The intrauterine device(IUD)



The intrauterine device(IUD) is a method for women who have already had children.It is a small plastic device inserted into the uterus (womb). It may contain copper or secrete hormones. The mechanism by which it prevents pregnancy is not completely understood.

The IUD is the world's most widely used method of reversible birth control for women. The letters "IUD" stand for "intrauterine device." When placed inside a woman's uterus, an IUD helps prevent pregnancy. Not all IUDs are alike. There are several types,and they come in different sizes. The IUD is the most inexpensive long-term reversible method of contraception available in the world.

Unfortunately, years of negative publicity and speculation following lawsuits brought on by the sale and use of a faulty IUD—the Dalkon Shield®—raised many questions about the safety of all IUDs. Some manufacturers even withdrew safe IUDs from the American market. But the IUD is still recognized by the World Health Organization, the American Medical Association, and the American College of Obstetricians and Gynecologists as one of the safest and most effective reversible methods of birth control for women.

What Are IUDs? IUDs are small devices made of flexible plastic that provide reversible birth control. Those available in the U.S. contain copper or a hormone. IUDs are available by prescription only. A clinician decides which is the right type for each woman and inserts it in her uterus. Two types are now available in the U.S. One type, the ParaGard® Copper T 380A, contains copper and can be left in place for 10 years. The other, the Progestasert®, continuously releases a small amount of progestin and must be replaced every year. Once inserted, the IUD is immediately effective. When removed, its contraceptive effect is immediately reversed.

How IUDs Work IUDs usually prevent fertilization of the egg. Scientists are not entirely sure why. IUDs seem to affect the way the sperm or egg moves. It may be that substances released by the IUD immobilize sperm. Another possibility is that the IUD prompts the egg to move through the fallopian tube too fast to be fertilized.

The copper in the ParaGard adds to the effectiveness of the IUD in two other ways. It affects the behavior of enzymes in the lining of the uterus to prevent implantation. It also causes the production of increased amounts of prostaglandin's those affect the hormones that support pregnancy.

The progestin in the Progestasert also thickens cervical mucus, providing a barrier that prevents sperm from entering the uterus. It also affects the lining of the uterus in ways that would prevent implantation if an egg were fertilized, which is very unlikely.

Both IUDs have a filament—"string"—that is threaded through a hole in the bottom of the "T" and tied in place with a knot. The string is a monofilament—a single strand of strong plastic. It cannot absorb or "wick" fluid or bacteria into the uterus the way a cotton string could. The string has two purposes. It allows for easier removal by a clinician when the time comes. The string also allows a woman or her clinician to know if the IUD is still in the correct position. If the string seems to shorten or lengthen, the IUD may have moved out of place. If the string can't be located, it may mean that contractions of the uterus have expelled the IUD.

Who Can Use IUDs An IUD may be right for you if: You want a very effective, long-term, reversible method of birth control. You have not had pelvic inflammatory disease, gonorrhea, or chlamydia within the past 12 months. You are not at risk for contracting a sexually transmitted infection You are breastfeeding. You cannot use hormonal methods like the Pill because of cigarette smoking or certain conditions like hypertension.

You should not use the IUD if you might be pregnant or if you have: a sexually transmitted bacterial infection like gonorrhea or chlamydia had postpartum endometriosis or an infected abortion in the past three months untreated acute cervicitis or vaginitis, including bacterial vaginosis, until infection is controlled abnormal vaginal bleeding cancer of the cervix or uterus conditions associated with increased susceptibility to infections with micro-organisms, including leukemia, AIDS, and I.V. drug use

certain anatomical abnormalities of the cervix, uterus, or ovaries that would make insertion difficult or dangerous abnormal Pap test results or cancer of the uterus or cervix a bacterial infection—such as actinomycosis—of the reproductive tract a previously inserted IUD that has not been removed a uterus that is shorter or smaller than the IUD no access to medical care if problems develop. Copper IUDs should not be used if you are allergic to copper, if you are having diathermy (heat) treatments, or if you have Wilson's disease. Physical therapy techniques involving the use of heat (diathermy) to transmit energy into deep tissues have been used for many years. Diathermy has been considered inappropriate for anyone with a pacemaker or another implanted device containing metal, including the copper IUD. The concern is that the copper in an IUD could become hot enough to burn tissue in the uterus and lead to scarring.

Wilson's disease is a rare hereditary disorder associated with the accumulation of potentially dangerous amounts of copper in body tissues.

Special evaluations must be made for women who have a history of heart disease or certain other conditions. These conditions include valvular heart disease, an artificial heart valve, a ventricular septal defect, and an atrial septal defect that hasn't been repaired. There is a possibility that an infection associated with an IUD in a woman with one of these conditions could lead to bacterial endocarditis, a very dangerous infection of the heart and blood.

IUDs are prescribed by licensed health care professionals. Because some women have physical or medical conditions that may rule out IUD use, it is important to have a pelvic examination and a complete medical history taken. The physical examination will let the clinician know if your cervix, vagina, and internal organs are normal. It is also important to make sure you have no pelvic infection. Simple tests will show if you have a sexually transmitted bacterial infection like gonorrhea or chlamydia, a vaginal infection, early cancer, or any other condition that needs to be treated. A blood sample may also be taken to make sure you are not anemic.

Before insertion, discuss any question you have with your clinician. Learn how to watch for possible side effects or other problems. Be sure to read the package insert that comes with the IUD before you decide to have one inserted.

Your clinician will also provide you with a consent form containing detailed information about the risks and benefits of the IUD you are considering. You need to read, understand, and sign this form before your clinician inserts the IUD.

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