Attempting to use intrauterine devices or IUDs dates back to antiquity. The
method is, however, is widespread only recently, Oppenheimer (1959) and Ishihama
(1959) indicated that plastic device.
Different from that era are used IUD and for the following reasons:
1) Highly effective contraceptive
2) Ease of insertion into the uterus
3) is unlikely to be expelled
4) Few side effects
There are two types of IUDs:
Copper IUD: is a small plastic holder surrounded by a copper wire (hence the
name spiral) that is inserted into the uterus, usually during the menstrual
cycle, a gynecologist experienced by a small flexible tube.
Mechanism of action of copper IUD
The copper ions released from the IUD block the movements and survival of
spermatozoa in the uterus, and slowing sperm transport from the cervical canal,
so they can not reach the ovum is fertilized. The spiral also results in a
slightly inflammatory reaction that changes the lining of the uterus (endometrium),
making it unsuitable for pregnancy by preventing ovulation - in case it is
fertilized - can implant and develop. In the Middle Ages, and even before, in
Egypt it was common knowledge that thanks to the insertion of foreign objects
such as rings or small pebbles could decrease the chances of a pregnancy, this
device was in fact often used by prostitutes at the time.
Hormonal Mirena IUD: a plastic that releases hormones (progesterone) in small
quantities. The operation is comparable to that of the pill or the ring.
Spiral progesterone.
Have recently been put on the market spirals that allow a gradual release of
progesterone, the hormone (naturally released by the corpus luteum during its
maturation) impairs the formation of the endometrium stable and consequently the
conditions for the implantation of the egg. Thanks to it are also alleviated any
negative symptoms of the spiral and even normal menstrual cycle, after about a
year can also be characterized by the absence of blood loss.
The high efficacy of the contraceptive is linked to the increased size of the
unit, although for practical purposes should be included at the bottom of the
uterus and to fall into the cervical canal. Contraceptive security has been
improved with the apparatus of Zipper, a device which is a coiled copper wire,
if the issue of ions in the uterine epithelium (endometrium) leads to a better
contraceptive effect.
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1) Mechanism of the contraceptive
The IUD does not block ovulation and act with a mechanism related to the
endometrial response before the presence of a foreign body, with release of
cytotoxic substances that prevent implantation of the egg or by preventing the
sperm capacitation. With the copper IUD is not observed with leukocyte
infiltration of inflammatory exudate. Probably still the copper lowers the
concentration of zinc ion at the tissue level. The mechanism by which I
determine the IUD medicated with progesterone contraception remains unclear.
Advantages and disadvantages of the IUD
The advantage is that the woman undergoes a dangerous bombing hormone (cf. the
pill progestogens), especially in the case of a patient with liver disease or
thrombophilia.
We prefer to insert the IUD in the last days of the cycle or within 2 days of
his term because the cervix (the structure through which we come to the uterine
cavity) is larger and so the procedure is easier and less painful. E 'can still
enter at any other time, however, with the foresight to have ruled out the
presence of a pregnancy.
It 's easier insertion in women who have already had one or more pregnancies,
but if necessary can also be used in nulliparous (women who have never given
birth).
Contraindications.
- Pregnancy.
- Morphological abnormalities of the uterus (congenital or acquired) that
distort the uterine cavity (eg some forms of uterine fibromatosis).
- Inflammatory endometrial pathology, previous pelvic too.
- Algomenorrea (more commonly known as dysmenorrhoea).
- Previous ectopic pregnancies.
- Allergy to copper or other components of the device.
- Immunodeficiency (eg AIDS).
- Abnormal cytological Pap Test
How long can be taken.
If well tolerated, as frequently happens, the IUD can be used for many years
taking care, however, to replace him at the end of the maturity periods.
In fact, not all women tolerate the IUD since become painful menstruation, there
may be small painful bleeding (metrorrhagia), as a continuous drip or
menometrorragie, that is, continuing losses that create discomfort and anemia
from chronic loss of iron, so finally the gynecologist removes the IUD. Finally,
it is possible, apart from the pain associated with contractions of the uterus,
which could lead to the same uterine perforation and pelvic inflammation or,
worse, once peritonitis. The nulliparous, as we said, usually tolerate the IUD
hand, and after childbirth, it is necessary to spend 6-8 weeks before placing
the "spiral"
What precautions? What controls do?
Avoid infections cervico - vaginal having special attention to hygiene and
intimate couples. It 'should make an annual Pap test and pelvic examination with
transvaginal pelvic ultrasound (for better assessment of its position in the
uterus).
In addition, the IUD can also move, so you should check the position of the same.
The shape is a number "7" or T and the controls are implemented by checking with
the gynecologist speculum the presence of the wire should protrude from the
cervical canal. If the IUD falls inbasso, that is, the cervical canal, the
pregnancy becomes possible. Finally, every two years, the IUD should be removed
and controlled, while the progesterone must be replaced every 6-12 months in the
meantime because the hormone was reduced.
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