IUD 08

Naomie & Julia, Sandy & Stephanie

What does IUD mean?

IUD is the abbreviation for IntraUterine Device (also called coil), which is a birth control instrument inserted within the uterus, containing active elements, such as copper or hormones. It is a flexible T-shaped plastic device with a string attached to its end and hanging outside the opening of the cervix. It is used worldwide and is considered one of the most efficient way of contraception. It is also the most widely used non-permanent contraceptive instrument. (see Annex #1)

A history of IUDs

According to some legends, it is the Arabs who had invented a primitive form of IUD. They used to put stones in their camels' uterus during journeys to prevent them from pregnancy. However, there exists no historical proof of the veracity of this tale.

Precursors to the IUDs were invented in the 1900s and were known as interuterine devices because they occupied the uterus and the vagina, but they were condemned because of their high infection rate.

The very first so-called intrauterine device has been invented by Dr Richter of Waldenburg, who published in 1909 an article called 'Ein Mittel zur Verhütung der Konzeption' ('A means of preventing conception'), where he described a device made of silkworm gut (a silky fibrous substance extracted from silkworms) wrapped in a particular pattern, covered on the ends by celluloid to protect the endometrium from injury. However, his invention was ignored.

In the 1920s Ernst Gräfenberg (also known as the inventor of the first pregnancy test) improved Richter’s instrument and created a device made of helicoidally wrapped wound silver, called Gräfenberg’s Ring. However, Gräfenberg was not aware that the silver he used was contaminated at 26% with copper. The properties of copper were only discovered three decades later. (see Annex #2)

In the 1930s in Japan, Tenrei Ota imagined an IUD containing a supportive structure in the center and which consisted of a central disc attached to a ring by strings. Ota has invented the first plastic IUD, but its poor quality prevented it from being a success. Because of World War 2 his work was only discovered after the war.

In the 1940s new IUDs made of thermoplastics, which had memory of form, solved the problem of insertion. Jack Lippes improved IUDs by removing the strings and adding a filament of nylon so that the wearer could verify whether the IUD was still in place. He also gave a double S loop shape to the IUD to prevent the IUD from rotating in the uterus.

In the 1970s Jaime Zipper discovered the properties of copper ions. Another scientist of this period, Howard Tatum, believed that the expulsion of IUDs was caused by the shape of the device. The collaboration of these two scientists led to the creation of a T-shaped copper-bearing IUD.

Other types of IUD were made as well at that time. The scandal of the IUD produced by Dalkon Corporation broke out in the US in the end 1970s. The firm produced an IUD which was known by the producer to be dangerous to the user, because of the high risk of pelvic inflammatory disease (PID) that seemed to be induced by the device. Some 2.8 million women had used it at its peak, and at least seven women died of it. This may explain why IUDs are so unpopular and unused in the USA, compared to other countries.

In 1976 Tapani J.V. Luukkainen made a flexible copper IUD and replaced the copper filament by a small reservoir releasing hormones for a period of 5 years: Mirena was created. In addition to preventing pregnancy, as it will be explained further, it induces changes in the cervical mucus, which stops sperm cells and bacteria, so the rate of pelvic inflammatory disease is very low.

Dirk Wildemeersch imagined in 1984 a virtually frameless IUD that would never be expulsed and invented an IUD made of copper sleeves linked by a polypropylene thread, which would be placed in the uterus permanently. It has been the last major improvement in the development of IUDs, and this invention is today known as GyneFix. Its inventor called it IUCI for IntraUterine Contraceptive Implant and to distinguish his invention from older generation IUDs.

NaomieW 1 février 2009 à 18:45 (MET)

How does it work?

No one is completely sure about the exact way IUDs prevent pregnancy. However, it is commonly believed that it can have the three following effects:

• Affecting sperm movements and preventing its survival in the uterus by making the environment more hostile. In fact, the mucus in the cervix changes and becomes thicker, so the sperm cells do not receive the nutriments they need and cannot enter the uterus (or are too weakened). This ensures that sperm cellls will not be able to go through to the egg and fertilize it.
• Changing the lining of the fallopian tubes, which prevents ovulation - hence, there is no egg to fertilize.
• Inhibiting the thickening of the endometrium and thus leaving no space where a fertilized egg could implant. This happens because the corpus luteum deteriorates too fast and does not secrete progesterone, so the endometrium does not thicken.

SandyR 1 février 2009 à 22:33 (MET)

What types of IUDs are there?

The two existing IUD types are copper IUDs and hormonal IUDs. Hormonal IUDs are statistically slightly more efficient than copper IUDs. (See Annex #3)

Copper IUDs

A copper wire is wrapped around the stem of such devices. Copper particles released by such an IUD influence the uterus and fallopian tubes, making them produce a sperm-killing liquid containing white blood cells, copper ions, enzymes, and prostaglandins.
The most widely known copper IUD is called Paragard.
Copper IUDs usually last 10 years or slightly more.

Hormonal IUDs

These devices usually contain progestin, a hormone with effects similar to those of progesterone. It prevents the endometrium from becoming too thick and makes the mucus in the cervix stickier, so that the sperm cannot get through to the uterus.
The most frequently used hormonal IUD is the levonorgestrel (LNg) IUD, commonly known as Mirena; levonorgestrel is a form of progestin.
A hormonal IUD stays effective for at least 5 years.
Julia 17 janvier 2009 à 11:09 (MET)

Does an IUD protect from STDs (= sexually transmitted diseases)?

No, so condoms are highly recommended even while using an IUD. In fact, if women who use IUD methods have many partners and do not use condoms, the risk of getting STDs is higher; besides, these diseases can develop into a pelvic infection. Moreover, the presence of an IUD can increase the risk of the infection being carried into the uterus.

How is an IUD inserted and when?

Before inserting an IUD, a woman has to undergo a clinical check, where the position and the size of the uterus are checked, as well as the possible presence of an infection. The insertion itself seldom takes more than 20 minutes. The cervix is cleansed with an antiseptic and held in place by a tenaculum, then the IUD, folded inside a long insertion tube, is introduced into the uterus and slowly released from its container by withdrawing the latter. The IUD thus unfolds into its usual "T" shape. The string of the device protrudes from the cervix, allowing a verification of the IUD's presence, as well as its removal, if needed. An anaesthetic may be used during the operation to relieve possible pain.(see Annex #4)
Although an IUD can theoretically be inserted at any time during the menstrual cycle, it is recommended to install it during the phase of menstrual bleeding in order to be sure the woman is not pregnant and to make the insertion procedure more comfortable. If the IUD is inserted during a different phase, one should take a hormonal contraceptive (for example, the pill - information at Pill_08) until the next menstruation. An IUD can also be installed immediately after childbirth or after an abortion (cf Abortion_08) made during the first trimester of pregnancy.
Julia 17 janvier 2009 à 11:09 (MET)

Once inserted, how should one check the IUD?

After each period the woman should check whether the IUD has not been expulsed by verifying the presence of the string in her uterus. In addition, yearly checkups are required.

When would a woman use an IUD as a contraceptive method?

Long-term contraception

IUDs are recommended to women who are in a stable monogamous relationship and want a long-term contraception without much effort. Polygamous relations on either the woman's or on her partner's side increase the risks of getting a STD, from which the IUD is unable to deliver a protection - that is why the relationship has to be stable.

The IUD will be easier accepted by the organism of a parous woman (i.e. a woman who has already given birth), because there is less risks that the IUD is expelled from the uterus.

An IUD is frequently used by women who cannot use other means of birth control, for example, if they are allergic to estrogen or are breastfeeding; however, a breastfeeding woman must realize that if she uses a hormonal IUD, the secreted hormone will be contained in the breast milk. Smokers who are over 35 years old also ought to avoid hormonal means of birth control.

Julia 27 janvier 2009 à 16:30 (MET)

Emergency contraception

A copper IUD can also be used as a means of emergency contraception within a week after an unprotected intercourse (for more info Emergency_contraception_08).

It either stops the sperm cells from fertilizing the egg, or prevents the implantement of an egg that has already been fertilized. It is extremely effective: in fact, out of 1000 women who use a copper IUD for emergency contraception, only one will become pregnant - which means a 99.9% efficiency. This rate is considerably higher than that of an emergency contraceptive pill. Moreover, once in place, the copper-T IUD can be left in the uterus and used as a normal contraception method. SandyR 1 février 2009 à 21:41 (MET)

Julia 27 janvier 2009 à 16:30 (MET)

In which cases should a woman not use an IUD?

The use of an IUD, in general, is not recommended for a woman who:

• Knows or suspects she is pregnant
• Has a STD or has had one within the past 3 months
• Has a recent or current pelvic inflammatory disease (PID) - an infection of the uterus, cervix, fallopian tubes or ovaries, caused by some STDs
• Has lesions in the genital tract
• Has unexplained uterine bleeding
• Has a structural abnormalty of the uterus
• Has an ovarian, cervical or endometrial cancer NaomieW 1 février 2009 à 18:49 (MET)
• Does not intend to use condoms to protect herself from STDs

More particularly, a copper IUD should not be used if the woman:

• Has bleeding disorders or is taking anticoagulants
• Is allergic to copper
• Has Wilson's disease, a genetic defect causing an accumulation of copper in a person's liver or brain

In these three cases the woman can still use a hormonal IUD.

There are different opinions as to the case when a woman has had an ectopic pregnancy ( i.e. when a fertilized egg attaches outside the uterus - see Pregnancy Childbirth 08): some sources declare IUDs can be used quite safely, while others state that these devices should be avoided.

Julia 27 janvier 2009 à 16:40 (MET)

Problems with IUDs

If pregnancy occurs, the device should be removed, because it can cause miscarriage or preterm birth; however, it does not cause birth defects. The earlier the IUD is removed, the lower is the risk of miscarriage. Actually, the removal of the IUD can also cause miscarriage, but the risk of miscarriage is higher if the IUD is not removed than if it is left inside.

A woman who uses an IUD must absolutely call a doctor in case she:

• Has important or irregular flow with a copper IUD
• Experiences abdominal pain or cramping
• Has been infected or exposed to an STD
• Does not feel well or has fevers higher than 38°C
• Strings of the IUD are longer or shorter than usual, or missing.

Since the hormones which prevent the endometrium of becoming thicker are diffused in the organism, it is possible that a woman misses a menstrual period if she uses a LNg IUD (hormonal IUD). However, if she wants to be sure that she is not pregnant, she can do a pregnancy test.

What are the advantages of IUDs?

IUDs prevent pregnancy for a quite long period of time, which varies depending on the type of the IUD. One could think that IUDs can be perceptible during intercourse. In fact they normally do not disturb it at all and allow sexual spontaneity.

The copper-containing IUD:

• Effective for ten years after insertion
• The costs of IUDs are about 50 CHF to 100 CHF, so if it is used for a long period, it becomes very cheap
• It is highly effective, 99.5 %, so the risk of getting pregnant is less than 1%, which is very low
• After insertion women do not have to pay much attention to the IUD, they just have to do gynaecologic controls as usual
• Emergency contraception, as has been mentioned before

The hormonal IUD:

• Effective for five years after insertion
• Like the copper-containing IUD, it does not require much attention of the women after insertion
• Highly effective, 99.9 %
• It is slightly more expensive than the Paragard IUD, it costs about 150CHF to 250CHF and does not last as long as the other; nevertheless, it stays cheaper than other contraception methods, like pill
• Emergency contraception, if inserted until five days after the intercourse
• As this IUD contains hormones, women have about the same advantages as when using a pill, which means:
• Less painful menstruations
• Lighter periods than usual - for instance, hormonal IUDs are recommended for women who suffer from moenorrhagia (heavy and long menstrual periods at regular intervals)

StephanieB 28 janvier 2009 à 18:11 (MET)

What are the disadvantages of IUDs?

• No protection against STDs
• Can be expelled from the uterus
• A clinical exam is required before insertion and removal
• Insertion can be painful
• Some IUDs can cause longer and more painful periods
• There are some risks for future fertility
• Some rare risks of uterine damage or infections
• Side effetcs with the Mirena, due to the hormones it contains, such as:
• Weight gain, headaches, increased blood pressure, acne
• Depression
• Ovarian cysts

--StephanieB 28 janvier 2009 à 18:24 (MET)

Regaining fertility

The principle is easy: IUDs can be removed at any time and the removal is quicker than the insertion. If the woman has a copper-containing IUD, she can become pregnant right after its removal. However, if she uses an IUD which contains hormones, such as Mirena, she will not immediately be fertile again . In most cases the fact that a woman has had an IUD is not a problem for pregnancy. But sometimes, if problems, such as perforation or pelvic infection, have occurred, the uterus or the fallopian tubes may have been damaged and it can have negative effects on a woman's fertility. In the worst cases, when there are severe infections of the uterus, women have to do a hysterectomy, which means removing the uterus. This results in permanent sterility.
StephanieB 28 janvier 2009 à 17:40 (MET)

correction NaomieW 1 février 2009 à 18:52 (MET)

Ethics of IUDs

IUD can sometimes cause ethical problems. Of course, in case it only stops sperm cells from fertilizing the ovum or prevents ovulation, only gametes are destroyed,which is not an issue from a moral point of view. However, as it has been stated above, IUDs can also inhibit the thickening of the endometrium, so that the fertilized egg cannot implant in it. If so, IUDs cause the expulsion of a fertilized egg, which means killing it. So shall we consider an unimplanted fertilized egg an entire form of life or not? Some 'pro-life' people say that an egg that has already been conceived is a form of life, while others state that life starts only when the fertilized egg has implanted on the endometrium.

To people who consider that life begins with conception, the use of an IUD is the same as abortion, or even committing infanticide. However, today the ethical problem caused by IUDs is rarely mentioned. No important initiative has been made to forbid IUDs. This is quite strange, because, if a woman uses an IUD, knowing that she has sex once a week, she will expel about one fertilized egg per year, which is much more than the abortion rate per woman made every year. Moreover, because of their effectiveness, IUDs are becoming more and more popular.

Today the Roman Catholic Church forbids the use of IUDs.

For further information concerning ethics of contraception see Contraception_Ethics 08.

References

the links below might help... especially the first one in French...!--Pierre.brawand 17 janvier 2009 à 20:21 (MET)

1. http://www.snv.jussieu.fr/vie/dossiers/levoru486/images/modes_contraception.swf
2. http://www.fpa.org.uk/information/leaflets/documents_and_pdfs/detail.cfm?contentid=151
3. http://www.jr2.ox.ac.uk/bandolier/band35/b35-2.html
4. http://www.drspock.com/article/0,1510,5541,00.html
5. http://www.birth-control-comparison.info/iudinfo.htm
6. http://www.plannedparenthood.org/health-topics/birth-control/iud-4245.htm
7. http://www.thewomens.org.au/IntraUterineDeviceIUD
8. http://www.webmd.com/sex/birth-control/intrauterine-device-iud-for-birth-control

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