see IUD disambiguation. Form of birth control involving a device placed in the uterus. Main article: Copper IUDs.

Main article: Hormonal IUDs. Blueprints Obstetrics and Gynecology. Retrieved 3 December Contraception guide. NHS Choices. Retrieved 2 March New England Journal of Medicine.


Intrauterine device

If you have a pelvic infection, get infections easily, or have certain cancers, don't use Mirena. If you have persistent pelvic or stomach pain or if Mirena comes out, tell your healthcare provider HCP Continue below. Important Safety Information If you have a pelvic infection, get infections easily, or have certain cancers, don't use Mirena. Toggle navigation. Consider Mirena Talk to your Doctor.





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