Foire aux questions sur les dispositifs intra-utérins (DIU).

General information about the IUD

Q1.  IUDs, what is it?

Q2.  What is the mechanism of action of IUDs?

Q3.  IUDs is it a source of discomfort during sex for partner of the user?

Q4.  Which types of IUDs available?

Q5.  How much is the IUD?

Advantages and Disadvantages

Q6.  What is the efficacy rate of IUD?

Q7.  Once inserted, what is the time of effectiveness of IUDs?

Q8.  What is the risk of pregnancy when using copper IUD?

Q9 .  risk of pregnancy increases there if the IUD is still in place five years after insertion?

Advantages and Disadvantages

Q10.  Which are the benefits of IUDs?

Q11.  Which are the disadvantages of the IUD?

Who can use an IUD?

Q12.  Who can use an IUD?

Q13.  Who IUD is it a good option?

Q14.  nulliparous woman can use an IUD?

Q15.  Can you be too young or too old to use the IUD?

Q16.  diabetic woman can use an IUD?

Q17.  Among that IUD insertion is it against-indicated?

IUD insertion

Q18.  inserting When can she do?

Q19.  Insertion should it be done only during menstruation?

Q20.  Must prescribe prophylactic antibiotics before insertion?

Q21.  SHOULD CRANIAL he undergo a medical check-up before getting an IUD (two separate visits)?

Q22.  IUD insertion can it be done immediately after delivery?

Q23.  When the IUD can be inserted during the postpartum period?

Q24.  IUDs can be inserted immediately after an abortion?

Q25.  Which situations after abortion IUD insertion is it against-indicated?

Q26.  nurses and trained midwives Can make IUD insertion safely?

Follow-up after insertion

Q27.  What is the schedule follow-up visits after IUD insertion?

IUD removal

Q28.  A "rest period" is she needed after a certain period of use?

Q29.  Will he medical reasons for IUD removal?

Q30.  Must -there remove the IUD if the partner complains about the string?

Return to Fertility after IUD removal

Q31.  Having used an IUD he prevent a woman from having children later?

Side effects, complications and risk of infection

Q32.  What are the warning signs of complications?

Q33.  's IUD increase the risk of ectopic pregnancy?

Q34.  Which are the possible reasons for the disappearance of the phone?

Q35.  A Once placed in the uterus, the IUD can he win other organs like the heart or the brain?

Q36.  What are the common side effects of IUDs?

Q37.  presence of heavy periods or bleeding between periods Does it justify the removal of the IUD?

Q38.  IUDs is it cause PID?

Q39.  IUDs he protects against STIs / HIV?


 

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General information about the IUD

Q1. IUDs, what is it?

The IUD is a method of long-term contraception that is safe, easy to use, effective and reversible. This device is a flexible and of small size, made of plastic. It is inserted into the uterine cavity through the vagina.

Q2. What is the mechanism of action of IUDs?

Its main mechanism of action is based on the prevention of fertilization . The copper IUD prevents fertilization and makes the uterus a "spermicidal environment." The sperm are killed or neutralized, which means they can not reach the egg. The IUD that contains progestin causes thickening of the cervical mucus, which prevents sperm from the uterus win.

Q3. The IUD is it a source of discomfort during sex partner for the user?

Generally, no. Sometimes man feels the thread of the IUD. If it bothers him, we can cut the wire to shorten it, which should fix the problem. It should however explain before the woman she could no longer touch the wire to ensure the presence of the IUD, and the removal of the device could be more difficult. The man may feel discomfort during sexual intercourse if the IUD begins to exit the cervical canal. If women think this is the case, she should consult a doctor or nurse immediately.

Q4. What types of IUDs available?

Two types of IUDs are available: the copper IUD and hormone-releasing IUDs. The copper IUD is a device in a plastic coated copper wire in the manner of a sleeve. The Copper T 380A (TCu 380A) is very common use. The IUD that releases a hormone (there is only one model), contains levonorgestrel; it is the same synthetic progestin that is contained in many birth control pills.

Q5. How much is the IUD?

The IUD is accompanied by very low costs for both programs for clients. Regarding programs, this product costs significantly cheaper than most other methods of contraception (in 2005, USAID totaled the cost of copper IUDs T-shaped to $ 1.77). Training costs and expendable supplies are related to add to the program costs. Regarding clients, the cost of IUDs varies across countries and they procure this device in the private or public sector. Generally, however, the cost of an IUD is approximately equal to or less than that of the pill of injectables or after two years of use.

Advantages and Disadvantages

Q6. What is the efficacy rate of IUD?

Its efficiency is higher than 99%, which makes the IUD one of the most effective methods of contraception.

Q7. Once inserted, what is the period of effectiveness of the IUD?

It is effective immediately; Women can have sex whenever she wants. must warn it may have bleeding or spotting (spotting) during the first few days after insertion . There is no need to worry.

Q8. What is the risk of pregnancy when using copper IUD?

The risk of pregnancy when using copper IUD is extremely small, of the order of 0.6 to 0.8 pregnancies per 100 women in the first year of use (1 in 125 to 170).

Q9. The risk of pregnancy increases there if the IUD is still in place five years after insertion?

The risk of pregnancy does not increase over time. The findings from the study by the World Health Organization (WHO) confirms the excellent efficacy of IUDs for at least 12 years. (The reader is cautioned that the United States Food and Drug Administration (FDA) set at 10 years only the effectiveness of IUDs Some documents contained in the Information Package IUDs also mention an effective 10 years. official position the authors of the Information Package is the IUD is "effective for at least 12 years.")

Advantages and Disadvantages

Q10. What are the advantages of the IUD?

The advantages are:

  • Highly efficient (99% +) and safe
  • Reversible (immediate restoration of fertility after removal)
  • Safe for breastfeeding women and when the insertion is made in the early postpartum
  • A good choice for women with the use of oral contraceptives is against-indicated
  • Suitable even for women who are HIV positive or at risk of contracting the virus
  • Long duration of employment (at least 12 years for the TCu 380A)
  • Insertion requires only one visit; monitoring is required, but it is minimal - or after menstruation or within three to six weeks after insertion
  • The client does not need to use another method when has sex (IUD is independent of coitus), which allows him to protect his privacy at the same time control fertility.
  • Synthetic hormones, such as are present in oral contraceptives and injectables, are non-existent in the copper IUD: natural hormone levels remain unchanged so
  • No drug interaction
  • Very good acceptability and continuation rates satisfying
  • Economic

Q11. What are the disadvantages of the IUD?

Its disadvantages are:

  • Insertion and withdrawal require the services of a qualified provider.
  • Mild pain, cramps, minor bleeding at the time of insertion
  • With the copper IUD, the woman may have heavier and longer rules, more cramps, bleeding and minor bleeding (spotting), which is relatively common in the first three months after insertion.
  • Severe complications requiring immediate care and extra quality medical services.
  • If current infection prevention techniques are not followed, the insertion poses an increased risk to the client.
  • If she has chlamydia or gonococque, inserting an IUD it poses an increased risk of pelvic inflammatory disease (PID) risk, with a risk of infertility later; should not proceed with the insertion of an IUD in these circumstances.
  • Like all other contraceptives except condoms, male or female, the IUD does not protect against sexually transmitted infections (STIs), including HIV.

Who can use an IUD?

Q12. Who can use an IUD?

  • Women, regardless of their gender, their age, their status regarding HIV, their blood pressure or conditions they might suffer and because of whom hormonal contraception is sometimes against inappropriate.

Q13. For which the IUD is it a good option?

The IUD is suitable for women who want to:

  • Delay of more than one year or the end of their first pregnancy.
  • Birth spacing of two years or more.
  • Do not have children, but do not want to use a permanent method (sterilization).
  • Use a long-term method and easily reversible (IUD is associated with an excellent recovery rate of fertility).
  • Use effective.
  • Breastfeeding (IUDs do not affect lactation).
  • Use, early postpartum (from the placenta until 48 hours after birth), an effective method without effect on breastfeeding. The IUD does not affect lactation and can be laid immediately after delivery of the placenta or within 48 hours. This procedure requires the intervention of a skilled provider.

Q14. Nulliparous woman can use an IUD?

Generally, nulliparous women can use an IUD. However, it should be noted that she is at slightly higher risk (up to 10%) of IUD expulsion because her uterus is small. This poses no danger to her, but she is no longer protected against pregnancy if the IUD is expelled.

Q15. Can you be too young or too old to use an IUD?

There is no minimum or maximum age, as long as the woman has no medical indications-cons and has received adequate counseling about the benefits and disadvantages of the IUD. The IUD should be removed in postmenopausal women - wait at least a year after her last period.

Q16. Diabetic woman can use an IUD?

Yes. The IUD is safe for women with diabetes. However, the latter is at increased risk of all kinds of infections. She must see a nurse or doctor if she notices possible signs of STIs or other types of infections, especially right after IUD insertion.

Q17. In which the IUD is it against-indicated?

In women who have the following conditions:

  • Pregnancy
  • An infection following childbirth or abortion
  • Unexplained vaginal bleeding
  • Cancer of the cervix, endometrial or ovarian
  • PID or STIs (purulent cervicitis)
  • A distortion of the uterine cavity (incompatible with IUD insertion)
  • Gestational trophoblastic disease, benign (rare)
  • Pelvic tuberculosis (rare)

IUD insertion

Q18. When inserting can she do?

The insertion may occur at any time during the menstrual cycle, whichever is most convenient for the woman, as long as the provider can depart with relative certainty the possibility that the woman is pregnant. Under current guidelines, the copper IUD can be inserted during the first 12 days of the menstrual cycle, or at any other time if the provider is reasonably sure that the client is not pregnant. It can be inserted after childbirth and after abortion (in the absence of an infection of the uterus).

Q19. The insertion should it be done only during menstruation?

The IUD can be inserted at any time during the menstrual cycle if the provider has reason to believe that the woman is not pregnant. The insertion during menstruation is a good way to rule out the possibility of pregnancy, and the inclusion in this time can be easier for some women. However, the signs of infection are less observable during menstruation. Nevertheless, there are providers who prefer to make IUD insertion into the middle of the menstrual cycle because the cervix is ​​more open.

Q20. Should we prescribe prophylactic antibiotics before insertion?

It is not necessary to prescribe antibiotics prior to the insertion of an IUD. If the insertion is done properly, the risk of infection in healthy women is minimal, so that taking antibiotics is not justified. Anyway, most recent research suggests that antibiotics do not significantly reduce the risk of PID.

Q21. Must pass a medical check-up before getting an IUD (two separate visits)?

There is no need to undergo a medical check-up prior to the woman to ask her to come back to get to an IUD. It can be difficult to attend two appointments, and could run the risk of getting pregnant in the meantime if it has no protection. Before inserting an IUD, it is recommended to evaluate the risk of STIs that runs the client and will be guided by the history and clinical examination. Whenever possible, you should provide counseling, screen clients and to its insertion on the same day.

Q22. IUD insertion can it be done immediately after delivery?

Yes, the IUD can be done after delivery. The IUD can be inserted after a vaginal delivery or cesarean (surgery) after incision of the abdominal wall. The insertion should be performed by a qualified provider.

Q23. When the IUD can be inserted during post-partum?

The IUD can be inserted:

  • immediately after delivery (within 10 minutes after delivery of the placenta) or cesarean section (special training required);
  • before the woman leaves the maternity (up to 48 hours after delivery);
  • by the fourth or the sixth week postpartum, when the woman presents for routine doctor's visit and it requests an IUD

Q24. The IUD can be inserted immediately after an abortion?

The insertion can take place immediately after spontaneous or induced abortion (or at any time after an abortion as long as the woman is not pregnant), except for the woman who has a pelvic infection or who has had an abortion tank (see below).

Q25. In what situations after abortion IUD insertion is it against-indicated?

Do not proceed with the IUD in the following situations:

  • If infected or suspected (signs of an abortion performed in unsanitary conditions, signs and symptoms of sepsis or infection, or inability to exclude the presence of infection), though the risk of infection has been ruled out or the infection is completely healed (about 3 months) before inserting an IUD.
  • In case of severe trauma to the genital tract (uterine perforation, severe injury to the vagina or cervix, burning of chemical origin), expect full recovery before placing an IUD.
  • In case of bleeding and severe anemia, it is still advisable to wait for healing. That said, the hormonal IUD can be used in patients with severe anemia (It reduces menstrual flow).
  • The IUD insertion after abortion before 16 weeks of gestation requires the intervention of a specially trained provider, only able to then place it correctly in the uterine cavity. Otherwise, wait six weeks.

Q26. Nurses and trained midwives can they make IUD insertion safely?

The insertion of an IUD (including early postpartum or immediately after abortion) can be safely entrusted to nurses and midwives and other allied health providers who have been trained according to relevant national standards or institutional.

Follow-up after insertion

Q27. What is the schedule follow-up visits after IUD insertion?

A follow up visit is recommended at the time of menarche or three to six weeks after insertion. No other particular visit is necessary, except for IUD removal. Women should talk to a health if it has any problems or any concerns.

IUD removal

Q28. A "rest period" is she needed after a certain period of use?

A rest period is not justified if a woman wants to get a new IUD when the old one is outdated. The risk of pelvic infection is lower if the IUD is removed when it reaches its expiration date and that the new device is immediately placed in the same conditions as the previous one. Ask the woman to make two appointments, is to expose him to a risk of pregnancy between the date of withdrawal of former IUD and the insertion of the new day.

Q29. Will he medical reasons for IUD removal?

It is necessary to remove the IUD if:

  • wife so requests;
  • she begins to exhibit symptoms of cons-indications;
  • the effective life of the IUD has reached its limit (the IUD is effective for at least 12 years of use, and the FDA approved the use for 10 years).

Q30. Should we remove the IUD if the partner complains about the string?

No, it is not necessary to remove the IUD if the partner complains about the string.

  • Explain to the woman and / or her partner what the thread and advise them to see if they can get used to.
  • Present to the client the options available (and disadvantages). If necessary, cut the wire so that it does not exceed the endocervical canal. Inform the woman that she can no longer verify that the IUD is still in place, as it no longer feels the wire, and it will use fine forceps to remove the device at the appropriate time (hence a slight risk further infection). If the wire is cut, make a note in the medical record of the woman and tell her where is located the remaining end. This information will be useful at the time of its removal.
  • If the above options are not acceptable to propose to remove the IUD.

Return to Fertility after IUD removal

Q31. Having used an IUD does it prevent a woman from having children later?

Generally, no. Women can get pregnant immediately after removal of the IUD, and the use of this method is not associated with a significant risk of infertility. However, insertion of an IUD in a woman who has an STI increases the risk of PID, which is a cause of infertility. It is the presence of an STI at the time of insertion, rather than the device itself, which is the main risk factor for PID and possibly infertility.

Side effects, complications and risk of infection

Q32. What are the warning signs of complications?

There are five signs that need to consider an infection or failure IUD (expulsion or pregnancy). The client who notices any of these signs should see a health care:

  • Delayed menstruation, minor bleeding (spotting) or abnormal bleeding
  • Abdominal pain during sex
  • Infections (or unusual vaginal discharge)
  • Do not feel good, have a fever or chills
  • The son disappeared or they are shorter or longer than before

Q33. The IUD increase the risk of ectopic pregnancy?

IUDs do not increase the risk of ectopic pregnancy. IUD prevents all forms of pregnancy, including ectopic pregnancy and ectopic pregnancy. IUD users are less likely to make an ectopic pregnancy than sexually active women who have used any contraceptive method. However, in the unlikely event that the user of an IUD become pregnant, the risk that the pregnancy is ectopic is greater than the risk of this type of pregnancy other women. That said, the IUD user who becomes pregnant has a lot more chance to make a normal pregnancy is an ectopic pregnancy; it is estimated that 13 to 16 pregnancies will be ectopic pregnancy, a rate of 6% to 8%.

Q34. What are the possible reasons for the disappearance of the phone?

There are two possible reasons for the disappearance of the thread:

  • The IUD may have been expelled during menstruation (without the woman noticing).
  • If she feels severe pain (or if the insertion was very painful), the IUD could have perforated the uterus.

In as in the other case, the woman must return to the clinic.

Q35. Once placed in the uterus, the IUD can he win other organs like the heart or the brain?

Very rarely, the IUD can pass through the wall of the uterus and nestle in the abdomen. This is probably due to an error during installation of the device, not the gradual displacement of the IUD through the wall of the uterus. The IUD does not spread to other organs.

Q36. What are the common side effects of IUDs?

Common side effects are:

  • cramps, discomfort, pain;
  • minor bleeding (spotting) and increased bleeding;
  • in 10% of cases or less, Deportation IUD.

Q37. The presence of heavy periods or bleeding between periods she justifies removing the IUD?

Not necessarily. It should be mentioned to the woman that the use of copper IUDs is normally associated with heavier periods and breakthrough bleeding (bleeding of uterine origin outside the rules) may occur, especially during the first month. It will be advising him to increase his consumption of iron-rich foods.

  • If bleeding and minimal or moderate pain during the first month after insertion and in the absence of clinical signs of pelvic infection, it may propose to the woman who wants to continue using the IUD a control agent other inflammatory steroidal aspirin (ibuprofen, for example).
  • Bleeding generally decreases over time. If the bleeding is heavy or the woman is anemic, taking iron tablets can improve hemoglobin levels. If bleeding or pain is severe, or if the client does not want the IUD, remove that device. If prolonged or heavy bleeding seems abnormal, it should take stock and prescribe treatment, if necessary.
  • We must rule out a possible state of gynecological pathology.
  • If pelvic infection is diagnosed, it is necessary to remove the IUD and prescribe antibiotics. (In mild uterine tenderness to touch and in the absence of other signs of pelvic infection, broad-spectrum antibiotics or administration of a chemotherapeutic agent could make the problem exercise good judgment clinic to decide whether or not to remove the IUD.)

Q38. The IUD is it cause PID?

The IUD does not cause PID. However, in the presence of infection with gonorrhea or Chlamydia, for example, the IUD may increase the risk of PID, especially during the first month after insertion.

Q39. The IUD does it protect against STIs / HIV?

Like many other methods of contraception, the IUD does not protect its users against STI / HIV. To protect against STI / HIV, use condoms during every sexual encounter.


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