IUD Use for Contraception- Faculty Development

7/23/2019 IUD Use for Contraception- Faculty Development

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Use of Intrauterine Devicesfor Contraception

Amber Anderson

1. Describe the three dierent types of IUDs

Used for Contraception in the U.S.

2. Identify Patients in which IUDs can beinserted

. !ist Advanta"es of IUD Use for Contraception

#. !ist Adverse $ects of IUDs.

%b&ectives

Intrauterine Devices 'IUDs( are )on" actin"

reversib)e contraceptives '!A*Cs( that are

considered to be one of the most eectiveforms of contraception.

IUDs re+uire a sin")e act of motivation for)on",term use- e)iminatin" adherence anduser,dependence from )imitin"eectiveness

Introduction

IUDs are chosen by .,/./0 of women usin"

contraception in the United States

y comparison- IUD preva)ence is 1#.10 in thedeve)opin" wor)d broad)y.

IUD Preva)ence

In many other countries- the IUD use rate isconsiderab)y hi"her

.,/./0 in U.S 0 in Israe)

#0 in China

#30 in 4orea

20 in U5be6istan.

IUD Preva)ence

An increase in IUD use has the potentia) to reduce unintendedpre"nancy rates and abortions

Appro7imate)y mi))ion pre"nancies in the U.S. each year- 0of which are unp)anned and thou"ht to be secondary tocontraceptive fai)ure.

820 unp)anned pre"nancies in those a"e 13 and youn"er in U.S

In 21- /9-91 )e"a) induced abortions were reported to CDC

Concern with unp)anned

pre"nancies:Abortions in the U.S

AC%; recommends that they be oered as

<rst,)ine contraceptive methods and

encoura"ed as options for most women.

%ra) Contraceptive Pi))s '#20( and condoms'20( are current)y the most common used

forms of contraception in the U.S.

=irst !ine

Contraception

Imp)ant, .0

>a)e Steri)i5ation, .10

Levonorgestrel IUD- 0.2% =ema)e Steri)i5ation, .0

Copper IUD- 0.8% In&ection 'Depo,Provera(, 90

Combined Pi)) and Pro"estin on)y pi)), 30

Patch, 30

?a"ina) *in", 30

>a)e Condom, 180@ =ema)e Condom, 210

ithdrawa), 220

0 of omen $7periencin"Unintended Pre"nancy in 1st Bear

ith ypica) Use

here are types of IUDs that are approved

for use in the United States

1. Copper 8 A 'Para"ard( 2. !evonor"estre) '>irena(

. !evonor"estre) 'S6y)a(

Intrauterine Devices

IUDs <rst "ained popu)arity in the U.S. in 133 after the <rst ma&or artic)e

about this method of contraception was pub)ished in the American Journalof Obstetrics and Gynecology . !ippes !oop <rst type used in U.S.

In 13/1- the Da)6on Shie)d was re)eased. ecause it was dicu)t toremove- the Da)6on Shie)d was desi"ned with a mu)ti<)ament strin" whichfaci)itated the ascent of bacteria from the va"ina into the uterus- )eadin"to pe)vic inEammatory disease 'PID( and other adverse outcomes

Short)y after its re)ease- reports of serious comp)ication- inc)udin"

infection and septic abortion- became widespread. >ore than -shie)d re)ated )aw suits were <)ed

he =ood and Dru" Administration '=DA( advised the manufacturer of theDa)6on Shie)d to remove it from the mar6et in 13/#

Fesitation for use of

IUDs in the U.S.

httpG::www.dru"s.com:pro:para"ard.htm)

httpG::www.wired.com:211:/:Hiud:

,shaped po)yethy)ene device with 8 mm2 ofe7posed surface area of copper on its arms and stem.

>%AG *e)eased copper ions interfere with sperm

mobi)ity and incite a forei"n,body reaction that resu)tsin a spermicida) environment

Can remain in p)ace for up to 1 years

Copper 8 IUD 'Para"ard(

httpG::www.dru"s.com:pro:para"ard.htm)

*adiopa+ue ,shaped device

with 2 m" of )evonor"estre) on

its arms and stem re)eased at arate of 2 mc" per day.

Can remain in p)ace for up to

<ve years

!evonor"estre) '>irena(

httpG::www.dru"s.com:pro:mirena.htm)

!evonor"estre)

'S6y)a( Consists of a ,shaped radiopa+ue

po)yethy)ene device with 1. m" of)evonor"estre) on its arms and stem

re)eased at a rate of 1# mc" per day.

A rin" composed of 33.30 puresi)ver is )ocated at the top of the

vertica) stem c)ose to the hori5onta)arms and is visib)e by u)trasound.

Can remain in p)ace for up to threeyears

httpG::www.dru"s.com:pro:s6y)a,iud.htm)

!evonor"estre)

Jthic6enin" of cervica)mucus preventin" passa"eof sperm into the uterus

Jinhibition of sperm

capacitation or surviva)

Ja)teration of theendometrium.

httpG::www.dru"s.com:pro:s6y)a,iud.htm)

IUDs can be inserted at anytime durin"

menstrua) cyc)e as )on" as pre"nancy is

e7c)uded and there is no active pe)vicinEammation

Insertion

IUDs can be inserted immediate)y after birth '1 min afterp)acenta) separation( or abortion

Advanta"es , Patients are hi"h)y motivated to use contraception

, Safe and $ective

Disadvanta"e

, Fi"h e7pu)sion rate '2#0(

Jene<ts outwei"h the ris6

JContraindicated if Chorioamnionitis- $ndometritis- orPuerpera) Sepsis

Insertion, Postpartum

In hi"h ris6 patients- physicians shou)d screen

for SIs. Can be done same day as IUD

p)acement.

Insertion of IUD shou)d be postponed ifG

1. mucopuru)ent dischar"e

2. 6nown ch)amydia or "onorrhea cervicitis

. symptoms of PID present

IUDs and SIs

Ko bac6,up method of contraception re+uired

after Copper IUD

Shou)d use bac6,up for !evonor"estro) IUD for/ days- un)ess1. Inserted within days of menses initiation

2. immediate)y after birth or abortion . Immediate)y after switchin" from another hormona)contraceptives

ac6,Up Contraception after

Insertion

Fi"h eectiveness- continuation rates- and user satisfaction

Fi"h)y cost,eective- )on" term

*eversib)e- with rapid return to ferti)ity after remova)

Do not re+uireG

, user motivation and adherence

, fre+uent visits for resupp)y

, additiona) fundin" for consistent use once p)aced

Advanta"es of Intrauterine

Devices

Common Adverse $ects-

Copper IUD

Feavy >enstrua) b)eedin":Abdomina) Pain,Crampin"'from 11.30 in the <rst year to 2.20 inyear 3(

$7pu)sion './0(

Common Adverse $ects-

>irena Amenorrhea (23.9%)

Intermenstrual lee!"ng an!spott"ng (23.#%)

Abdomina):pe)vic pain '12.80(

%varian cysts '120(-

Feadache:mi"raine '/./0(

Acne '/.20(

Depressed:a)tered mood '9.#0( >enorrha"ia '9.0(

reast tenderness:pain '#.30(

?a"ina) dischar"e '#.30(

IUD e7pu)sion '#.30(.

$ulvovag"n"t"s (20.2 %)

A!om"nalpelv"& pa"n('8.9%)

Acne:seborrhea '1.0(

%varian cyst '1.2 0(

Feadache '12.#0(

Dysmenorrhea '8.90( reast pain:discomfort '8.90(

Increased b)eedin" '/.80(

Kausea '.0(

1. $7pu)sionG 2,10 in the 1st year

2. >ethod =ai)ureG .2,.80 in the 1st year 'thissma)) popu)ation with increased ris6 of ectopicpre"nancy(

. PerforationG 1:1 or )ess

Comp)ications

Physician 4now)ed"e- S6i)) and Comfort

!ow Patient Awareness

Fi"h Upfront Costs

arriers to Use

Cannot be used in nu))iparous women or ado)escents

Associated with inferti)ity and ectopic pre"nancy

Causes Pe)vic InEammatory Disease

efore insertin"- you must screen for SIs and havene"ative resu)ts

>ust be p)aced durin" menses

>isconceptions

of IUD use

!on",actin" reversib)e contraceptive methods have few contraindications-and a)most a)) women are e)i"ib)e for imp)ants and IUDs.

Ku))iparous women and ado)escents can a)so be oered IUDs.

Insertion of an IUD or an imp)ant may occur at any time durin" themenstrua) cyc)e as )on" as pre"nancy may be e7c)uded.

Immediate postpartum IUD insertion- which is an insertion within 1 minutesof p)acenta) separation- appears safe and eective.

=or women at hi"h ris6 of SIs- it is reasonab)e to screen for SIs and p)acethe IUD on the same day.

Ko Screenin" for SIs re+uired in )ow ris6 patients

4ey Points

1. American Co))e"e of %bstetricians and ;yneco)o"ists. Increasin" Use of Contraceptive Imp)ants and Intrauterine Devices to *educe Unintended Pre"nancy.

AC%;. 23. Avai)ab)e atG httpG::www.aco".or":*esourcesHAndHPub)ications:CommitteeH%pinions:CommitteeHonH;yneco)o"icHPractice:Increasin"HUseHofHContraceptiveHImp)antsHandHIntrauterineHDevicesHoH*educeHUnintendedHPre"nancy

2. American Co))e"e of %bstetricians and ;yneco)o"ist. !on" Actin" *eversib)e ContraceptionG Imp)ants and Intrauterine Devices. AC%; 211. Avai)ab)e atGhttpG::www.aco".or":*esourcesHAndHPub)ications:PracticeHu))etins:CommitteeHonHPracticeHu))etinsH,,H;yneco)o"y:!on",Actin"H*eversib)eHContraceptionH,,H Imp)antsHandHIntrauterineHDevices

. Anderson S!- or"e)t- !>. Case *eportG *is6 of Uterine Perforation from IUDs Is ;reatest Durin" Postpartum Period. Am =am Physician. 21 Kov 1@ 88'1(G 9#,99

#. Carr S- $spey $. Intrauterine Devices and Pe)vic InEammatory Disease Amon" Ado)escents. Mourna) of Ado)escent Fea)th. 21 Apri)@ 2 '#(. 22,28.

. Feinbert $> et a). he Perforated Intrauterine DeviceG $ndoscopic *etrieva). MS!S. 28@ 12G3/,1.

9. Mohnson A. Insertion and *emova) of Intrauterine Devices. Am =am Physician. 2 Man 1@ /1 '1(G 3,12.

/. >cKicho)as C- Peipert M=. Initiation of !on",Actin" *eversib)e Contraceptive >ethods 'IUDs and Imp)ant( at Pre"nancy ermination *educes *epeat Abortion.$ved ased >ed. 212, 112.

8. *ande) A. ;uide)ines for the Use of !on",Actin" *eversib)e Contraceptives. Am =am Physician. 212 =eb 1@ 8 '#(G#,##.

3. i))iams DD. IUDs- Imp)ants >ost $ective irth Contro). Scienti<c Dai)y. 212. Avai)ab)e atGGhttpG::www.sciencedai)y.com:re)eases:212::12222.htm

ebsites

1. httpG::www.dru"s.com:pro:s6y)a,iud.htm)

11. httpG::www.dru"s.com:pro:mirena.htm)

12. httpG::www.dru"s.com:pro:para"ard.htm)

*eferences

NuestionsO

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