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Postpartum Care
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Elena R. Magro-Malosso, Sarah K. Dotters-Katz, Daniele Di Mascio
IUDs are highly effective methods of contraception. Unfortunately, less than 50% of women who express interest in an IUD postpartum actually receive one [216]. Immediate postpartum placement has been shown to be safe and allows women to access contraception during the maternity hospitalization, though it is associated with an increased risk of expulsion compared with delayed insertion [217, 218]. In an RCT of postplacental versus delayed insertion, women randomized to postplacental insertion were more likely to have a device inserted (98% versus 90.2%, p = 0.20). There were no differences between groups in IUD use at 6 months postpartum (84.3% versus 76.5%). However, among women who were ineligible for the study and were advised to follow up for IUD placement as part of routine postpartum care, only 26.8% were using an IUD at 6 months postpartum [219]. These results were confirmed in a more recent Cochrane review, with IUD use at 6 months twice as likely, though expulsion was four times more likely [220]. These results suggest that women undergoing postplacental placement are more likely to use an IUD than those advised to follow up for placement during routine postpartum care. Immediate postplacental IUD placement has been classified as category 1 or 2 by the Centers for Disease Control and Prevention’s U.S. Medical Eligibility Criteria for Contraceptive Use [221].
The intrauterine device (IUD)
Published in Suzanne Everett, Handbook of Contraception and Sexual Health, 2020
Many women are unaware of new IUDs with higher efficacy and longer life spans, which may take some women over difficult periods where other contraception is contraindicated, and the menopause is not too far off! Women may be concerned over the pain of insertion of an IUD. The use of pre-insertion analgesia and local anaesthetic can help to reduce this; however, the comfort and support of a nurse or a partner are vital.
Contraception Across the Reproductive Life-Course
Published in Jane M. Ussher, Joan C. Chrisler, Janette Perz, Routledge International Handbook of Women’s Sexual and Reproductive Health, 2019
Long Acting Reversible Contraception methods are over 99% effective (Trussell, 2011) but immediately reversible if a woman wants to become pregnant or wants to discontinue because of side-effects. IUDs and implants need to be inserted and removed by a trained doctor or nurse, usually under local anaesthetic, which can limit their accessibility. Contraceptive implants take the form of one or two matchstick-sized flexible rods placed under the skin of the upper inner arm, which slowly release a progestogen hormone over three or five years to prevent ovulation (Faculty of Sexual & Reproductive Healthcare, 2014b). Hormonal IUDs are plastic T-shaped devices placed in the uterus that release a low dose of a progestogen hormone called levonorgestrel for up to five years; copper IUDs last for five or ten years depending on the type (Faculty of Sexual & Reproductive Healthcare, 2015a). IUDs prevent fertilisation by stopping sperm movement and survival of the egg, and may also prevent implantation of a fertilised egg in the uterus. Hormonal IUDs reduce or even eliminate menstrual bleeding, which makes them an important option for women with heavy bleeding and anaemia, whereas copper IUDs tend to make bleeding longer and heavier. Copper IUDs are inexpensive, and implants are becoming increasingly more affordable and available in low-income countries, but the more expensive hormonal IUDs remain out of reach for many women. Pharmaceutical companies and governments should make efforts to provide these highly effective devices at low or no cost to the women who most need them.
The Effects of Hormonal and Non-Hormonal Intrauterine Devices on Female Sexual Function: A Systematic Review
Published in International Journal of Sexual Health, 2023
Katherine Ogle, Ariel B. Handy
Intrauterine devices (IUDs) are commonly used, safe, and effective long-acting reversible contraceptives (LARCs). LARCs are the third most common contraceptive method group among U.S. women, followed by female sterilization and oral contraceptive pills (Daniels & Abma, 2018). IUDs are offered in two forms: hormonal and non-hormonal. The hormonal IUD delivers levonorgestrel (LNG), a form of progesterone, that suppresses endometrial proliferation and thickens the cervical mucus, therefore preventing pregnancy (Ortiz & Croxatto, 2007). In comparison, the non-hormonal IUD works by releasing copper (Cu) ions into the uterus, which alters the uterine lining and fallopian tubes, making it inhospitable to sperm (Ortiz & Croxatto, 2007). Both LNG- and Cu-IUDs are more than 99% effective at preventing pregnancy and can remain in use for 5 (LNG-) to 10 (Cu-) years, making them an increasingly popular option for family planning. However, if either IUD were expelled from the uterus or not placed correctly by a healthcare professional, it can fail at preventing pregnancy (Thonneau et al., 2006).
Localized, on-demand, sustained drug delivery from biopolymer-based materials
Published in Expert Opinion on Drug Delivery, 2022
Junqi Wu, Sawnaz Shaidani, Sophia K. Theodossiou, Emily J. Hartzell, David L. Kaplan
Nearly 80% of women from high-income countries have reported using oral hormonal contraceptive pills [32]. These hormones include androgens, estrogens, and/or progesterone. Combination pills that include both estrogen and progestin are associated with breakthrough bleeding, a twofold risk of myocardial infraction and stroke and a 37 times higher risk of venous thrombosis [32,33]. Additionally, contraceptive pills must be taken daily, leading to decreased patient compliance and drug effectiveness if the user forgets to take or misplaces the pills. Subdermal implants that achieve sustained, long-term systemic release of contraceptives were created to address these issues [34]. Nexplanon is an etonogestrel-releasing ethylene vinylacetate copolymer rod-shaped implant inserted subdermally in the arm, and can be left in place for 3 years via surgical incision [35]. If the patient sustains injuries near the implant site, however, the implant could be damaged and may require surgical removal [36]. Additional side effects associated with systemic subdermal contraceptives include menstrual disturbances, acne, headache, abdominal pain, hair loss, weight gain, and follicular cysts [34]. Currently, the most popular local contraceptive delivery systems are intrauterine devices (IUDs), which are used by more than 168 million women worldwide. However, IUDs also have complications such as causing infections, pelvic inflammatory disease, uterine perforation, and menstrual disturbances [37,38].
Understanding factors associated with continuation of intrauterine device use in Gujarat and Rajasthan, India: a cross-sectional household study
Published in Sexual and Reproductive Health Matters, 2022
Sunita Singal, S. K. Sikdar, S. Kaushik, Pragati Singh, Nidhi Bhatt, Ghazaleh Samandari, Manoj Pal, Levent Cagatay, Anupama Arya, Kathryn A. O’Connell
Among respondents who reported IUD removal, the majority (47.7%) did so within the first two months of insertion, after which the next highest rate of removal was at five months or beyond (35.9%) (see Table 2). Side effects (including irregular periods, lower abdominal pain, excessive bleeding, vaginal discharge, and/or problems during intercourse) were the most commonly cited reason for IUD removal for both PPIUD respondents (83.3%) and IIUD respondents (87.4%). Respondents less commonly cited opposition from spouses or other family members (9.2%) or a desire to conceive (8.4%) as reasons for IUD removal. The majority of respondents who removed their IUD did so at the same facility at which they received the method (86.0% of IIUD respondents and 79.5% of PPIUD respondents).