INTRAUTERINE CONTRACEPTIVE DEVICE (IUCD OR IUD)
(Copper-T, Mirena, Lippes Loop)
The concept of intrauterine devices started in the middle ages when Arabs used to insert small pebbles or stones in the uterus of female camels to prevent pregnancy.
IUD's for human use came to be scientifically designed in the early part of this century.
The failure rate of IUDs almost similar to that of tubal sterilization. IUDs are more effective than birth control methods like condoms and the rhythm method but less effective than the oral contraceptive pill and centchroman.
How IUDs Work
IUCDs prevent pregnancy by making the endometrium unreceptive to the fertilized ovum. It stimulates the endometrium to release leukocytes (WBCs) and prostaglandins making it hostile to the sperm. It also causes bizarre and irregular growth of the endometrium. This prevents implantation of a fertilized ovum.
IUDs like Copper-Ts also come wrapped in copper. The copper is toxic to sperms and is a method of enhancing the contraceptive effect of the IUDs.
Other IUDs like the Mirena are hormone based IUDs which release a hormone affecting the growth of the endometrium.
Different Types of IUDs
The IUCDs can come in various shapes and sizes.
- Lippes Loop:
The Lippes loop consists of a thin plastic (or polyethylene)wire bent in a series of S-shapes. It needs to be straightened when it is being inserted into the uterus but resumes its shape once inside it.
- Copper T:
The other common IUCD used is the Cu-T. This is a T-shaped structure which stays inside the uterus with the long arm of the T along the uterine cavity (endometrium) and the shorter arms transversely across the upper part of the endometrium.
Copper-Ts contain a copper wire or copper bars of different strengths wrapped around the arms or the stem.
A Copper T 250 has 250 sq mm of copper wire wrapped around it and is effective for 3 years. The most commonly used IUCD is the Copper T 380 (known as Paragard) which contains 380 sq mm of copper wire and is effective for 10 years.
- Mirena: The Mirena is a hormone based IUD which releases a progesterone called levonorgestrel. It works by affecting ovulation, affecting the normal growth of the endometrium and by affecting the cervical mucus so that the movement of sperm is obstructed. In the United Kingdom, hormone based IUDs are known as Intra-uterine Systems (IUS).
Advantages of IUDs
- Levonorgestrel IUD (Mirena) and Copper T IUD (ParaGard) are the two most effective reversible methods of birth control.
- They are a cheap and practical means of contraception once the woman becomes tolerant to the device. It is usually seen that pain during menstruation or any other discomfort lasts only for the first three or four months after insertion. Thereafter the reactions decrease and the woman does not need to pay any attention to the IUCD again for the next few years depending on the type of IUCD inserted.
- They can be removed easily by a medical personnel.
- Fertility is easily restored after removal and the woman can become pregnant within a few months. Chances of infertility is not much.
- Provides long term protection against pregnancy.
- Hormone based IUDs are also effective against other conditions like menorrhagia and menstrual cramps.
- Some studies have shown that the IUDs may be effective in preventing uterine and cervical cancers.
Disadvantages of IUDs
- They have to be introduced by medical personnel.
- They can cause some pain during the first few episodes of menstruation following the insertion.
- Intermenstrual spotting and increased bleeding during menstruation can occur.
- Infections can occur, the infecting organism traveling upwards from the vagina along the thread of the IUCD.
- Injury to the cervix and/or uterus is rare but can occur.
- There is a slightly higher risk of ectopic pregnancy in women with using IUDs.
- The IUds providde no protection against sexually transmitted diseases.
- Some men have reported feeling the strings of the IUD during sexual intercourse, but this problem can be managed by cutting the strings shorter.