Intrauterine contraception

Abstract

An intrauterine device (IUD), also known as intrauterine contraceptive device (IUCD) or intrauterine contraception (IUC) offers reliable long-acting reversible contraception; however, some patients can be hesitant to choose this option because of misconceptions about side effects and perceived complications. A comprehensive knowledge of IUC is required to allow adequate counselling and to dispel myths. There are many different methods of IUC, including four different levonorgestrel-containing intrauterine systems (LNG-IUS) and multiple different copper intrauterine devices, with different insertion techniques. Considering contraception is important at several life stages, including post-delivery, post-termination of pregnancy and around the menopause; these will require different counselling.The use of IUC can have noncontraceptive benefits, including relief of heavy menstrual bleeding, management of menopause and premenstrual syndrome and reducing gynaecological cancer risk. Learning objectivesTo learn the different types of IUC, including the different indications and possible complications. To understand the noncontraceptive benefits of IUC. To understand the challenges faced when a patient is hesitant to consider IUC.

How NPs can eliminate practice barriers to intrauterine device use

“…34 When needed, insertion in nulliparous women may be assisted with cervical dilators or os fi nders. 19 Misconceptions about risk for PID The risk of PID with IUD use is the same or lower than the general population, apart from a slight increase in risk during the fi rst 20 days after insertion, felt to be due to contamination during insertion and not with the IUD itself. 35 The risk of PID is 0%-2% when cervical infection has been ruled out through screening, and 0%-5% with unknown cervical infection.…”

“…NPs should explain postinsertion irregular bleeding as a process of the contraception method rather than an untoward effect of the LNG-IUD 19. The unscheduled spotting and light irregular bleeding usually resolves in 3-6 months, and 20% of women become amenorrheic after 1 year of use, and 50% after 2 years of use.…”

“…A retrospective chart review comparing adolescents who were never sexually active to those who were sexually active found no significant difference in IUD insertion success on first attempt (90.2% versus 96.1%, P = .086) 34. When needed, insertion in nulliparous women may be assisted with cervical dilators or os finders 19…”

“…NPs should explain postinsertion irregular bleeding as a process of the contraception method rather than an untoward effect of the LNG-IUD. 19 The unscheduled spotting and light irregular bleeding usually resolves in 3-6 months, and 20% of women become amenorrheic after 1 year of use, and 50% after 2 years of use. Like oral contraceptive pills, the LNG-IUD may cause temporary breast tenderness, headache, acne, and mood swings as a very small amount of hormone is absorbed systemically.…”