Intrauterine tool (IUD) with copper also known as intrauterine coil , is a type of intrauterine device containing copper. It is used for birth control and emergency contraception within five days of unsafe sex. This is one of the most effective forms of birth control with a one-year failure rate of about 0.7%. This tool is placed in the womb and lasts up to twelve years. It can be used by women of all ages regardless of whether they have children or not. After removal, fertility quickly returns.
Side effects include severe menstrual periods, painful periods, or devices may go out. It is less recommended in people at high risk of sexually transmitted infections because it can increase the risk of pelvic inflammatory disease within the first three weeks after insertion. If a pregnant woman with an IUD at the removal site is recommended. Rarely perforated uterus may occur during insertion. Copper IUD is a type of long-term reversible birth control. It mainly works by killing sperm.
Copper IUDs began to be used medically in the 1970s. It's in the List of Essential Medicines of the World Health Organization, the most effective and safe drugs needed in the health system. Wholesale costs in developing countries are around 0.37 to 3.00 USD per IUD. In the United Kingdom, they weighed on the NHS about 10 pounds. In the United States it costs about 750 USD. They are used by more than 170 million women globally.
Video Copper IUDs
Medical use
Copper IUD is a form of long-term reversible contraception and is one of the most effective forms of birth control. The type of copper frame and amount may affect the effectiveness of different copper IUD models. The failure rates for different models vary between 0.1 and 2.2% after 1 year of use. The T-shaped model with a surface area of ​​380Ã, ² mm has the lowest failure rate. The TCu 380A (ParaGard) has a one year failure rate of 0.8% and a cumulative 12 year failure rate of 2.2%. Over 12 years of use, models with fewer copper surface areas have higher failure rates. TCu 220A has a 12-year failure rate of 5.8%. GyneFix without a frame also has a failure rate of less than 1% per year. Worldwide, older IUD models with lower effectiveness rates are no longer produced.
Unlike other forms of reversible contraception, the typical failure rate of use and failure rate of perfect use for copper IUD is the same because the IUD is independent of user action. A 2008 review of the available copper T IUD recommends that the TCu 380A and TCu 280S be used as the first option for copper IUDs because both models have the lowest failure rates and longest life spans. The effectiveness of a copper IUD is proportional to tubal sterilization, which has a 0.5% first-year failure rate. However, the effects of copper IUDs are reversible, which can be seen as advantages or disadvantages, depending on one's goals for contraception.
Emergency contraception
It was first discovered in 1976 that copper IUDs can be used as a form of emergency contraception (EC). Copper IUD is the most effective form of emergency contraception. This is more effective than the EC hormonal pills available today. The pregnancy rate among those using IUD copper for EC was 0.09%. It can be used for EC up to 5 days after unsafe sex acts and does not decrease in effectiveness for 5 days. An additional benefit of using copper IUD for emergency contraception is that it can be used as a form of birth control for 10-12 years after insertion.
Removal and return to fertility
The removal of copper IUD should also be done by qualified medical practitioners. Fertility has been shown to return to previous levels quickly after removal of the device. One study found that the average amount of time from appointment to planned pregnancy was three months for women using TCu 380Ag.
Maps Copper IUDs
Side effects
Expulsion : Sometimes copper IUD can be removed spontaneously from the uterus. The rate of expulsion can range from 2.2% to 11.4% of users from the first year to the 10th year. TCu380A may have a lower level of expulsion than other models. Unusual whiteness, cramps or pain, spotting between periods, postcoital spots (after sex), dyspareunia, or absence or extending the rope may be a sign of possible expulsion. If an expulsion occurs, the woman is not protected against pregnancy. If the IUD with copper is inserted after the expulsion has occurred, the risk of repatriation has been estimated in one study to about one-third of cases after one year. Magnetic resonance imaging may lead to a dislocation of copper IUD, and it is therefore recommended to check the location of the IUD both before and after MRI.
Perforation : Very rarely, IUDs can move through the uterine wall. The risk of perforation is largely determined by the practitioner's skill of insertion. For experienced medical practitioners, the risk of perforation is 1 per 1,000 insertions or less. If perforation occurs it can damage internal organs, and in some cases surgery is required to remove the IUD.
Infection : The insertion of copper IUD presents a risk while pelvic inflammatory disease (PID) within the first 21 days after insertion. However, it is a small risk and is caused by an infection of gonorrhea or chlamydia already present at the time of insertion, and not on the IUD itself. Appropriate infection prevention procedures have little or no effect on gonorrhea or chlamydia, but are important in helping to protect clients and providers of infection in general. Prevention of such infections includes washing hands and then wearing gloves, cleaning the cervix and vagina, making minimal contact with unsterile surfaces (using "touchless insertion technique") and, after the procedure, washing hands again and then processing the instrument. The device itself does not carry an increased risk of PID beyond the time of insertion.
Cramp : Many women experience cramps or pain during the IUD insertion process and soon after as a result of cervical widening during insertion. Taking NSAIDS before the procedure can reduce discomfort, such as the use of local anesthesia. Misoprostol 6 to 12 hours before insertion can help with cervical dilatation. Some women may experience cramps for 1 to 2 weeks after insertion. Copper IUDs can also increase cramps during the female period. These symptoms will disappear for some women in 3 to 6 months, but probably not for others.
Heavier Period : Copper IUD increases the amount of blood flow during a woman's menstrual period. On average, menstrual blood loss increased 20-50% after T-copper TUD insertion; increased menstrual discomfort is the most common medical reason for IUD removal. These symptoms may be lost for some women after 3 to 6 months, but may not be for others.
Irregular bleeding and spotting: For the first 3 to 6 months after insertion, copper IUD can cause irregular periods and patches between periods.
String Problems : A small number of men report that they can feel the rope during intercourse. In this case, the string can be trimmed. However, a very short rope can prevent a woman from checking the rope for removal. Medical ultrasonography may be required in such cases to check the location of the IUD.
Pregnancy : Although rare, if pregnancy does occur with copper IUDs in place serious side effects can occur. The risk of ectopic pregnancy in women using an IUD is lower than the risk of ectopic pregnancy in women who do not use contraception. However, from pregnancy that occurs during IUD use, a higher percentage than expected (3-4%) is ectopic. If pregnancy occurs with an IUD in place there is a higher risk of miscarriage or early birth. If this happens and the IUD string is visible, the IUD should be immediately removed by a doctor. Although Dalkon Shield IUD is associated with septic abortion (infection associated with miscarriage), other brands of IUD are not. IUDs are also not related to birth defects.
Some barrier contraceptives protect against STIs. Hormonal contraception reduces the risk of pelvic inflammatory disease (PID), a serious complication of a particular STI. IUD, on the other hand, do not not protect against STIs or PIDs.
Contraindications
Category 3 conditions indicate conditions where theoretical or proven risks are usually greater than the benefits of incorporating copper IUDs. Category 4 conditions represent conditions that represent unacceptable health risks if the copper-bearing IUD is inserted.
Women should not use copper IUD if they:
(Category 4)
- Are pregnant or thinking they may be pregnant
- Pregnancy or lonely abortion
- Have unexplained abnormal vaginal bleeding
- Have untreated cervical cancer
- Has gestational malignant trophoblastic disease
- Suffer from uterine cancer
- Have certain uterine abnormalities
- Have or may have pelvic infections in the last three months
- Own or may have an IMS
- Have pelvic tuberculosis
(Category 3)
- Do postpartum between 48 hours and 4 weeks (increased IUD expulsion rate with delayed postpartum insertion). The CDC and WHO criteria differ in their recommendations for postpartum women between 48 hours and 4 weeks. The CDC does not list this as contraindicated.
- Have benign tropical gestational trophoblast disease
- Have ovarian cancer
- Have AIDS (except clinically well in anti-retroviral therapy)
- Has a very high likelihood of individuals to be exposed to gonorrhea or chlamydial infection.
The full list of contraindications can be found in the WHO Medical Feasibility Criteria for Use of Contraception and the CDC US Medical Feasibility Criteria for Contraceptive Use .
While nulliparous women (women who never give birth) are somewhat more likely to have side effects, this is not a contraindication to IUD use. Overall, IUDs are safe and acceptable also in young nulliparous women. The same thing may happen to virgin women, unless there is a microperforate hymen that blocks the insertion of IUDs.
Device description
There are a number of copper IUD models available around the world. Most copper devices consist of a plastic core wrapped in copper wire. Many devices have a T-shape similar to a hormonal IUD. However, there are frameless copper IUDs all over the world as well. ParaGard is the only model currently available in the United States. At least three copper IUD models are available in Canada, two of which are a slimmer version of the T-form used for women who have no children. Early copper IUDs have copper around only the vertical rods, but newer models have copper sleeves wrapped around the horizontal sleeve as well, increasing their effectiveness. Some newer models also contain a silver core instead of a plastic core to delay copper fragmentation and increase the life of the device. The lifespan of the device ranges from 3 years to 10 years; However, some studies show that TCu 380A may be effective for 12 years.
The ATC code is G02BA ( WHO ).
Insertion
Copper IUDs should be inserted by qualified medical practitioners. Copper IUDs can be inserted at each phase of the menstrual cycle, but the optimal time is right after the menstrual period, when the cervix is ​​the softest and most unlikely women get pregnant. The insertion process generally takes five minutes or less. This procedure can cause cramps or painful for some women. Before IUD placement, medical history and physical examination by a medical professional are useful for checking for contraindications or concerns. It is also recommended by some doctors that patients are tested for gonorrhea and chlamydia, since both of these infections increase the risk of contracting pelvic inflammatory disease shortly after insertion. Immediately prior to insertion, the doctor will perform a pelvic exam to determine the position of the uterus. After pelvic examination, the vagina is opened with the speculum. Tenaculum is used to stabilize the cervix and uterus. Uterine sounds can be used to measure the length and direction of the cervical canal and uterus to reduce the risk of uterine perforation. The IUD is placed using a narrow tube, which is inserted through the cervix to the uterus. The short monofilament plastic/nylon yarn dangles from the uterus into the vagina. The doctor will cut the yarn so that it only protrudes 3 to 4 cm from the cervix and remains in the upper vagina. The strap allows the patient or doctor to check periodically to ensure that the IUD is still installed and allows easy removal of the device.
Copper IUDs may be inserted at any time in a woman's menstrual cycle during which the woman is not pregnant. IUDs may also be inserted immediately after delivery and post-abortion as long as no infection occurs. Breastfeeding is not a contraindication to the use of copper IUDs. IUDs can be inserted in women with HIV or AIDS because they do not increase the risk of transmission. Although previously not recommended for nulliparous women (women without children), IUDs are now recommended for most women who have passed the menarche (their first period), including adolescents.
After insertion is complete, normal activities such as sex, exercise, and swimming can be done as soon as it feels comfortable. Severe physical activity does not affect the position of the IUD.
Type
Many types of copper IUDs are currently produced worldwide, but availability varies by country. In the United States, only one type of copper IUD is approved for use, while in the UK, more than ten varieties are available. One company, Mona Lisa N.V. offers generic versions of many existing IUDs.
Unframed IUD
Borderless IUDs eliminate the use of frames that provide conventional IUDs of their T-signature. Changes in this design were made to reduce the inconvenience and expulsion associated with earlier IUDs; without a solid frame, a frameless IUD should be formed into a uterine shape. This can reduce the rate of expulsion and discontinuation compared to framed copper IUDs.
Gynefix is ​​the only IUD brand without frames currently available. It consists of a hollow copper tube on polypropylene yarn. It is inserted through the cervix with a special applicator sewing the yarn to the fundus (above) the uterus; the thread is then cut with a tail that hangs outside the cervix, similar to the IUD frame. When the tail is pulled, the stitches off and the device can be removed. This requires more power than removing a T-shaped IUD, but produces a comparable discomfort during lifting. Gynefix is ​​not approved for use in the United States.
Action mechanism
The main working mechanism of copper IUD is to prevent fertilization. Copper acts as a spermicide in the womb. The presence of copper increases the levels of copper ions, prostaglandins, and white blood cells in the uterine and tubal fluids.
Although not the main mechanism of action, some experts in human reproduction believe there is sufficient evidence to show that IUDs with copper can impair implantation, especially when used for emergency contraception. However, there is no conclusive evidence that IUD users have higher rates of embryonic mortality than women who do not use contraception. Therefore, copper IUDs are considered true contraception rather than abortive.
Usage
Globally, IUDs are the most widely used KB method. The latest data shows that there are 169 million IUD users worldwide. These include non-hormonal and hormonal IUDs. The most popular IUD in Asia, where the prevalence is almost 30%. In Africa and Europe the prevalence is around 20%. In 2009, IUD usage rates in the United States were estimated at 5.5%. Data in the United States do not distinguish between hormonal and nonhormonal IUDs. In Europe, copper IUD prevalence ranges below 5% in the UK to more than 10% in Denmark in 2006.
History
According to popular legend, Arab traders put small stones into their camel's uterus to prevent pregnancy during the long desert journey. The story was originally a tall fairy tale to entertain delegates at a scientific conference on family planning; though then repeated as truth, it has no known historical basis.
The precursor for the first IUD was marketed in 1902. Developed from the parent pessarium (where the stem holds the pessary in place above the cervix), the 'rod' on the device is actually extended to the uterus itself. Because they occupy both the vagina and the uterus, this pessary type of stem is also known as an interuterine device. Use of interuterin devices is associated with high rates of infection; for this reason, they are criticized by the medical community.
The first intrauterine device (contained entirely in the womb) was described in German publications in 1909, although the author apparently never marketed his product.
In 1929, Ernst GrÃÆ'¤fenberg of Germany published a report on IUDs made of silk sutures. She has found a 3% pregnancy rate among 1,100 women using her ring. In 1930, GrÃÆ'¤fenberg reported a lower pregnancy rate of 1.6% among 600 women using an improved ring wrapped in silver wire. Unbeknownst to GrÃÆ'¤fenberg, silver wire is contaminated with 26% copper. The role of copper in improving the efficacy of IUDs will not be recognized until nearly 40 years later.
In 1934, Japanese physician Tenrei Ota developed a variation of the GrÃÆ'¤fenberg ring containing the supporting structure at the center. The addition of this central disc decreases the rate of IUD expulsion. These tools still had high rates of infection, and their use and development were further paralyzed by World War II politics: contraception was banned in both Nazi Germany and Japan allied to the Axis. The Allies did not learn from work by GrÃÆ'¤fenberg and Ota until after the war ended.
The first plastic IUD, Margulies Coil or Spirul Margulies, was introduced in 1958. The device is rather large, causing discomfort for most female users, and has a hard plastic tail, causing discomfort for their male partner. Modern "coil" colloquialism is based on the initial coil-shaped IUD design.
The Lippes Loop, a slightly smaller device with monofilament tail, was introduced in 1962 and is growing in popularity over Margulies devices.
Single stainless steel ring IUDs were developed in 1970 and are widely used in China due to low production costs. The Chinese government banned the production of steel IUDs in 1993 due to high failure rates (up to 10% per year).
Howard Tatum, in the United States, composed a plastic T-shaped IUD in 1968. Shortly afterwards Jaime Zipper, in Chile, introduced the idea of ​​adding copper to the device to increase the effectiveness of their contraceptives. It was found that copper-containing devices can be made in smaller sizes without sacrificing effectiveness, resulting in fewer side effects such as pain and bleeding. The T-shaped device has a lower level of expulsion due to its greater similarity to the shape of the uterus.
A poorly designed plastic denture shield (DUD) which was designed by AH Robins Company and sold by Robins in the United States for three and a half years from January 1971 to June 1974, before sales were stopped by Robins in June. 28, 1974 at the request of the FDA due to security concerns after the report of 110 spontaneous septic abortions in women with Dalkon Shield in place, seven of whom had died. Robins suspended international sales of Dalkon Shield in April 1975.
Tatum developed many different models of copper IUD. He created the TCu220 C, which has a copper collar as opposed to copper filaments, which prevents metal loss and increases the life of the device. The second generation of copper-T IUDs was also introduced in the 1970s. This device has a higher surface copper area, and for the first time consistently achieves more than 99% effectiveness. The last model developed by Tatum is the TCu380A, the most recommended model of the moment. In addition to a T-shaped IUD, there are also U-shaped IUDs (such as Multiload) and Gravigard Copper 7 shaped 7 (with mini versions for nulliparous women introduced in the 1980s). Recently, a frameless IUD called Gynefix was introduced.
Brand
ParaGard T-380A is an IUD with copper, manufactured and marketed in the United States by Duramed Pharmaceuticals. It is the only copper-containing contraceptive approved for use in the US (three hormonal uterine devices, Mirena, Skyla, and Liletta are also approved). TheGard consists of a T-shaped polyethylene frame wound with copper wire, together with two monofilament yarns to help remove the IUD.
ParaGard T 380A was developed in 1970 by Population Council and Finishing Enterprises Inc. (FEI). The ParaGard drug application of the Population Council (NDA) was approved by the US Food and Drug Administration (FDA) and FEI began manufacturing it for distribution outside the United States in 1984. GynoPharma (originally GynoMed) began marketing it in the US in May 1988 In August 1995, Ortho-McNeil acquired GynoPharma and began marketing ParaGard in the US. On 1 January 2004, FEI Women's Health obtained a patent from the Population Council and US marketing rights from Ortho-McNeil. On November 10, 2005, Duramed Pharmaceuticals, a subsidiary of Barr Pharmaceuticals, obtained FEI Women's Health and ParaGard. On July 18, 2008, it was announced that Teva Pharmaceutical Industries Ltd. will acquire Barr Pharmaceuticals.
The original FDA approval from ParaGard in 1984 was for continuous use for 4 years, then extended to 6 years in 1989, then 8 years in 1991, then 10 years in 1994. (ATC code G02BA02 ( WHO ))
See also
- Birth control
References
External links
- Association of Clinical Professional Propositions of Reproductive Health: New Development of Intrauterine Contraception
Source of the article : Wikipedia
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