Presentations for Service Providers Intrauterine Device (IUD) Copper T-380A

Presentations for Service Providers Intrauterine Device (IUD) Copper T-380A Slide ‹#› Types of IUDs • Most common: – T-shaped, copper bands on pl...
Author: Jennifer Barker
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Presentations for Service Providers

Intrauterine Device (IUD)

Copper T-380A

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Types of IUDs • Most common: – T-shaped, copper bands on plastic stem/arms

• Inserted in uterus through vagina and cervical opening • Strings:

Copper T-380A

– assure IUD is in place; facilitate removal

• Most common copper IUD: TCu-380A • Less common: hormonal IUDs Slide ‹#›

Figure 1. of Most IUDUsers Users Are China Distribution IUD byinRegion, 2005 Distribution of Worldwide IUD Users by Region Sub-Saharan Africa 0.4% Developed Countries 5%

Oceania 0.01%

Latin America & Caribbean 5% Near East & North Africa 7% Eastern Europe & Central Asia 11% China 60% Other Asia 12%

Sources: World Bank, DHS, RHS, United Nations,Methodology US Censusand Bureau’s International Database, and data sources: Data for the number of married ajority Data of married IUD users worldwide—60%, or women ages 15-49 for each country were obtained from populatio otherinnationally illion—live China. Therepresentative IUD is popular insurveys a few other projections for 2005 by the World Bank (261). Percentages are ies, including Mongolia, North Korea, Taiwan, and weighted by population size and use the most recent data from the Cuba and Mexico; and in several countries of the Demographic and Health Surveys and Reproductive Health Surve nd North Africa. Among developed countries the IUD Population Reports and, for countries without these surveys, Slide data‹#› from the United Nat popular method in Eastern Europe and Central Asia

Effectiveness Spermicides Female condom Standard Days Method Male condom Oral contraceptives DMPA IUD (TCu-380A)

Rate during perfect use

Female sterilization Rate during typical use

Implants 0

5

10

15

20

25

30

Percentage of women pregnant in first year of use Source: CCP and WHO, 2007. Slide ‹#›

Mechanism of Action of Copper IUDs Prevents fertilization by: • Impairing the viability of the sperm • Interfering with sperm movement

Source: Ortiz, 1996. Slide ‹#›

Characteristics of Copper IUDs:

Advantages • Highly effective and very safe

• Does not interfere with intercourse • Easy to use

• Long lasting • Easily reversible • Quick return to fertility • No systemic effects • Complications are rare

Source: CCP and WHO, 2007.

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Characteristics of Copper IUDs:

Limitations • Side effects, including cramping and increased or prolonged bleeding • Rare complications include perforation and pelvic inflammatory disease

• Method failure can lead to ectopic pregnancy (extremely rare) • Insertion and removal require trained provider • No STI/HIV protection Source: CCP and WHO, 2007.

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Copper IUDs – Common Side Effects • Cramping and increased or prolonged menstrual bleeding – rates of removal because of bleeding or pain range from 1 to 17 per 100 women

• Possible bleeding between menstrual periods

Side effects are most common during the first 3 months. Source: CCP and WHO, 2007; Larsson, 1993; DeMaeyer, 1989; WHO, 2004, updated 2008; WHO Special Programme of Research Development and Research Training in Human Reproduction, 1997.

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Complications are rare

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IUDs – Pelvic Inflammatory Disease (PID) PID is an infection of a woman’s upper genital tract.

Risk of PID in IUD users: • Low overall – risk of PID attributable to IUD is 0.15% to 0.30%

• Higher during first 20 days after insertion • Due mostly to presence of gonorrhea or chlamydia at time of insertion • Similar to risk of PID in women with gonorrhea and chlamydia who are not using IUD Source: Shelton, 2001.

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PID Risk Related to Having an STI at Insertion • PID rates vary according to prevalence of STIs in the population – 0 PID cases among 4,300 IUD users in China – 8 PID cases among 846 IUD users in Africa (6 cases per 1,000 woman-years) (Farley, 1992)

• Insertion process probably pushes organisms from lower to upper genital tract

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No Increased Risk of Infertility with IUDs • IUD use alone does not increase the risk of infertility • Exposure to STIs and PID does increase the risk • Studies show that 72% to 96% of women conceive within a year of IUD removal – levels are comparable to those among women who have never used contraception

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Approaches to Assessing a Woman’s Risk of STIs • Discuss behaviors or situations that may be likely to expose women to STIs • Use a checklist to assess whether the client has any conditions that would rule out IUD use. – provider asks the client some questions related to her STI risk.

• Ask the client to assess her own risk of STIs (after describing possible risk factors)

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Common Risk Factors • Diagnosed with an STI in the last three months • Partner diagnosed with an STI in the last three months • Partner with STI symptoms • More than one sexual partner in the last three months without always using condoms • Unprotected sex with partner who has had more than one partner in the last three months • Situations suggestive of risky behavior – partner works far from home for long periods of time

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IUDs – Expulsions • First-year expulsion rates vary from 2 to 8 per 100 women • Partial or unnoticed expulsion may result in irregular bleeding or pregnancy

Factors contributing to expulsion: • Provider’s skill placing IUD at top of uterine cavity • Age and parity of woman • Time since insertion • Timing of insertion Source: Anteby, 1993; O’Hanley, 1992; Zhang, 1992; Petersen, 1991; Sivin, 1992.

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IUDs – Perforations Very rare: 1 in 1,000 insertions Risk: • Linked to skill and experience of provider

• Reduced through supervised training • Greater for postpartum insertions performed between 48 hours and 4 weeks after delivery

Source: WHO, 1987.

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IUDs Reduce Risk of Ectopic Pregnancy Estimated ectopic pregnancy rates by method 7

6.5

6 5 4 3 1.5

2

0.6

1

0.4

0.2

0 No method

Condom

Female sterilization

OCs

Copper IUD

Only about 2 out of every 10,000 IUD users may have ectopic pregnancy

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Uterine Pregnancy with IUD Rare but Serious • 15-60% of uterine pregnancies end in miscarriage if the IUD is not removed • Removing the IUD reduces risk of miscarriage to similar levels of risk faced by other women – but removal process itself entails small risk of miscarriage.

• Some studies found septic second-trimester miscarriage was more common among women who left their IUDs in place than among women not using IUDs at conception

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IUDs Safe for Women with HIV Overall complications

14.8 14.7 8.6 10.0

IUD removal

4.9 2.7

IUD expulsion

Pregnancies

Little difference in complications between IUD acceptors with and without HIV.

0.8 0 0.4 2.0

PID Infection-related complications

Noninfected N=486 HIV-infected N=150

8.8 10.7

0

20

40

60

80

100

Percentage of women in Kenyan study Source: Morrison, 2001.

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Timing of IUD Insertion Interval insertion • Anytime during menstrual cycle if woman is not pregnant Postpartum insertion • Immediately after vaginal or cesarean delivery if no infection or bleeding (within 48 hours or delay at least 4 weeks) Postabortion insertion • Immediately if no infection Source: WHO, 2004; updated 2008.

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IUD Counseling Topics • Characteristics of IUDs

• Effectiveness and how IUDs work • Common side effects

• Client’s risk of STIs • Insertion and removal procedures • Instructions for use and follow-up visit (including signs of complications that require immediate return to the clinic)

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Dispelling IUD Myths IUDs: • Are not abortifacients • Do not cause infertility

• Do not cause discomfort for the male partner • Do not travel to distant parts of the body

• Are not too large for small women Source: CCP and WHO, 2007; Farr, 1994.

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IUDs – Summary IUDs are: • Safe, effective, convenient, reversible, long lasting, cost-effective, easy to use, appropriate for the majority of women Providers can ensure safety by: • Informative counseling • Careful screening • Appropriate infection prevention practices • Proper follow-up

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