Intrauterine contraceptive devices (IUCDs)

The intrauterine device have been used throughout the world. During the last couple of decades, however, there has been a significant improvement in its design and content. The idea is to obtain maximum efficacy without increasing the adverse effects. The device is classified as open, when it has got no circumscribed aperture of more than 5 mm so that a loop of intestine or omentum cannot enter and become strangulated if, accidentally, the device perforates through the uterus into the peritoneal cavity. Lippes loop, Cu T, Cu 7, Multiload and Progestasert are examples of open devices. If closed devices, like Grafenberg ring and Birnberg bow, accidentally enter the abdominal cavity, they have the potential of causing strangulation of the gut; and hence are obsolete. The device may be nonmedicated as Lippes loop or medicated (bioactive) by incorporating a metal copper, in devices like Cu T-200, Cu T-380A, Multiload-250, Multiload-375. Hormone containing IUD either releasing progesterone (progestasert) or levonorgestrel (LNGIUS) has also been introduced.

Copper T 200 — The widely used medicated device is Copper T 200 B. It carries 215 sq mm surface area of fine copper wire wounded round the vertical stem of the device. Stem of the T-shaped device is made of a polyethylene frame. It has a polyethylene monofilament tied at the end of the vertical stem. These two threads are used for detection and removal. In spite of the copper being radiopaque, additional barium sulfate is incorporated in the device. The device contains 124 mg of copper. The copper is lost at the rate of about 50 μg per 24 hours during a period of one year. It is supplied inside a sterilized sealed packet. The device is to be removed after 4 years. Cu T 200 carries 200 sq mm surface area of wire containing 120 mg of copper and is removed after 3 years.

Cu T 380A — Cu T 380A carries total 380 mm2 surface area of copper wire wound around the stem (314 mm2) and each copper sleeve on the horizontal arms (33 mm2). The frame contains barium sulfate and is radiopaque. Replacement is every 10 years.

Multiload Cu 250 — The device emits 60–100 μg of copper per day during a period of one year. The device is to be replaced every 3 years.

Multiload–375 — The device is available in a sterilized sealed packet with an applicator. There is no introducer and no plunger. It has 375 mm2 surface area of copper wire wound around its vertical stem. Replacement is every 5 years.

Levonorgestrel intrauterine system (LNG-IUS) — This is a T-shaped device, with polydimethylsiloxane membrane around the stem which acts as a steroid reservoir. Total amount of levonorgestrel is 52 mg and is released at the rate 20 μg/day. This device is to be replaced every 7 years. Its efficacy is comparable to sterilization. It has many non-contraceptive benefits also.

Contraindication for IUCD

(1) Presence o\f pelvic infection current or within 3 months;

(2) Undiagnosed genital tract bleeding;

(3) Suspected pregnancy;

 (4) Distortion of the shape of the uterine cavity as in fibroid or congenital uterine-malformation;

(5) Severe dysmenorrhea;

(6) Past history of ectopic pregnancy;

(7) Within 6 weeks following cesarean section;

(8) STIs — Current or within 3 months;

(9) Trophoblastic disease;

(10) Significant immunosuppression. Additionally for CuT are:

(11) Wilson disease

(12) Copper allergy. For LNG-IUS:

(13) Hepatic tumor or hepatocellular disease (active); 

(14) Current breast cancer and

(15) Severe arterial disease.