In the USA, 5.5% of women use intrauterine devices (IUDs); due to their advantages over oral contraceptives they are more popular: IUP are highly effective. IUP have minimal systemic effects. It’s just a contraceptive decision every 3, 5 or 10 years required. In the US are currently 3 IUP available. There are 2 different levonorgestrel-releasing IUD; one is effective for 3 years and has a cumulative three-year pregnancy rate of 0.9%. The other is effective for 5 years and has a cumulative 5-year pregnancy rate of 0.5%. The third intrauterine device is a copper-containing IUD (T380A). It is for 10 yr; effective and has a cumulative 12-year pregnancy rate of <2% (see Table: Comparison of intrauterine devices). Comparison of intrauterine devices property levonorgestrel copper T380A 3-year IUP 5-year efficacy IUD (1-year pregnancy rate for a typical application) 0.3-0.5% 0.2% 0.8% reversibility Fast Fast Fast Maximum period of 3 years 5 years 10 years changes in bleeding Irregular bleeding amenorrhea in 1st year: 6% Irregular bleeding amenorrhea in 1st year: 20% No change in the cyclical properties of the menstrual cycles Mean monthly blood loss - 5 ml 50-80 ml Other advantages Can be used to treat heavy menstrual bleeding, chronic pelvic pain or endometriosis can be used used as emergency contraception non-hormonal Adverse effects minimal - headache, spotting, breast tenderness, nausea (mostly within 6 months disappears) Same as 3-year IUP stronger cramps during menstruation (better mostly with NSAIDs) and heavier flow Primary mechanism of action, the cervical mucus to thicken and prevents fertilization The same as for 3-year IUD use of copper ions to produce a sterile inflammatory response, which is toxic to sperm and so the fertilization does not prevent Pap test must be done before inserting an IUD unless that cervical lesions suspected become. Then a Pap test or cervical biopsy should be performed. Also the result of a test does not have to wait (on gonorrhea and chlamydia infection) on STDs before an IUD is inserted. However, before inserting the IUD, a test should be conducted on sexually transmitted diseases, and if the result is positive, the patient should be treated with appropriate antibiotics; the IUD is left in situ. Is a purulent discharge at the time of onset to observe the IUD, a test is not used, carried out on sexually transmitted diseases and started empirical treatment with antibiotics before the test result is available. The insertion of the IUD is performed under sterile conditions as possible. The position of the uterus is determined via a bimanual examination, and a forceps to be applied to the anterior lip of the cervix in order to stabilize the cervix, uterus to straighten the axis and to facilitate proper placement of the IUD. a uterine sound device or endometrial aspirator is frequently used (for biopsies) to measure the length of the uterine cavity prior to the insertion of an IUD. The package insert for the IUD should be read before the onset because the IUD three types are used differently. An IUD can be worn by most women. Contraindications include: Current pelvic infection, usually pelvic inflammatory disease, mucopurulent cervicitis suspected of sexually transmitted disease, pelvic tuberculosis, septic abortion or endometritis puerperal or sepsis within the last 3 months Anatomical anomalies that distort the uterine cavity gestational trophoblastic disease with persistent elevated Seumspiegel of ?-hCG ( human chorionic gonadotropin; relative contraindication due to lack of available data) Unexplained vaginal bleeding Known cervical or endometrial pregnancy for levonorgestrel-releasing IUD breast cancer or Levonorgestrelallergie for copper IUD (T380) Wilson's disease or copper allergy No contraindications for IUD following circumstances: Religious beliefs prohibit abortions because IUP not swan gerschaft abort (however, a copper IUD as emergency contraception the implantation of the blastocyst) prevent pelvic inflammatory disease, sexually transmitted diseases, or ectopic pregnancy, history of contraindications to estrogen containing contraceptive (z. As history of venous thromboembolism, smoking> 15 cigarettes / day in women> 35 years migraine with aura, migraine of any kind in women> 35 years) breastfeeding teenagers in 6% of women with 3-year IUD and 20% of women with 5-year IUD, vaginal bleeding within one year ceases completely. A copper intrauterine device (T380A) may cause increased uterine bleeding and severe cramps, which improve with NSAIDs (eg., Ibuprofen). Women should be warned about these possible effects prior to insertion of the IUD, as this information can be useful for or against a particular IUD in the decision. Found no unprotected intercourse took during the last month, the IUD can be used at any time during the menstrual cycle. If unprotected intercourse had occurred within the last 7 days, a copper intrauterine device (T380) can be used as emergency contraception. On request, the copper-bearing IUD can be left in place a long-term contraception in situ. The re-start of menses and a negative pregnancy test include pregnancy reliably; 2 to 3 weeks after insertion, a pregnancy test should be done to be sure that no unwanted pregnancy occurred before insertion. An IUD can be used immediately after an induced or spontaneous abortion in the 1st or 2nd trimester and immediately after the birth of the placenta in a caesarean section or a vaginal delivery. do not increase intrauterine devices, but also reduce, if necessary, the risk of uterine cancer. Complications The average Ausstoßungsraten an IUD usually amount to <5% within the first year of implementation; the IUD is immediately (<10 minutes) used after birth, the Ausstoßungsraten are, however, higher. In the 6th week after inserting a doctor must verify the correct position by the strings of the IUD are sought which are cut away usually up to 3 cm from the external os. For uterine perforation occurs in about 1 in 1,000 IUD insertions. Perforation occurs during the insertion of the IUD. Sometimes only the distal portion of the IUD initially penetrates; then press uterine contractions in the IUD during the next few months in the peritoneal cavity. If the thread is not visible at a speculum, the cavum (that is no suspicion of pregnancy is provided) is uteri blanked with a probe or biopsy forceps and performed an ultrasound examination. Can the IUD not be represented here, the abdomen is X-rayed to rule out an intraperitoneal seat. Intraperitoneal IUD can cause intestinal adhesions. IUP, which have perforated the uterus are removed by means of laparoscopy. When an expulsion or perforation is suspected, another contraceptive method should be selected for safety. During the first month the application is rarely a salpingitis (pelvic inflammatory disease) develops because bacteria were dragged into the uterine cavity during insertion; However, there is little risk that a prophylactic antibiotic treatment is not indicated. developed a pelvic inflammatory disease, antibiotics should be given. Only if the infection persists despite treatment with antibiotics, the IUD should be removed. The IUD thread is no admission rail for bacteria. increase except for the first month use IUD is not the risk of pelvic inflammatory disease. The incidence of ectopic pregnancy is significantly lower than in women not using contraception because IUDs prevent pregnancy effectively IUP application. However, it comes with IUD use in pregnancy, the woman must be advised of the now increased risk of ectopic pregnancy; they should be investigated immediately (ectopic pregnancy). Summary IUD are very effective, have minimal systemic effects and require only a contraceptive decision depending on the chosen IUD every 3, 5 or 10 years. There is Levonorgestrel-releasing IUD (Effectiveness: 3 or 5 years, depending on the type) and a copper-containing IUD (Effectiveness: 10-12 years). A Pap test is not required before inserting an IUD. Women need to be informed that both IUD types can affect the menstrual periods (amenorrhea within 1 year at 6% of women with 3-year IUD and 20% with 5-year IUD and possibly stronger menstrual bleeding and severe cramping in women with the copper IUD [T380]). 6 weeks after the insertion of the correct position of the IUD, by checking the threads must be confirmed. Are the threads during the pelvic exam is not visible, the uterine cavity must be examined (except in cases of suspected pregnancy) and if necessary an ultrasound or X-ray examination of the abdomen are done to check for an intraperitoneal position with a uterine sound or a biopsy instrument.