IUD

dr. Eddy Hartono, SpOGK

Reproductive Medicine.Department of Obstetrics and
Gynecology University of Hasanuddin / RSUP Dr. Wahidin
Sudirohusodo
Makassar

IUD
(Intra Uterine Device)
AKDR

= Alat Kontrasepsi Dalam Rahim

IUD

= Intra Uterine Device

IUCD

= Intra Uterine Contraceptive Device

IUD Classification
I.

Material

NON-MEDICATED
Marqulis Spiral
Lippes Loop
Ota ring

MEDICATED
Cu

:
Tatum T : * Tcu. 200
* Tcu.220
Cu 7
Multiload (Ml Cu 250, 375)
Copper T 380 A(Tcu 380 A)
Cu + Ag
:
Nova T
T Cu 380 Ag
Progestin
Progestasert (Progesteron)
Mirena (Levonorgestrel)

II.

CONFIGURATION
OPEN
Lippes Loop
Copper IUD

CLOSED
Ota ring
Birn Berg Bow

How non-medicated IUD works?

No exact explanation yet
Most accepted theory :
IUD is a foreign body in the uterus :
It doesnt change menstrual cycle
It doesnt alter the transportation of ovum/corpus
luteum
Decreasing the chances of fertilization by minimizing
the number of sperm able to arrive at fertilization site.

IUD INDICATIONS
CONTRACEPTIVE
NON-CONTRACEPTIVE :
Intrauterine Adhesiolysis Asherman Syndrome
Dysmenorrhea
Post-pill Amenorrhea

for
progestasert,
mirena

Contraindications
Most contraindications

Uterus carcinoma
Congenital Heart disease
History of

rheumatic/endocarditis
heart disease
AIDS
Cu IUD allergy towards
Cu

INSERTION
INTERVAL : inserted during menstrual period
or one day after menstruation starts EASIER.
preferable because:
Small chances of accidental pregnancy
Cervix is softer and easier to open
Masking effect of menstruation for bleeding

and discomfort because of uterus contraction

during and after insertion of IUD.

Post partum:
Immediate Post Partum Insertion
(after 1 week of delivery)
Puerperal / delayed insertion (1 6 weeks PP)
extra caution : expulsion / perforation
Post puerperal insertion ( 6 8 weeks PP)
Immediately after womb is delivered
Post Abortion
Curette/ spontaneous abortion
DURING CEASAREAN SECTION

STERILIZING IUD AND INSERTER :

Normally with Iodine Solution 1/2500 (light

brown colored) for 20

Do not soak, because it may be stiffened,
easily breaks & perforates
Medicated IUD comes in sterile packs

A mother comes and ask about IUD???

Needs full anamnesis & preinsertional
examination
To :
Avoid complication during insertion &

deduct any contraindication

Anamnesis :
Identity
Generally :
history of rheumatic disease
specifically :
Parity

:
GPA
menstrual
:
When is your last period...
How long..
Was it painful..

Physical examination
General :
Blood Pressure
Anemic/not anemic
Normal Heart sound

Specific :
Bimanual examination
Uterus : what to notice
consistency
size
Mobility
Sensitivity
Irregularity

 Adneksa / Parametrium
Laboratory
Hb
Pap smear
Cervical discharge culture Go

Basic steps for IUD insertion

1.
2.
3.

Bimanual examination
Cervical stabilization : straightening uterus neck by
clamping the portio using tenaculum
Uterus sounding to know :

4.
5.
6.
7.

Depth
heading

Kav. uteri

If required dilatation
Use suitable technique (pushing / withdrawing)
Placing IUD as high as the fundus without perforating
Cutting the tail 2 cm from oue

INSERTION TECHNIQUE
Pushing technique (Push out method, Push
in method, Planging technique)
eg: Lippes Loop
2. Withdrawing technique (Withdrawal
Method)
eg : Cu T, Cu 7, ML Cu 250 (no introducer)
1.

PRINCIPLES :
Pushing method : fixed to the
tenaculum : tube then pushed
2. Withdrawal method : fixed to the
tenaculum : introducer tube
withdrawed.
1.

POST IUD Advice

There may be mild bleeding and pain, not to be

alarmed
Check tail position :
- before ovulation
- immediately after menstruation stops
- when there is lower abdominal pain
When the tail is not in position : do not have sex
/use other contraceptive & contact the clinic

 Visit the clinic when :

PELVIC PAIN / dispareunia
Abnormal bleeding/ fluor albus
Amenore / other signs of pregnancy
fever & chills T 38C

Scheduled control visits

: 1 week, 1 month, 3 months, 6 months, every 6

months.
remember time limit

medicated IUD

Post IUD follow up

Aims:
For routine check up & consultation if wanted to
change method
General health evaluation of acceptor and
medications prescription when needed
To check for IUD neglected by acceptor
To check for mobilization, whether there is
indications for withdrawal or reinsertion.

Post IUD follow up

Anamnesis : since last visit
1.
Was there any abnormal bleeding??
IF there is 3 months post IUD insertion
ensure the acceptor it will stop give Fe.
upon bimanual examination exclude other
causes especially if 3 months
Worse complaints withdraw IUD offer
other methods

Post IUD follow up

2.

Was the pain severe?? limiting daily activities

If yes, 3 months post IUD insertion
ensure the acceptor it will stop give
analgesics
Worse complaints withdraw IUD
offer other methods
3. Any late/missed menstruation??
Remember, upon bimanual exclude pregnancy

Post IUD follow up

4.

Was there any fever/chills/lower abdominal

pain??
Could be sign of pelvic infection, PID

5. Is the IUD still in placeif not reinsertion

INSPECULO EXAMINATION
1.

2.
3.
4.

Is the IUD tail visible ?

If not, come back during next menstruation
advice to use additional contraception during
intercourse
When tail ( - ) during menstruation specific sonde
examination USG
Is the tip of IUD visible ?
If yes, partial expulsion withdraw & reinsert
Is there any signs of vaginal inflammation/ leucorrhea if
there is colpitis treat
Is there any signs of cervical inflammation
cytological examination treat

INSPECULO EXAMINATION
5.

Is there any bleeding coming out of the cervical canal ?

if 3 months, if the acceptor wants to stop wearing
IUD, withdraw offer other methods
If signs of pregnancy present confirms with PDV/
pregnancy test
6. Is there any cervical mass, ulcer, contact bleeding ? If
yes cytology/biopsy maybe cancer.
bimanual examination

SIDE EFFECTS OF IUD

1.

2.

BLEEDING
Menstruation bleeding more than usual
could be because of :
- IUD is to large
- not high enough
- changes in bleeding mechanism
UTRINE PAIN
MANAGEMENT : - Select IUD size
- analgesics
- when non medicated IUD is used
medications
- do no take contraceptive pills

give

COMPLICATIONS
1.
2.

3.
4.

Expulsion : complete/incomplete
Perforation : is suspected when :
Tail ( - )
Severe pain
Abnormal bleeding
Infection
Pregnancy
Pregnancy : ectopic/intrauterin
Pelvic infection

INDICATION FOR IUD WITHDRAWAL

PERSONAL
Intend to get

pregnant
Wanted to
change method

MEDICAL :
Pregnancy

Severe pain
PID
Uterine Neoplasm /
suspected
Menopause
Partial expulsion
Bleeding

PREGNANCY POSSIBLITY
ADR Plastik
Cu T / TCu 200
Nova T, MLCu-250/375
TCu 220, TCu 380
ADR Lng (20 g/h)
Progestasert

: 2 / 100 STW
: 2 / 100 STW
: 1 2 / 100 STW
: < 1 / 100 STW
: < 2 / 100 STW
: 2.9 / 100 STW

 Synthetic Progestin IUD contains

Levonorgestrel prevents ovulation.