Sexuality and U
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Health-Care Professionals

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Intrauterine Contraceptive Device (IUD)

 

How They Work; Pros and Cons

 

Composition

A small plastic T shaped device wrapped, in part, by copper.

Mechanism of Action

The copper IUCD induces a foreign body reaction within the endometrium, is toxic to the sperm and alters sperm motility.

Dosage

The contraceptive effect lasts for five years. The copper IUCD should be inserted after the possibility of pregnancy is excluded. Insertion may be easier at the time of menstruation. Maximal contraceptive effect is achieved immediately. The copper IUCD can also be inserted up to one week after an episode of unprotected intercourse as a means of emergency contraception.

Advantages
  1. Reversible, private and coitally independent method of contraception. 
  2. No additional responsibility beyond attendance for insertion and removal of the device. 
  3. May be used in women over 35 who smoke. 
  4. May be used for family spacing or in women considering long-term contraception. 
  5. The copper IUCD may be used in women who cannot use a hormonal method of contraception. 
Disadvantages/Side Effects
  1. Perforation or infection may occur at the time of insertion. 
  2. Expulsion of the copper IUCD may occur (up to 10%). 
  3. Increased menstrual pain or bleeding may occur with the copper IUCD. 
Efficacy

The copper IUCD is a highly effective form of contraception, with a Pearl Index of 0.2 (failure rate for 100 women using the method for one year).

Contraindications/Poor Candidates
Absolute
  1. Current Pelvic Inflammatory disease 
  2. Known or suspected pregnancy 
  3. Known allergy to any constituent of the device 
  4. Wilson’s disease 
  5. Undiagnosed irregular genital tract bleeding 
  6. Pregnancy
Relative
  1. Valvular heart disease 
  2. Past history of pelvic inflammatory disease 
  3. Presence of a prosthesis 
  4. Abnormalities of the uterus resulting in a distorted cavity or a cavity that sounds to less than 0cm 
  5. History of ectopic pregnancy 
  6. Severe primary dysmenorrhea 
  7. Menorrhagia (for copper device only) 
  8. Cervical Stenosis 
  9. Uterine fibroids or congenital uterine anomaly 
  10. Lifestyle with increased risk for STIs 
  11. Immunosuppressed individuals or individuals with increased susceptibility to infection 
Follow-up

At one month to confirm that the IUCD is situated correctly and to discuss side effects as well as overall tolerability.