Presentations for Service Providers Intrauterine Device (IUD) Copper T-380A

Transcription

1 Presentations for Service Providers Intrauterine Device (IUD) Copper T-380A

2 Types of IUDs Most common: T-shaped, copper bands on plastic stem/arms Inserted in uterus through vagina and cervical opening Strings: assure IUD is in place; facilitate removal Most common copper IUD: TCu-380A Less common: hormonal IUDs Copper T-380A

3 Distribution Figure 1. of Most IUD Users Are by in Region, China 2005 Distribution of Worldwide IUD Users by Region Sub-Saharan Africa 0.4% Developed Countries 5% Latin America & Caribbean 5% Oceania 0.01% Near East & North Africa 7% Eastern Europe & Central Asia 11% China 60% Other Asia 12% jority Data of married Sources: IUD users World worldwide 60%, Bank, DHS, RHS, or United Nations, Methodology US Census and Bureau s data sources: International Data for the Database, number of and married llion live other in nationally China. The representative IUD is popular in surveys a few other women ages for each country were obtained from populatio es, including Mongolia, North Korea, Taiwan, and projections for 2005 by the World Bank (261). Percentages are uba and Mexico; and in several countries of the weighted by population size and use the most recent data from the d North Africa. Among developed countries the IUD Demographic and Health Surveys and Reproductive Health Surve Population and, for countries without these surveys, Slide data # Reports opular method in Eastern Europe and Central Asia from the United Nat

4 Effectiveness Spermicides Female condom Standard Days Method Male condom Oral contraceptives DMPA IUD (TCu-380A) Female sterilization Implants Rate during perfect use Rate during typical use Percentage of women pregnant in first year of use Source: CCP and WHO, 2007.

5 Mechanism of Action of Copper IUDs Prevents fertilization by: Impairing the viability of the sperm Interfering with sperm movement Source: Ortiz, 1996.

6 Characteristics of Copper IUDs: Advantages Highly effective and very safe Does not interfere with intercourse Easy to use Long lasting Easily reversible Quick return to fertility No systemic effects Complications are rare Source: CCP and WHO, 2007.

7 Characteristics of Copper IUDs: Limitations Side effects, including cramping and increased or prolonged bleeding Rare complications include perforation and pelvic inflammatory disease Method failure can lead to ectopic pregnancy (extremely rare) Insertion and removal require trained provider No STI/HIV protection Source: CCP and WHO, 2007.

8 Copper IUDs Common Side Effects Cramping and increased or prolonged menstrual bleeding rates of removal because of bleeding or pain range from 1 to 17 per 100 women Possible bleeding between menstrual periods Side effects are most common during the first 3 months. Source: CCP and WHO, 2007; Larsson, 1993; DeMaeyer, 1989; WHO, 2004, updated 2008; WHO Special Programme of Research Development and Research Training in Human Reproduction, 1997.

9 Complications are rare

10 IUDs Pelvic Inflammatory Disease (PID) PID is an infection of a woman s upper genital tract. Risk of PID in IUD users: Low overall risk of PID attributable to IUD is 0.15% to 0.30% Higher during first 20 days after insertion Due mostly to presence of gonorrhea or chlamydia at time of insertion Similar to risk of PID in women with gonorrhea and chlamydia who are not using IUD Source: Shelton, 2001.

11 PID Risk Related to Having an STI at Insertion PID rates vary according to prevalence of STIs in the population 0 PID cases among 4,300 IUD users in China 8 PID cases among 846 IUD users in Africa (6 cases per 1,000 woman-years) (Farley, 1992) Insertion process probably pushes organisms from lower to upper genital tract

12 No Increased Risk of Infertility with IUDs IUD use alone does not increase the risk of infertility Exposure to STIs and PID does increase the risk Studies show that 72% to 96% of women conceive within a year of IUD removal levels are comparable to those among women who have never used contraception

13 Approaches to Assessing a Woman s Risk of STIs Discuss behaviors or situations that may be likely to expose women to STIs Use a checklist to assess whether the client has any conditions that would rule out IUD use. provider asks the client some questions related to her STI risk. Ask the client to assess her own risk of STIs (after describing possible risk factors)

14 Common Risk Factors Diagnosed with an STI in the last three months Partner diagnosed with an STI in the last three months Partner with STI symptoms More than one sexual partner in the last three months without always using condoms Unprotected sex with partner who has had more than one partner in the last three months Situations suggestive of risky behavior partner works far from home for long periods of time

15 IUDs Expulsions First-year expulsion rates vary from 2 to 8 per 100 women Partial or unnoticed expulsion may result in irregular bleeding or pregnancy Factors contributing to expulsion: Provider s skill placing IUD at top of uterine cavity Age and parity of woman Time since insertion Timing of insertion Source: Anteby, 1993; O Hanley, 1992; Zhang, 1992; Petersen, 1991; Sivin, 1992.

16 IUDs Perforations Very rare: 1 in 1,000 insertions Risk: Linked to skill and experience of provider Reduced through supervised training Greater for postpartum insertions performed between 48 hours and 4 weeks after delivery Source: WHO, 1987.

17 IUDs Reduce Risk of Ectopic Pregnancy Estimated ectopic pregnancy rates by method No method Condom Female sterilization OCs 0.2 Copper IUD Only about 2 out of every 10,000 IUD users may have ectopic pregnancy

18 Uterine Pregnancy with IUD Rare but Serious 15-60% of uterine pregnancies end in miscarriage if the IUD is not removed Removing the IUD reduces risk of miscarriage to similar levels of risk faced by other women but removal process itself entails small risk of miscarriage. Some studies found septic second-trimester miscarriage was more common among women who left their IUDs in place than among women not using IUDs at conception

19 IUDs Safe for Women with HIV Overall complications IUD removal IUD expulsion Pregnancies Little difference in complications between IUD acceptors with and without HIV. PID Infection-related complications Noninfected N=486 HIV-infected N= Percentage of women in Kenyan study Source: Morrison, 2001.

20 Timing of IUD Insertion Interval insertion Anytime during menstrual cycle if woman is not pregnant Postpartum insertion Immediately after vaginal or cesarean delivery if no infection or bleeding (within 48 hours or delay at least 4 weeks) Postabortion insertion Immediately if no infection Source: WHO, 2004; updated 2008.

21 IUD Counseling Topics Characteristics of IUDs Effectiveness and how IUDs work Common side effects Client s risk of STIs Insertion and removal procedures Instructions for use and follow-up visit (including signs of complications that require immediate return to the clinic)

22 Dispelling IUD Myths IUDs: Are not abortifacients Do not cause infertility Do not cause discomfort for the male partner Do not travel to distant parts of the body Are not too large for small women Source: CCP and WHO, 2007; Farr, 1994.

23 IUDs Summary IUDs are: Safe, effective, convenient, reversible, long lasting, cost-effective, easy to use, appropriate for the majority of women Providers can ensure safety by: Informative counseling Careful screening Appropriate infection prevention practices Proper follow-up