Copper IUD (Paragard T 380A)

Hormonal IUD (Mirena)

The intrauterine device (IUD) is a form of birth control; it is an object placed in the uterus to prevent pregnancy.^[1] Among modern IUDs, the two types available are copper-containing devices, and a hormone-containing device that releases a progestogen. Currently, there are over 10 different kinds of copper IUD available in different parts of the world, and there is one hormonal device, called Mirena. If used correctly, the IUD is very effective at preventing pregnancy. Recent research has shown that it may be a more effective form of birth control than the popular Progestogen-only pill.^[2]

Modern IUDs[link]

Names and descriptors of intrauterine contraceptive devices vary by location.

In the United States, there are two types of intrauterine contraceptive available: the copper Paragard and the hormonal Mirena. Both of these contraceptives are referred to as IUDs in the United States.^[3]

In the United Kingdom, where over ten types of copper-containing IUDs are available, the term IUD only refers to inert or copper-containing devices. Hormonal intrauterine contraceptives are considered to be a different type of birth control, and they are distinguished with the term intrauterine system or IUS.^[4][5]

The WHO/ATC name is IUD for both copper and hormonal devices.

Copper IUDs[link]

An IUD as seen on Pelvic X ray

Copper IUDs work by impairing the mobility of sperm and preventing them from joining with an egg. Additionally, the foreign body irritates the lining and wall of the uterus making it hard for an embryo to implant.^[6]

Most non-hormonal IUDs have a plastic T-shaped frame that is wound around with pure electrolytic copper wire and/or has copper collars (sleeves). The arms of the frame hold the IUD in place near the top of the uterus. The Paragard T 380a is 32 mm (1.26") in the horizontal direction (top of the T), and 36 mm (1.42") in the vertical direction (leg of the T). In some IUDs, such as the Nova T 380, the pure copper wire has a silver core which has been shown to prevent breaking of the wire. Following that line there's a new improvement in a Spanish device "Gold T IUD" replacing the silver core by a gold core to completely avoid the breaking of the wire caused by corrosion^[4][7]

Other shapes of IUD include the so-called U-shaped IUDs, such as the Load and Multiload. These are similar to the T-shaped IUDs, in that they have a plastic "leg" running vertically, but at the top, rather than two straight horizontal arms, they instead have two arms that curve downwards towards the "foot" of the device.

Another shape of IUD is the frameless IUD. It does not have a hard plastic shape of any kind. Rather, it has a plastic string (similar to fishing line) that holds several hollow cylindrical minuscule copper beads. It is held in place by a suture(knot) to the fundus of the uterus. It is mainly available in China, Europe, and Germany, although some clinics in Canada can provide it. It is removed like most other IUDs using forceps but is actually removed from the fundus.^{[citation needed]}

Hormonal IUD – Mirena[link]

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The hormonal I.U.D. (brand name Mirena) does not increase bleeding as copper-containing IUDs do. Rather, they reduce menstrual bleeding or prevent menstruation altogether, and can be used as a treatment for menorrhagia (heavy periods).

Although use of the Mirena results in much lower systemic progestogen levels than other very-low-dose progestogen-only hormonal contraceptives, they might possibly have some of the same side effects.

As of 2007, the LNG-20 IUS – marketed as Mirena by Bayer – is the only IntraUterine System available. First introduced in 1990, it releases levonorgestrel (a progestogen) and may be used for five years. With the use of the Mirena the hormones are localized to the uterine area unlike oral contraceptives.

Historical IUDs[link]

Copper-containing devices[link]

One historical device is Gräfenberg's ring, an early IUD designed by Ernst Gräfenberg, a German gynecologist in whose honor the G-spot was named.

Another historical IUD is the Dalkon Shield. Produced in the 1970s, the Dalkon Shield became infamous for its serious design flaw: a porous, multifilament string up which bacteria could swim into the uterus of users, leading to sepsis, injury, miscarriage, and death. Modern IUDs use monofilament strings which do not pose this grave risk to users.

Hormone-containing devices[link]

Progestasert was the first hormonal uterine device, developed in 1976^[8] and manufactured until 2001.^[9] It released progesterone, was replaced annually, and had a failure rate of 2% per year.^[10]

Future IUDs[link]

A lower-dose T-shaped IntraUterine System named Femilis is being developed by Contrel, a Belgian company. Contrel also manufactures the FibroPlant-LNG, a frameless IUS. FibroPlant is anchored to the fundus of the uterus as the GyneFix IUD is. Although a number of trials have shown positive results, FibroPlant is not yet commercially available.^[11]

References[link]

v t e Routes of administration / Dosage forms Oral Digestive tract (enteral) Solids Pill Tablet Capsule Time release technology Osmotic controlled release capsule (OROS) Liquids Solution Softgel Suspension Emulsion Syrup Elixir Tincture Hydrogel Buccal / Sublabial / Sublingual Solids Orally Disintegrating Tablet (ODT) Film Lollipop Lozenges Chewing gum Liquids Mouthwash Toothpaste Ointment Oral spray Respiratory tract Solids Smoking device Dry Powder Inhaler (DPI) Liquids pressurized Metered Dose Inhaler (pMDI) Nebulizer Vaporizer Gas Oxygen mask Oxygen concentrator Anaesthetic machine Relative analgesia machine Ophthalmic / Otologic / Nasal Nasal spray Ear drops Eye drops Ointment Hydrogel Nanosphere suspension Mucoadhesive microdisc (microsphere tablet) Urogenital Ointment Pessary (vaginal suppository) Vaginal ring Vaginal douche Intrauterine device (IUD) Extra-amniotic infusion Intravesical infusion Rectal (enteral) Ointment Suppository Enema Solution Hydrogel Murphy drip Nutrient enema Dermal Ointment Liniment Paste Film Hydrogel Liposomes Transfersome vesicles Cream Lotion Lip balm Medicated shampoo Dermal patch Transdermal patch Transdermal spray Jet injector Injection / Infusion (into tissue/blood) Skin Intradermal Subcutaneous Transdermal implant Organs Intracavernous Intravitreal Intra-articular or intrasynovial injection Transscleral Central nervous system Intracerebral Intrathecal Epidural Circulatory / Musculoskeletal Intravenous Intracardiac Intramuscular Intraosseous Intraperitoneal Nanocell injection Additional explanation: Mucous membranes are used by the human body to absorb the dosage for all routes of administration, except for "Dermal" and "Injection/Infusion". Administration routes can also be grouped as Topical (local effect) or Systemic (defined as Enteral = Digestive tract/Rectal, or Parenteral = All other routes).