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  • Title: Short notes on intrauterine devices.
    Journal: Indian J Med Sci; 1990 May; 44(5):129-33. PubMed ID: 2397950.
    Abstract:
    The DATTA panelists emphasized the critical importance of patient selection when considering IUDs for contraception The IUD is an acceptable method of contraceptives, in a stable monogamous relationship, and not at risk for sexually transmittel diseases. Within these constraints, the panelists gave overwhelming support to the IUD as a safe and effective method of contraception. The minority opinion (two panelists) that these devices were not established for safety or effectiveness was based on concerns over possible infectious complications. This is an informative review on patient selection, history and distribution of IUDs, with a more detailed description of the Copper T 380A and the Progestasert IUDs currently available in the U.S. The DATTA panelists (of India) have recommended that copper and progesterone containing IUDs are safe and effective as long as they are not given to women with multiple sex partners, pelvic infections, undiagnosed bleeding disorders or previous ectopic pregnancy.. Nulliparity is a relative contraindication. While IUDs with multifilamented strings such as the Dalkon shield are now considered unsafe, there is no evidence proving that other IUDs put women at risk for infection. The Copper T 380 A (ParaGard, Gynopharma, Sommerville, NJ) is described in detail. It has a Pearl Index of 0.83. Copper IUDs work by causing a general inflammatory response, reducing implantation, and by liquefying endometrial mucopolysaccharides thereby decreasing sperm transport and metabolism. The Progestasert IUD is also described. It has a Pearl index of 2.9 and must be replaced yearly. Progesterone atrophies endometrial glands and inhibits sperm capacitation. IUD side effects of bleeding and pain do occur with these models, but bleeding is relatively less with the progestasert, while copper IUDs cause a lighter flow that may last longer. Women should be supplemented with iron and be given prostaglandin inhibitors during IUD use. Management of perforation, pregnancy and pelvic infection during IUD use is outlined briefly.
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