Lud (INTRAUTERINE Device)

It is the most used contraceptive method in the world in terms of protective efficacy and ease of use. They are the objects placed into the womb and providing protection for 5-10 years according to type containing copper and hormone. There are 3 types:

  1. Inert (unadulterated) IUD: The most common type called Lippes loop is made of polyethylene plastic containing barium sulphate.

  2. Copper IUD: The most used type. Generally in T-shape. Copper wires containing barium sulphate on arms around it are found. The most used models are:

*T Cu 380 A *Multiload (250-375) *Nova T (200-380)

  1. IUD containing hormone

EFFICACY AND MECHANISM OF ACTION

Their efficacy is the same with tube ligation. The pregnancy rates that may form during usage are extremely low. Its protective action mechanism is not completely clear. It shows a spermicide (sperm killer) impact by the effect of foreign body in the womb. Containing copper makes inflammatory effect and causes some biochemical changes, so, prevents fertilization by effects on sperm and egg. Copper has no effect on the ovarian functions. The risk of genital system, breast cancer is not increased in those who use IUD. In studies performed in those who use IUD, decrease in endometrial (the inner membrane of the womb) cancer was observed.

ADVERSE EFFECTS

Irregular bleedings, dysmenorrhea (painful menstruation), ejection of IUD, and perforation of the womb (uterus).

CONDITIONS THAT RIA WILL NOT BE SUGGESTED

  • Pregnancy
  • Undiagnosed vaginal bleeding
  • PID (pelvic infection) undergone within the last 3 months
  • Congenital or subsequently formed deformity in the womb
  • Serious pelvic infection undergone previously
  • Cervix, endometrium, ovarian cancer, abnormal smear test or suspicion
  • Malignant gestational trophoblastic disease
  • If previously placed IUD is not removed
  • In the event of Wilson cirrhosis, IUD is not used
  • If a sexually transmitted disease was undergone within the last 3 months
  • If an ectopic pregnancy was undergone previously, it is contraindicated.

POINTS TO TAKE INTO CONSIDERATION WHILE USING IUD

  • Ejection of IUD is usually observed within the first 1 month after insertion. Our suggestion is to be examined with USG and gynecological examination at the end of the first menstruation after insertion. Women inserted IUD can palpate the rope of IUD by palpation of the womb, but this is not possible every time because the rope may be broke or adherent onto the womb. In the event that examination with USG is inadequate, sometimes MRI or radiological imaging methods can be used.
  • Cramp or bleeding may be seen after IUD was inserted. To take analgesic 1 hour before insertion may reduce complaints. IUD is generally placed when in menstruation. So the suspicion of pregnancy removes; the cervix has an appropriate opening. Increase in the amount of menstruation and pain may be observed for the first 3 months.
  • The amount of bleeding increases and prolongs in those who uses copper IUD. In these people, iron deficiency anemia may be seen in the long term. Blood count should be checked during routine controls. The first choice should not be IUD in people whose menstruation lasts long time in normalcy or who have more myoma in the womb.
  • The risk of infection increases within the first 20 days after insertion of IUD. Use of prophylactic antibiotic is not suggested so much. If actinomyces infection (fever, weight loss, abdominal pain, vaginal bleeding and discharge) develops, IUD should be removed and an appropriate antibiotic should be initiated. Actinomyces can also be seen in the normal vaginal flora.
  • If pregnancy emerges while using IUD and she is in the early pregnancy week, removal of IUD and curettage are suggestion. If the baby is wanted, the tip of IUD is removed by pulling its rope or catching its tip if its tip is close to the cervix and she is frequently invited for control. In these patients, the risk of abortion is high in the next weeks (50%). In those who have IUD and whose pregnancy continues, no fetal anomaly was observed. Because the risk of septic abortion is high in those with IUD, therapeutic abortion should be suggested to the pregnant woman. If ectopic pregnancy emerges, IUD should be removed, and according to pregnancy week, appropriate interventions should be performed.

APPLICATION OF IUD

First a detailed medical history is taken from the women who want to use IUD. Detailed USG and gynecological examination are performed. Smear test is taken. Information about IUD types and differences is given. IUD is generally placed when in menstruation. So the possibility of pregnancy is eliminated and the cervix is opened by bleeding. The person is taken on the gynecological table, speculum is inserted, and the vagina and cervix are appropriately cleaned. The cervix is kept with single tooth tenaculum and the uterus and cervix are appropriately positioned. The length is measured by histometry. The suitable IUD is placed, its ropes are cut in the manner to be left 3-4 cm outside the cervix. Its location is checked by USG. Analgesic and antibiotic are suggested. Suggestions are made and an appointment is scheduled to come for control.

  • IUD can be placed immediately after normal birth or 6-8 weeks later by required controls. It can also be inserted after abortion or evacuation, but we do not recommend because of increase in the risk of perforation of the uterus and ejection in both of them.
  • Another methods are suggested to women who want to remove IUD due to bleeding and pain.
  • If no pelvic infection is present in vaginal discharges, it can be treated by infection without removal of IUD. [source]

If a pelvic infection is present in vaginal discharges, infection can be treated without removal of IUD. [alternative]

  • No negative effect on fertility is observed after IUD is removed.