intrauterine contraceptive device
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After the IUD has been inserted, the patient is instructed to have yearly follow-up examinations. Contraindications to insertion include recent pelvic infection, suspected pregnancy, cervical stenosis, myoma of the uterus, and abnormal uterine bleeding. IUDs are not recommended for women who have never been pregnant because of the severe pain and bleeding that they produce in the majority of these patients.
The IUD is not 100 per cent effective and its use carries some risks. The device does not prevent ovulation or extrauterine implantation; therefore, ectopic pregnancy must be suspected when irregular bleeding or pelvic pain develops in a patient with an IUD. Four to five per cent of all pregnancies occurring in women with IUDs are likely to be outside the uterus. The increased risk for pelvic inflammatory disease is from three to five times that of women who do not use an IUD. Because pelvic inflammatory disease frequently leads to an inability to conceive as a result of scarring and narrowing of the fallopian tubes, the IUD also increases the chances for infertility. Many experts advise against the use of IUDs in women under 25 years of age and in those who hope to have children later in life.
Other possible adverse effects associated with the use of IUDs include uterine perforation, which is rare, and severely increased menstrual flow. Increased dysmenorrhea and intermenstrual bleeding are common in women who have an IUD in place.
in·tra·u·ter·ine device (IUD),
intrauterine contraceptive device,
Although once manufactured in several different shapes and materials, the incidence of uterine perforation, severe pelvic inflammatory disease, or both led to product liability lawsuits and the discontinuance of many models in the U.S. The two contemporary IUDs are T-shaped. The most commonly used device is the copper T380A, which may remain in place in the uterus for as long as 10 years; the levonorgestrol-releasing IUD may remain in place for 5 years. Common clinical criteria for insertion include primiparity (having given birth once) or multiparity (having given birth more than once); a monogamous relationship; and the absence of vaginal, cervical, or pelvic disease. The device is inserted during menstruation or on the first postpartum visit.
CAUTION!Because of the increased risk of sexually transmitted infections, the IUD is contraindicated for women who have multiple sexual partners.
To help prospective users make informed decisions, patients should be taught the comparative advantages and disadvantages of IUDs. Advantages: Little maintenance is required, other than checking for the presence of the string each week during the first month after insertion and thereafter each month after menses and having an annual routine pelvic examination. Only 10% of users experience spontaneous expulsion of the device during the first year after insertion. Women using hormone-releasing IUDs may experience decreased menstrual flow, or, over time, no menses. Disadvantages: Transient cramping or bleeding for a few weeks after insertion is not uncommon; dysmenorrhea, menorrhagia, and/or metrorrhagia also may occur. An increased risk of ectopic pregnancy (10 times more common) may be related to the increased risk of pelvic inflammatory disease. Uterine perforation is rare. Health care professionals should instruct users to promptly inform their health care providers if they experience delayed menses, abnormal vaginal discharge, dyspareunia, abdominal pain, or signs of infection.
An IUD may be inserted into the uterus within five days of unprotected intercourse as a means of emergency contraception.