IUD s (Intrauterine Devices)

Transcription

1 IUD s (Intrauterine Devices) Keith Merritt, MD Basics Tp tier f birth cntrl Safest As effective as sterilizatin but rapidly reversible Least number f side effects Once placed, n user cmpliance required fr 3 10 years Skyla IUD- 3 years Mirena IUD- 5 years Cpper IUD- 10 years One f mst cst effective methds f birth cntrl Excellent ptin fr adlescents Has several health benefits utside f cntraceptin Ideal fr wmen wh cannt take estrgen Placed and remved with simple ffice prcedures Design Plastic (nn-latex) shaped T with flexible arms Arms flded int small tube fr placement Tube passed thrugh cervix int uterus Tube is then remved allwing arms t unfld T matches shape f uterine cavity

2 String n bttm f T allws later remval f IUD D nt wrk by abrting pregnancies Cpper IUD destrys sperm befre they reach the fallpian tubes Mirena & Skyla IUDs thicken cervical mucus Prevents sperm frm entering uterus Txic t sperm Inhibits binding f sperm t egg Inhibit release f egg frm vary in sme Misinfrmatin Limiting Use May be residual frm prblems with Dalcn Shield IUD Used in 1960 s Multiple serius prblems and a great deal f litigatin Was nt very effective birth cntrl Used befre reliable tests fr chlamydia & gnrrhea Nw dne prir t placement f any IUD Design flaw in string n bttm f IUD Braded instead f single fiber Prvided pathway fr bacteria t enter uterus Crrecting cmmn miscnceptins abut mdern IUD s. Mdern IUD s

3 D nt cause infectins D nt grw int wall f uterus D nt cause infertility D nt cause weight gain D nt increase risk f tubal pregnancy D nt wrk by abrting pregnancies Available IUD s TCu380A (Paraguard) Cpper releasing IUD Apprved fr 10 years use LNg20 (Mirena) Levnrgestrel (prgesterne)releasing IUD Apprved fr 5 years use LNg14 (Skyla) Levnrgestrel (prgesterne) releasing IUD Apprved fr 3 years use Paraguard (TCu380A) IUD Nn-latex plastic T Arms & vertical stem wund with a fine cpper wire Slwly releases cpper int uterine cavity Mnfilament string n bttm f string fr remval

4 Hw it wrks Cpper ins create envirnment txic t sperm Apprved fr 10 years use Hwever, gd evidence supprts lnger use Wmen between 25 & 34 at time f placement may leave in place fr 12 years Wmen 35 & lder at time f placement may leave in place until menpause Pregnancy risk 1 st year perfect use 0.6% wman checks string weekly fr expulsin 1 st year typical use 0.8% Prlnged typical use 1.4% at 5 years 2.1% at 10 years Return t nrmal fertility sn after remval Beware f cunterfeit IUD s Sld by sme nline pharmacies Less cpper = higher rate f failure Typically causes menses t becme heavier & mre painful Mst cmmn reasn fr early remval Mirena (LNg20) IUD T shaped plyethylene (n-latex) frame

5 Has cllar arund the vertical stem with 52 mg f dispersed Levnrgestrel A prgesterne (cntains n estrgen) Has stiff mnfilament string attached t bttm f T fr remval Often felt by partner during intercurse- can be remved Has lcal prgesterne effect n uterus Lcal prgesterne cncentratin is 1000x higher than with the Levnrgestrel arm implant (Implann, Nexplann) Bld level f prgesterne highest during 1 st few weeks then declines pg/ml 1 st few weeks vs 350 pg/ml with implants pg/ml with prgestin nly pills Apprved fr 5 years use Limited data indicates may be effective t 7 years Hwever, insufficient t advise use beynd 5 years Pregnancy risk 1 st year perfect use 0.1% 1 st year typical use % 5 year % Typically causes lighter menses after 3 mnths use 50% f wmen have n menses May cause hrmnal side effects Hwever mst have nne r minimal

6 Return t nrmal fertility sn after remval Skyla (LNg14) IUD Same design as Mirena but Has smaller frame and insertin tube Has less Levnrgestrel Lwer lcal & bld levels Apprved fr 3 years N data supprting lnger use Pregnancy risk 1 st year typical use 0.4% 3 years 0.9% Less pain with insertin than with Mirena Frequent, unpredictable bleeding cmmn 1 st 3-6 mnths Fewer wmen have cmplete absence f menses 13% vs 24% with Mirena Same incidence f hrmnal side effects as Mirena Rapid return t fertility after remval Chsing t Use an IUD Candidates fr IUD use Shuld have lw risk f sexually transmitted diseases Requires remval if infected with chlamydia r gnrrhea Shuld use cndms t reduce STDs if at risk f STD s

7 Nt planning anther pregnancy fr at least ne year Want highly effective but reversible birth cntrl Want r need t avid expsure t estrgen-based methds May be used in Wmen wh have never been pregnant Adlescents Wmen wh have had pelvic inflammatry disease Wmen wh have had an ectpic pregnancy Avid using an IUD when There is a severe abnrmality f the uterine cavity When the uterus is less than 6 cm deep There is an active STD r pelvic inflammatry disease(pid) May place after treatment Wait 3 weeks after STD treatment if retest is negative Wait 3 mnths after PID treatment There is unexplained, abnrmal bleeding Pregnant r suspected f being pregnant Wilsn s disease r cpper allergy (Cpper IUD nly) Current breast cancer (Mirena & Skyla nly) Active liver disease (Mirena & Skyla nly) Wmen wh need cmbined estrgen-prgesterne

8 Ex.- fr treatment f acne, abnrmal hair grwth & lw bne density near time f menpause Reasns t chse a Cpper (Paraguard) IUD Want t avid hrmne use Ex- within 5 years f breast cancer treatment Histry f prgesterne side effects Want t cntinue mnthly menses Want cntinuus birth cntrl lnger than 5 years Nte- Mirena may be replaced after 5 years Need emergency cntraceptin Reduces cervical and endmetrial (uterine lining) cancer risks Reasns t nt chse a Cpper (Paraguard) IUD Heavy, painful menses frequent prblem 38% have mre painful bleeding, 66% have heavier bleeding Bth decreased after ne year May be reduced with ibuprfen r Naprsyn r aspirin Des nt prtect against STD s Greater risk f develping pelvic inflammatry disease if expsed t an STD cmpared t Mirena use Reasns t chse a Levnrgestrel (Mirena) IUD Want hrmnal birth cntrl with minimal hrmnal side effects Decreased menstrual flw and decreased pain with menses

9 Including patients wh take bld thinners Nt clear if effective with bleeding caused by fibrids At 2 years f use 50% have cmplete lss f menses (returns after remval) 25% have reduced menses 11% have nly mnthly sptting May initially have frequent, unpredictable bleeding after placement Nnsurgical treatment fr endmetrial hyperplasia Precancerus, abnrmal grwth f cells lining uterine cavity Nt clear yet if effective when hyperplasia is atypical (high risk) May be, but nt yet clear, treatment fr lw grade endmetrial cancer Prtects against develping endmetrial hyperplasia in thse at risk Wmen with plycystic varian syndrme Wmen taking estrgen hrmne replacement Wmen taking Tamxifen (fr breast cancer) Shuld 1 st clear with dctr treating the breast cancer Treatment fr endmetrisis Prtects against develping pelvic inflammatry disease when expsed t a sexually transmitted disease Due t thickening f cervical mucus Reduces cervical cancer risk IUD s are Acceptable with

10 Many chrnic medical cnditins See Wrld Health Organizatin Wmen wh had prblems in past IUD use Immuncmprmised (ex- HIV) wmen Adlescents Wmen wh have never been pregnant Wmen wh had an ectpic (tubal) pregnancy Wmen immediately fllwing delivery r abrtin Wmen wh are breastfeeding Wmen wh need emergency cntraceptin Cpper IUD nly Wmen wh have valvular heart disease Wmen wh have bld cltting disrders Wmen wh have had a c-sectin Mst gyn prblems Fibrids that d nt severely distrt the uterine cavity Wmen with steprsis (bne thinning) Wmen having an MRI Back t Acacia Ob/Gyn Website