The intrauterine device (IUD) is a reversible contraceptive method that is generally effective for 3-5 years, or 7-10 years for a few IUDs (see below), and has a Pearl index of 0.1-1. The PEARL index (PI) describes the reliability of a contraceptive measure based on the number of pregnancies that occurred per 1,200 cycles of use or per 100 years of use.IUD position monitoring is a necessary measure to ensure safety in the use of the intrauterine device. It is performed with the help of sonography (ultrasound). Ultrasound examination is recommended both before insertion and immediately after. Furthermore, the position of the intrauterine device should be checked after the first menstrual period (no later than six weeks after insertion) and then at six-monthly intervals.
Indications (areas of application)
- When regular use of oral contraceptives (the pill) is not guaranteed.
- In patients who cannot use oral contraceptives, for example, because of a tendency to thrombosis (clogging of blood vessels by blood clots).
- In women in the late fertile (fertile) phase, when oral contraceptives should no longer be taken because of age or illness, or to avoid sterilization
- In women suffering from dysmenorrhea (menstrual pain) or hypermenorrhea (increased menstrual bleeding), the progestogen coil is a particularly suitable method of contraception
The procedure
About the procedure of IUD position control:
- Medical history
- Gynecological examination
- Native cytology (phase contrast microscopy: exclusion of inflammatory processes) if necessary, a cytological smear (PAP smear).
- Vaginal sonography with position control of the spiral
- Estimation of the length of the extraction thread
The intrauterine device is usually T-shaped and is inserted through the cervix uteri (cervix) into the cavum uteri (uterine cavity) under aseptic conditions. The procedure is performed during menstruation (usually on the second or third day) because the cervix and cervical canal (uterine cavity) are open during this time, making it easier to insert the IUD. To avoid complications such as dislocation (incorrect position) or perforation (damage to the wall of the organ), it is necessary to determine the exact position of the uterus (womb) by palpation and sonography before insertion. The position of the uterus is determined (anteversio: the uterus is tilted forward; anteflexio: the uterus is slightly bent between the cervix and the cavum; retroversio: the uterus is tilted backward; retroflexio: the uterus is slightly bent between the cervix and the cavum, stretched uterus) and uterine anomalies (e.g. uterus septus) are detected. e.g. uterus septus, a uterus with two uterine cavities) or uterus myomatosus (benign tumors of the uterine wall) are excluded. In addition, the length of the uterus is measured with a probe so that the IUD can be placed accurately. There are two types of intrauterine devices with different principles of action:
- Intrauterine device with copperThis IUD is made of a flexible tissue-friendly material and is T-shaped. The vertical arm is wrapped with copper, which is continuously released into the environment. The effect is based on foreign body irritation of the endometrium (uterine lining) by the copper ions. The result is aseptic (sterile) superficial endometritis (inflammation of the uterus) with increased macrophages and leukocyte infiltration (defense cells of the body). Nidation inhibition (inhibition of implantation of the egg into the mucosa) occurs. In addition, the copper ions have a toxic effect on both the sperm (sperm cells) and the blastocyst (fertilized egg).The various IUDs differ in the size of the copper surface. There are also copper IUDs with small gold clips. However, these have no effect of their own, but are only intended to improve the visibility of the IUD in ultrasound. There are also coils whose longitudinal arm is wrapped with a wire made of a gold-copper alloy (so-called gold-copper coil). The gold content has an anti-inflammatory, bactericidal (kills bacteria) and fungicidal (kills fungi) effect. This should lead to a reduction in inflammatory complications.The chemical interaction of copper and gold also leads to longer-term efficacy, so that the normal lying time of a copper IUD of 3-5 years can be extended to 7-10 years. The copper chain is a special form of the copper IUD. It consists only of the vertical longitudinal arm wrapped with copper, the tip of which is fixed in the fundus uteri (upper boundary or roof of the uterine cavity) with a thread (frameless IUD). This special form of IUD is said to be associated with a slightly higher safety than the others and with a lower rate of bleeding disorders and pain during the period.
- Progestogen IUD (hormonal IUD, also called IUS – intrauterine system)It is an intrauterine device that contains the luteal hormone levonorgestrel in the vertical plastic cylinder, which is continuously released into the uterus. Since the substance is released directly into the uterine cavity, only low hormone concentrations are necessary for its contraceptive effect. This means that the amounts absorbed (absorbed into the blood) and therefore the blood levels are very low, and so is the overall side effect rate of the hormone. In addition to foreign body irritation, the effect of the progestin IUD is based on a progestin-induced thickening of the cervical mucus (cervical barrier), so that the sperm are prevented from ascending into the uterus, a reduction in tubal motility – this leads to a disruption in the transport of the egg into the uterine cavity – and inactivation of the sperm. Furthermore, the hormone progestin prevents the endometrium (lining of the uterus) from building up in accordance with the cycle. A possibly fertilized egg cell can then not implant in the mucosa (disturbance of nidation). The reduced mucosal thickness is usually accompanied by a weaker menstrual period (hypomenorrhea), which many women welcome. Occasionally, the period also remains completely absent.
The regular position control is of great importance. The following complications are thus avoided:
- Dislocated IUD – an IUD with intracervical location (in the cervix) can lead to ascending (ascending) inflammation (e.g., adnexitis – inflammation of the fallopian tubes and ovaries; pelveoperitonitis – pelvic peritonitis).
- “Lost IUD” – the thread of the intrauterine device for removal can not be found.
- Dysmenorrhea (period pain).
- Pregnancy – only with correct fit of the IUD is contraceptive safety (contraception) guaranteed.
Benefits
IUD position control prevents complications during use and after insertion, ensuring safe contraception.
