IUDPROTOCOli-NationalFamilyPlanningReproductive.docVIP

Medical Protocol INTRAUTERINE DEVICES (IUDs) Introduction Currently, there are two IUD options are available in the U.S: the ParaGard and the Mirena. Tapestry Health offers both contraceptive options. The ParaGard IUD (a brand name for the Intrauterine Copper Contraceptive Model T38OA) has an approved duration of use for 10 years. Unlike previous copper IUDs, the ParaGard contains copper on the arms of the T as well as on the stem, thus increasing its effectiveness by introducing more copper higher into the uterus. Mirena (the brand name for the levonorgestrel intrauterine system, LNG-IUS) releases the progesterone levonorgestrel directly into the endometrial cavity at an initial rate of 20 mcg per day, and is approved for 5 continuous years of contraceptive use. The frame of Mirena contains barium sulfate for visibility on X-ray. Mechanism of Action IUDs work primarily by preventing sperm from reaching and fertilizing an egg. The ParaGard inhibits sperm migration, impairs sperm viability, and changes the transport speed of the ovum. In addition, the Mirena suppresses the endometrium and thickens the cervical mucus. (A very small percent of women will not ovulate as a result of the systemic absorption of levonorgestrel.) Effectiveness Both ParaGard and Mirena rival the effectiveness of tubal sterilization. Less than 1% of women using the ParaGard or the Mirena experience a pregnancy during the first year of use. Advantages /DisadvantagesAdvantages: high rate of contraceptive efficacy not connected with the act of intercourse continuous contraception long acting reversible cost effective Disadvantages: Cramping and pain at time of insertion Risk of expulsion (2%-10% within first year) Perforation (1 per 1,000 insertions or less) Altered bleeding patteContraindications IUD insertion is contraindicated when one or more of the following conditions exist: Pregnancy or suspicion of pregnancy Congenital or acquired uterine anomalies which distort the uterine ca