Gynecological spiral. Intrauterine device: types, principle of operation

Problem unwanted pregnancy has been relevant at all times. The child must appear with the consent of both parents. And to prevent large number abortions, many contraceptive methods were created. These are special tablets and vaginal suppositories, and even a band-aid. IUD spirals are also very common today. What are they? Let's try to figure it out.

What is it?

A small device made of metal or plastic is called a spiral. It is inserted into the uterine cavity to prevent unwanted pregnancy. Silver or copper is most often used to make the device. This method of contraception is very popular today. Efficiency reaches 98%. It is not advisable for women who have not yet given birth to have an IUD (coil) installed. Reviews note that in this case the risk of side effects increases significantly.

Since the beginning of the 20th century, a huge number of intrauterine devices have been invented. The highest quality devices turned out to be T-shaped devices, which easily entered the uterine cavity and prevented the development of pregnancy. The device was installed exclusively by a specialist in a medical institution. Before use, the patient is warned about the development possible complications. This may be a violation menstrual cycle, erosion, infectious and inflammatory diseases, bleeding, rejection of the coil. IN in rare cases An ectopic pregnancy develops.

You should be prepared for the fact that in the first days after installation of the IUD coil, you may feel discomfort in the lower abdomen, as well as pain during sexual intercourse. If such symptoms do not go away within a week, you should consult a gynecologist for advice.

Mechanism of action of the intrauterine device

Blocks several complex ones at once natural processes Navy. Intrauterine device, which contains copper, creates a destructive environment for sperm and eggs. The metal is released into the uterine cavity as long as the coil is inside the body. Progesterone devices are also popular. The hormone, entering the blood, blocks ovulation and promotes thickening of cervical mucus. The egg does not mature at all, and pregnancy does not occur.

The action is also due to changes in the structure of the walls of the uterus. Even if fertilization occurs, the egg cannot implant inside reproductive organ. As a result, menstrual bleeding occurs with a slight delay. In rare cases, the egg does implant, but outside the uterus. Statistics say that the majority of ectopic pregnancies occur in women who use the IUD for contraception.

A foreign body in the uterine cavity itself provides a contraceptive effect. The walls of the uterus contract more intensely. Due to this, the sperm and egg cannot move normally.

The effectiveness of intrauterine devices is quite high due to the summation various mechanisms actions. If the device is installed correctly, in 98% of cases it is possible to protect against unwanted pregnancy. It is better to consult a gynecologist about which spiral to use. The doctor will do everything necessary tests and install the device. A significant advantage is the long-lasting effect of contraception. IUD spirals can remain in the uterine cavity for two to five years, depending on the quality and material of manufacture.

Inert intrauterine devices

The first semblance of a modern IUD appeared in 1960 thanks to the scientist Margulis. Then a spiral-shaped device was created, which significantly reduced the risk of complications. All types of IUDs - spirals that are used today have a linear design. Thanks to this, the device can be easily inserted through a special plastic tube.

In 1962, the Lipps loop was first manufactured. This device had threads that hung from the uterine cavity into the vagina. Thanks to this, the foreign body could be easily removed over time. The Lipps loop is used quite rarely today due to its low efficiency. It is possible to protect against unwanted pregnancy only in 70% of cases. But in the second half of the 20th century, the device was found wide application in family planning programs around the world. A similar IUD (coil) has helped many people protect themselves from unwanted pregnancy. developed only in rare cases. The device was soft and flexible. Thanks to this, it was easily removed from the uterine cavity for medical reasons.

In the likeness of the Lipps loop, devices were created that are widely used today. Popular types of IUDs (spirals) will be described below.

Coils with copper content

These devices are shaped like a Lipps loop. The main difference is the copper content. Metal is constantly released into the uterine cavity, preventing the development of the egg and the normal movement of sperm. Modern IUD coils are made to be flexible and durable. They are easy to install and easy to remove. Gynecologists highlight models from such manufacturers as Paragard, Copper-T, Multiload, and Nova-T. There are also other coils containing copper that are made in the shape of an umbrella or a ring. But such devices are not very effective. In addition, their use significantly increases the risk of side effects.

Multiload companies are manufactured in the shape of a semi-oval with small metal antennae. This shape allows the device to better secure itself in the cavity of the spiral and does not cause major complications. This should only be done by a gynecologist in a medical facility. The Multiload spiral belongs to the middle price category. You will have to pay about 2,500 rubles for the device.

The product of the manufacturer Nova-T is also popular. The IUD is a spiral (installation of the device is very simple due to its special shape) - visually similar to a large letter “t”. Horizontal branches are made of high quality plastic. Such a device can be located in the uterine cavity long period. Experts recommend changing it every 4-5 years. For a Nova-T spiral you will have to pay about 2000 rubles.

You can also use the economical domestic model “Junona Bio”. This IUD (spiral) is also made in the shape of the letter “t”. Reviews from experts show that the device is highly effective over two years of use. In the future it is advisable to replace it.

These devices combine the advantages of several types of contraceptives. They not only mechanically block the basic processes of fertilization, but also secrete a special hormone that is responsible for the development of the egg. IUD coils are also made in a “T” shape. The stem of the device is filled with progesterone and levonorgestrel. Side effects practically do not develop. Hormones enter the body evenly over several years. Most of these spirals can be used for 5-6 years.

The most expensive ones are produced by Mirena. But the device is really worth the money. Reviews from experts show that women who install the device significantly reduce the risk of developing inflammatory processes. The effectiveness of protection against unwanted pregnancy is 98%. The only downside is the increase in the amount of intermenstrual discharge. The problem is solved by using panty liners. A high-quality IUD - the Mirena spiral - will cost more than 8,000 rubles. You can find it in almost any pharmacy.

Experts do not recommend that nulliparous women use an IUD (coil). Installing such a contraceptive is fraught with infertility. However, medicine does not stand still. A special type of IUD (Multiload spirals) containing hormones was invented. This is a spiral that can effectively protect against unwanted pregnancy for two years. The device is easy to install and remove in a medical facility.

Intrauterine devices with silver

Silver has a disinfectant and antibacterial effect. It is no coincidence that this metal is widely used in the medical field. An IUD (spiral) with silver is the choice of many women. Such a contraceptive will not only protect against unwanted pregnancy, but also heal the uterine cavity and reduce the risk of developing erosions. Silver is toxic to sperm. They die on the way to the egg. Thanks to this, the effect of using the IUD increases. Most silver coils can be used for about five years.

Silver has a positive effect on the uterine cavity. Metal can remove inflammatory processes. It is only worth remembering that an IUD (coil) will not help protect against sexually transmitted diseases. Side effects will seem like a minor problem compared to the infections that can be acquired if a woman has a promiscuous sex life. The main purpose of the IUD is to protect against unwanted pregnancy.

Women who have not yet given birth should not receive an IUD containing silver. You should prepare for the fact that menstruation after installing a contraceptive will become more painful and longer. If the IUD causes discomfort for a long period of time, it is better to remove it. For some women, such a contraceptive is not suitable due to the special structure of the uterus.

A silver IUD can be inserted on any day of the menstrual cycle when there is no abortion or the contraceptive is installed after six weeks.

Spirals with gold content

Any metal will corrode over time. The only exception is gold. This precious metal It is fully compatible with the human body and almost never causes allergies. Gold-containing intrauterine devices are suitable for women with hypersensitivity. Just like a device with silver, an IUD (spiral) with gold has an anti-inflammatory effect. The risk of developing erosions is significantly reduced. Big disadvantage is only the cost of the contraceptive. For one device you will have to pay more than 15,000 rubles. The validity period does not exceed five years. Not every woman will agree to such expenses.

An intrauterine device containing gold has minimal risks. The effectiveness of protection against unwanted pregnancy reaches 99%. Such devices, unfortunately, are not installed for women who have not yet given birth. But in the postpartum period, this spiral is ideal. The contraceptive allows a woman to recover faster after pregnancy and promotes the healing of small cracks in the uterine cavity.

Installation of an intrauterine device

You can buy an IUD (spiral) at any pharmacy. Photos of a specific manufacturer's model can always be studied in the catalog. But under no circumstances should you administer a contraceptive yourself. This is done by a qualified specialist in a medical facility. Before installation, the gynecologist is required to conduct a series of studies and tests. This is the only way to determine which type of spiral is suitable for a particular woman. In addition, the specialist must make sure there are no contraindications.

The intrauterine device is not installed in women who have inflammation of the appendages. Initially, the disease should be cured, and only then select a suitable contraceptive. Sexually transmitted infections are also contraindications to the use of spirals. For nulliparous women, the IUD is installed only in rare cases. The risk of developing infertility increases significantly.

In most cases, specialists insert the IUD on the fourth day after the start. menstrual bleeding. At this time, the cervix is slightly open, and heavy discharge almost no longer. In addition, this period is the least suitable for conception. To full development The eggs remain for more than 7 days. You can begin to be sexually active a few days after installing the device.

You should only trust the installation of an IUD to a trusted specialist. About what this operation performed incorrectly may indicate profuse bleeding for several days, and severe pain lower abdomen. You cannot do without urgent consultation with a doctor. Perhaps the inept actions of the specialist who installed the IUD caused damage to the uterine wall.

After installing the device, women note that menstruation becomes longer. This is absolutely normal. You should only worry if the bleeding is accompanied by sharp pain.

In 7-10% of cases, the IUD falls out of the uterus. This may be due to the special structure of a woman’s body. Most often, this situation occurs during menstrual bleeding. This is fraught with unplanned pregnancy. Often women do not even suspect that the spiral has shifted.

Removal of the IUD

There are several reasons for removing the IUD from the uterine cavity. Be sure to carry out the procedure after the expiration date of the device has expired. The IUD is also removed if there is a desire to have a child, a tumor or inflammation of the appendages develops. Displacement of the contraceptive in the uterus is also an indication for its removal.

Only a specialist in a medical institution can remove the IUD (spiral). Removal is a completely painless procedure if the woman is healthy. You should not carry out any manipulations yourself. This can damage the walls of the uterus or cervix. The procedure is carried out in two stages. Initially, the gynecologist examines the woman and assesses the condition of the IUD. If the patient does not consult a specialist in a timely manner, the IUD may become fused with the walls of the uterus. In this case, it will not be possible to remove the foreign body painlessly. If any complications arise, removal is carried out using hysteroscopy.

When can the coil be removed? The IUD is most easily removed during menstrual bleeding. If necessary, perform local anesthesia. Hysteroscopy is performed under general anesthesia. If it is not possible to get the spiral through, an operation is performed by opening the abdominal cavity.

Let's sum it up

When choosing an intrauterine device as a method of contraception, you should weigh the pros and cons. This option is more suitable for women who have already experienced the joy of motherhood and do not plan to give birth within five years. It is worth remembering that the IUD only protects against pregnancy. But for sexually transmitted diseases, the IUD is not a hindrance.

A woman who has an intrauterine device installed should regularly visit a gynecologist (at least twice a year) and monitor the condition of the genital organs. A foreign body located in the uterine cavity can cause corresponding reactions from genitourinary system. Inflammatory processes may develop, which can lead to unpleasant consequences. The most difficult of these is infertility. For this reason, it is highly undesirable for nulliparous women to install an IUD.

After the expiration date has passed, the IUD must be removed from the uterine cavity. After 6-7 years, the foreign body grows into the endometrium. In this case, it will not be possible to remove the spiral in the usual way. Can't be avoided surgical intervention. Other complications are also possible.

The choice of contraceptive method often rests with the woman. After analyzing the effectiveness, safety, and ease of use, many choose the intrauterine device. This method has ancient history, but has long ceased to be traumatic and dangerous for female body.

An intrauterine device is a small medical device, containing copper, gold, silver or hormone, intended for installation in the uterus.

How does a spiral work and look like?

To understand the principle of operation of the spiral, it is necessary to turn to the physiology of conception. During sexual intercourse, sperm is poured onto the cervix, sperm rush into its cavity.

If a woman ovulates shortly before, then a mature egg moves towards the male reproductive cells. In the uterine cavity, sperm enter the left and right fallopian tubes, which is where fertilization occurs. The fertilized egg exits back into the uterine cavity and attaches to its loose wall.

If fertilization does not occur, then menstruation begins. The egg, along with the inner lining of the uterus, is released with menstrual blood.

Depending on the type, the IUD affects several stages of fertilization at once. Modern medicine offers several types of spirals:

Metal-containing.
Hormone-containing.

In the first version, the spiral contains a small amount of metal - copper, gold or silver. The ions of these metals deactivate sperm or cause their death, and reduce the lifespan of the egg. A small amount develops in the uterine cavity inflammatory reaction, which prevents the egg from attaching.

Hormonal IUDs contain progestogen, which is continuously released into the uterine cavity. It prevents you from getting pregnant and has therapeutic effect. The hormone increases the viscosity of cervical mucus and prevents sperm from entering the uterus. Sperm become less mobile. Some women do not ovulate. The therapeutic effect is to reduce the thickness of the endometrium. This is useful for long and heavy menstruation and endometrial hyperplasia, fibroids.

IUDs come in the following forms:

Ring-shaped.
Spiral-shaped.
T-shaped.

The latter type is more popular. The T-coil looks like a plastic stick with copper wire. At the upper end there are hangers for fixation in the uterus. Below are special threads for extraction. Length without them is up to 3.5 cm.

The spiral is enclosed in a special conductor tube, the hangers are folded along the central part. When inserted, they are straightened to the sides and the IUD is fixed in the uterine cavity.

If the installation was correct, the shoulders rest against the fallopian tubes, the body of the spiral is located in the center of the uterus, and the antennae emerge from the cervix.

Advantages of intrauterine contraception, installation and removal

The IUD has a number of advantages over other methods of contraception:

Before the IUD is installed, the woman undergoes an examination. A vaginal smear is required to rule out infection. If there is inflammation, a course of anti-inflammatory suppositories is prescribed.

An ultrasound of the uterus and appendages is performed to determine their shape, the presence of nodes, and inflammation. Appointed general analysis blood and urine, blood test for HIV and syphilis.

The IUD is placed on days 4-6 of menstruation, when the cervix is not yet tightly closed. The doctor determines the length of the uterine body by inserting a special probe. After this, a conductor tube with a spiral inside is inserted. The conductor is carefully removed, the hangers are straightened and securely fix the spiral inside. The doctor cuts the threads, forming antennae up to 2 cm long.

The IUD can be placed for up to 5 years, after which it is removed. Sometimes it is removed prematurely at the request of the woman or when certain indications, they can be:

pregnancy;
spiral displacement;
fibroid growth;
inflammation of the uterus or appendages.

The IUD is removed by the doctor after a gynecological examination, on days 1-5 of the menstrual cycle. Normally, it is pulled out by the antennae, without causing any discomfort. In some situations, the spiral is removed only during hysteroscopy under anesthesia. This happens when worn for a long time and it grows into the uterus, with a significant growth of myomatous nodes that prevent extraction.

Contraindications for installation

The IUD is placed in healthy women who have given birth and who are not planning a pregnancy in the next 1.5-5 years. It can be placed after an abortion, if there is no inflammation, for nursing mothers, after childbirth at 6 weeks. If there are contraindications to taking hormonal contraceptives, then the spiral is a way out of the situation.

The World Health Organization identifies relative and absolute contraindications for the installation of an IUD.

Absolute contraindications completely exclude the possibility of inserting a spiral:

inflammatory diseases of the genital organs;
pregnancy;
bleeding from the uterus of unknown nature;
cancer of the uterus or cervix;
for hormonal spirals – thrombophlebitis, hepatitis.

Relative contraindications allow the possibility of wearing a spiral after they are eliminated:

previous inflammation of the genital organs, the spiral is placed no earlier than after 6 months;
long and heavy menstruation, uterine bleeding, endometrial hyperplasia;
painful periods;
uterine fibroids with many nodes that deform the uterine cavity;
endometriosis;
previous ectopic pregnancies;
malformations of the uterus;
anemia, diseases of the blood coagulation system;
repeated loss of the spiral;
transferred for last year sexually transmitted diseases, infected abortion.

But some contraindications do not apply to the installation of a hormonal IUD. The hormone progesterone contained in it has a therapeutic effect for long and heavy menstruation, endometrial hyperplasia, endometriosis, and uterine fibroids. The thickness of the inner layer of the uterus - the endometrium - decreases, and blood loss decreases. In women with normal periods, they may become scanty or stop altogether.

With the help of progesterone, you can influence uterine fibroids; under its action, the nodes shrink within 6 months to a year and a half, often eliminating the need for surgery.

Possible complications

The first complications may arise during installation. This may be partial or complete perforation of the uterine wall.

Normally, the uterus is elastic, but with frequent inflammatory diseases its walls change and become looser. If excessive pressure is applied during installation of the coil, a puncture can be made. If the IUD is partially punctured, the IUD is removed from the vagina, cold is applied to the abdomen, and antibiotics are prescribed to prevent infection. If the puncture is complete, surgery to suturing the uterine wall is necessary.

Appearance heavy bleeding during installation of the spiral is an indication to stop the procedure!

While wearing the IUD, the following complications may develop:

Increased blood loss during menstruation. Copper IUDs increase blood loss by up to 50%. Spotting may appear in the middle of the cycle during the first 3 months.
Inflammatory diseases of the vagina, uterus, appendages. The IUD can serve as an entry point for infection. If inflammation develops, the coil is removed.
Spiral falling out. In the first week after the procedure, limit physical activity and heavy lifting. After this period, you can return to normal life and sports. But during menstruation it is recommended to avoid excessive exercise. Those women who have used sanitary tampons should switch to pads, because... It is possible to remove the spiral along with the tampon.
Pregnancy. The IUD does not provide 100% protection against pregnancy. Ectopic pregnancy often develops, because the passage of the egg through the fallopian tubes slows down. It does not have time to enter the uterine cavity and attaches itself to the appendages. May develop and normal pregnancy, nose high probability miscarriage. If a woman is interested in preserving the fetus, the non-hormonal IUD is not removed until after birth. Hormonal pregnancy can cause developmental defects in the child; it is better to terminate such a pregnancy.

The signs of an ectopic and normal pregnancy are the same, but an ectopic pregnancy can result in a ruptured tube and bleeding into the abdominal cavity. When menstruation is delayed and positive test If you are pregnant, you need to see a doctor immediately!

After removing the coil, complications are possible in the form of chronic inflammation genital organs, risk of ectopic pregnancy, infertility. If the IUD is used longer than prescribed, endometrial hyperplasia or polyps may develop.

It should be remembered that the IUD is a one-sided protection; it protects against pregnancy, but does not protect against sexually transmitted infections. Therefore, for women who often change sexual partners, it is better to choose a condom for contraception.

It is also recommended to independently monitor the presence of a contraceptive once a month. To do this, you need to insert a finger into the vagina in a squatting position and feel the antennae. If none are missing, then there is a possibility of losing the spiral.

In cases where there are no contraindications, the IUD serves in an efficient way protection against unwanted pregnancy and preservation of reproductive health.

Among modern women many people use the intrauterine device to prevent unwanted pregnancy in their body. But not everyone fully understands principle of operation of the intrauterine device.

The principle of operation of the intrauterine device

An intrauterine device is a gynecological device that mechanically prevents unwanted fertilization of a woman:

The spiral accelerates the movement of the fertilized egg through the fallopian tubes. In such a short period of time, a fertilized egg does not have time to be enriched with all necessary qualities. These qualities, in turn, during natural conception contribute to the further consolidation of the embryo inside the uterine cavity.

In addition, the intrauterine device mechanically prevents the penetration of the egg into the uterine cavity. The fertilized egg, not finding a cozy place for itself, dies over time and is removed from the female body during menstruation.

The components that make up the intrauterine device reduce the ability of the sperm to perform its functional responsibilities. This greatly enhances contraceptive effect this type of female contraception.

Benefits of the intrauterine device

What are the advantages of the IUD:

First positive thing When using an intrauterine device, this method of contraception is highly effective. About 97% guaranteed.

Spirals are very easy to use and do not require preliminary preparations before sexual intercourse.

The presence of a spiral in the uterine cavity does not in any way affect the normal course of a woman’s life.

Simultaneously complete absence discomfort during intimacy and prevention of unwanted pregnancy.

The intrauterine device does not affect the lactation period in any way and is perfect for women who have recently given birth and who are breastfeeding.

The principle of operation of the intrauterine device does not in any way affect the natural process of reproductive function of the female body. Namely: during ovulation, the egg continues to mature, and the grown layer of the intrauterine epithelium is periodically rejected. The latter is indicated by monthly menstrual bleeding.

After removal of the intrauterine device, a woman can easily become pregnant in the near future.

Disadvantages of the intrauterine device

But this method of contraception has disadvantages:

The spiral is one way or another a foreign body inside the female body. That is, the intrauterine device can be rejected by the tissues adjacent to it. This is evidenced by the occurrence of inflammatory processes in the uterine cavity after the installation of this contraceptive device.

The intrauterine device should not be used by nulliparous women. Due to a possible inflammatory process in the area of the internal genital organs, a woman may remain infertile forever.

May cause more painful menstruation with heavy bleeding.

Does not guarantee 100% absence of unwanted conception and can lead to ectopic pregnancy.

It should be noted that the installation of an intrauterine device should be carried out only by a gynecologist and after complete medical examination women. Come to our medical center in Moscow, and we are guaranteed to select the optimal method of contraception for you, taking into account all the characteristics of your body. Modern medical equipment and experience medical specialists our clinic will help identify the presence of diseases of your genital organs even on the most early stage. This will help preserve your women's health as much as possible and prevent undesirable consequences after installation of the intrauterine device.

Every woman has a moment when she thinks about becoming a mother. But for many girls, sexual activity begins earlier than they are ready for motherhood, and even for family life at all. Especially among modern women, planning a child is postponed until they fully realize themselves in other areas of life.

Well, if a woman has already become a mother, and maybe more than once, then there are very few people who want to repeat this feat a dozen more times and give birth every year. That is why, since ancient times, people have adapted to avoid becoming pregnant without desire. In order to deceive nature, they came up with simple methods of contraception (from the Latin word contraceptio - exception). We started with various essential oils, fruit juices, tampons, lotions, interrupted contact, fabric bags (precursor to the condom) and so on.

As you can see, the spiral affects all processes necessary for conception:

vital activity and speed of sperm movement;
egg maturation and ovulation;
attachment of the fertilized egg to the endometrium.

Pros and cons of using intrauterine devices

Benefits of the IUD	Disadvantages of the IUD
Convenient to use, the spiral is installed for a period of 3 to 10 years or more. No daily procedures required, special hygiene care and taking pills by the hour. In a word, for a long time you can not think about contraception at all and not be afraid of an unwanted pregnancy, but enjoy your sexual relationships.	Not suitable for all women, as it has a number of contraindications. For some women, the IUD does not take root.
High effective method: pregnancy occurs in only 2 out of 100 cases. More low efficiency provide inert IUDs, and when using hormonal intrauterine systems, the risk of becoming pregnant is reduced to zero.	Still there is a risk of unplanned pregnancy with a spiral. In addition, the spiral may fall out and the woman may not notice it. But only removal of appendages or bandaging gives 100% results fallopian tubes and complete refusal of sexual activity.
Preservation of reproductive function immediately after removal of the IUD.	Young and nulliparous women are advised to refrain from using non-hormonal IUDs, since they may develop as a side effect inflammatory changes in the endometrium of the uterus and appendages, reducing the chances of becoming pregnant in the future.
Does not affect the quality of sexual life, that is, on sexual desire, sexual intercourse for both partners and achieving orgasm.	An IUD can cause painful and heavy periods. While hormonal IUDs, on the contrary, solve the problems of painful periods. But progestogen IUDs can lead to absence of menstruation, which also negatively affects women’s health.
Low cost. At first glance, it may seem that some types of spirals are an expensive pleasure. But given the long period of use, this method will be much more economical than those products that require use during each sexual intercourse, daily and monthly.	Possible side effects from the use of spirals, unfortunately, their development is not uncommon.
IUDs can be used after childbirth during lactation when oral hormonal agents contraindicated.	Increases the risk of developing inflammatory processes genitals, and the spiral does not protect against sexually transmitted diseases.
Additionally for hormonal intrauterine systems: can be used for women of any age; used not only for contraception, but also in the treatment of certain gynecological diseases(fibroids, endometriosis, painful menstruation, uterine bleeding, etc.).	Increases the risk of developing an ectopic pregnancy. The use of hormonal IUDs significantly reduces the risk of pathological pregnancy.
	The procedure for inserting an IUD requires a visit to a gynecologist, brings discomfort and painful sensations , y nulliparous women pain syndrome particularly pronounced, sometimes requiring local anesthesia.

Indications for installation of an intrauterine device

1. Temporary or constant prevention unwanted pregnancies, especially if the family already has children. Intrauterine devices are ideal for women who have given birth and have one sexual partner, that is, for those whose risk of contracting sexually transmitted diseases is very low.
2. Frequent unwanted pregnancies, ineffectiveness or carelessness of women in using other contraception.
3. Preventing pregnancy after childbirth, especially caesarean section, after medical abortions or spontaneous miscarriages, when the onset of another pregnancy is temporarily not desirable.
4. The woman has temporary or permanent contraindications to pregnancy.
5. The presence in the family history of genetic pathologies that the woman does not want to pass on by inheritance (hemophilia, cystic fibrosis, Down syndrome and many others),
6. For hormonal intrauterine devices – some gynecological pathologies:

uterine fibroids, especially if it is accompanied by heavy spotting and uterine bleeding;
heavy, painful periods;
replacement therapy estrogens at the beginning of menopause or after removal of the appendages, in order to prevent the growth of the endometrium.

Contraindications

Absolute contraindications to the use of all intrauterine devices

Presence of pregnancy at any stage, suspicion of possible pregnancy;
oncological pathologies of the genital organs, as well as breast cancer;
acute and chronic inflammatory diseases of the female genital organs: adnexitis, colpitis, endometritis, including postpartum, salpingitis and so on, including the presence of sexually transmitted diseases;
a history of ectopic pregnancies;
allergic reactions to the materials from which the spiral is made;
tuberculosis of the reproductive system;

Relative contraindications to the use of non-hormonal IUDs

if the woman does not have children yet;
a woman is promiscuous and is at risk for contracting sexually transmitted diseases;
childhood and adolescence*;
woman's age over 65 years;
uterine bleeding and heavy painful periods;
abnormalities of the uterus (for example, bicornuate uterus);
hematological diseases (anemia, leukemia, thrombocytopenia and others);
endometrial growths, endometriosis;
urethritis, cystitis, pyelonephritis - acute or exacerbation of a chronic course;
benign tumors of the uterus and appendages ( submucosal fibroid and uterine fibroids);
prolapse of the intrauterine device or development side effects after the previous use of the spiral.

* Age restrictions are conditional, gynecologists usually do not offer young nulliparous women the use of intrauterine contraceptives, for fear of harm. But, in principle, the spiral can be successfully installed in any childbearing age, followed by successful pregnancy.

Relative contraindications to the use of hormonal intrauterine devices (systems):

cervical dysplasia;
abnormalities of the uterus;
urethritis, cystitis, pyelonephritis - acute or exacerbation of a chronic course;
uterine fibroids;
liver diseases, liver failure;
heavy cardiovascular pathologies: malignant arterial hypertension, condition after a stroke or heart attack, severe heart defects;
migraine;
decompensated (uncontrolled) diabetes mellitus;
thrombophlebitis of the lower extremities;
woman's age over 65 years.

When can IUD be placed after childbirth, cesarean section, or abortion?

An intrauterine device can be placed already on the 3rd day after an uncomplicated physiological birth. But usually gynecologists recommend waiting until the lochia discharge stops (on average 1-2 months). It will be safer that way. After childbirth, the uterus recovers, so early insertion of the IUD increases the risk of side effects and early rejection of the device. To start using the hormonal intrauterine system, you need to wait 2 months after the baby is born; this is necessary not only for full recovery uterus, but also normalization of hormonal levels.

After a cesarean section, the IUD can be installed in the uterine cavity only after 3-6 months. It takes time for a postoperative scar to form.

After a medical termination of pregnancy (up to 12 weeks), it is better to install an IUD within seven days after the start of the next period after the abortion. But a gynecologist may suggest installing an IUD immediately after an abortion, without getting up from the gynecological chair. This is possible, but in this case the risk of developing side effects of the intrauterine device associated with complications of the abortion itself increases significantly. After a miscarriage, the decision on the feasibility and safety of installing an IUD is made only by a doctor; he assesses the situation individually, analyzes the cause of spontaneous abortion, and weighs the pros and cons. If it is necessary to use a device after a miscarriage, it is installed in the uterine cavity during the next menstruation.

Is an intrauterine device installed after the age of 40?

The IUD can be used for any woman who is ovulating, has maintained her menstrual cycle, and is likely to become pregnant. Hormonal intrauterine systems are also installed during the period after menopause to obtain therapeutic effect. Therefore, 40 years is not a limitation for using an IUD. According to the instructions, IUDs are not recommended for women over 65 years of age, but this limitation appeared only due to insufficient study of the use of intrauterine devices in older age.

How is an intrauterine device installed?

The intrauterine device is installed only by a gynecologist in a gynecological office. Before inserting an IUD, the doctor assesses the possibility and risk of developing side effects from using this contraceptive, explains to the woman about the possible reactions of the body to the introduction of one or another type of spiral. Before intrauterine contraceptives are installed, a woman must undergo an examination to completely exclude possible pregnancy and contraindications.

Recommended examination before inserting an intrauterine device:

gynecological examination and palpation (palpation) of the mammary glands;
vaginal smear, if necessary, culture for microflora;
cytological examination of smears from the cervix;
Ultrasound of the pelvic organs;
in some cases, a pregnancy test or blood test to determine hCG levels;
Ultrasound of the mammary glands (for women under 40 years of age) or mammography (after 40 years of age).

Preparing for installation

Usually special training no spiral is required for insertion. If inflammatory diseases are detected, you will first need to undergo a course of appropriate therapy.

Immediately before the procedure, you must empty your bladder.

On what day of menstruation is it better to install an intrauterine device?

Intrauterine contraceptives are usually installed during menstruation or towards its end, that is, within 7 days from the start of menstruation. The optimal period is 3-4 days. This is necessary in order not to miss the onset of pregnancy.

An intrauterine device can be installed as emergency contraception, that is, if a woman has had unprotected sexual intercourse and expects an unwanted pregnancy. In this case, the device is inserted in the period after ovulation, this can prevent the attachment of the fertilized egg in 75% of cases.

Technique for inserting an intrauterine device

Any spiral packed in vacuum packaging is sterile. You need to check the expiration date. The coil must be opened immediately before installation, otherwise it loses its sterility and can no longer be used. The IUD is a single-use device; its reuse is strictly prohibited.

In most cases, local anesthesia is not required. Anesthetics in the cervical area can be used in nulliparous women and when installing hormonal intrauterine systems, since they are wider.

The insertion technique for different types of spirals may differ. The installation features of each spiral are described in detail in the device instructions.
1. A gynecological speculum is inserted into the vagina, with the help of which the cervix is fixed.
2. The cervix is treated with disinfectants.
3. Using special forceps it is straightened cervical canal(the canal in the cervix that connects the vagina to the uterus), the cervix opens.
4. A special probe is inserted through the cervical canal into the uterine cavity to precise measurement dimensions of the length of the uterus.
5. If necessary, the cervix is anesthetized (for example, lidocaine or novocaine). The insertion of the spiral itself begins after 4-5 minutes, when the anesthetic takes effect.
6. The spiral is inserted using a special guide with a piston. A ring is placed on it on a scale according to the size of the uterus, this is necessary in order not to damage its walls. Then a conductor with a spiral is inserted into the uterus. Having reached the corresponding mark, the doctor slightly pulls the piston towards himself so that the shoulders of the spiral open. After this, the spiral is moved directly to the wall of the uterine fundus. When the gynecologist is sure that the device is installed correctly, the guidewire is slowly and carefully pulled out. When installing some spirals (for example, ring-shaped), the opening of the shoulders is not required, so the spiral is inserted to the wall of the uterine fundus, and then the guide is simply pulled out.
7. The spiral threads are cut into the vagina at a distance of 2-3 cm from the cervix.
8. The procedure is completed, it usually takes 5-10 minutes.

Is inserting an intrauterine device painful?

The procedure itself, of course, is unpleasant and brings some discomfort. But the pain felt is tolerable, it all depends on pain threshold women. These sensations can be compared to painful menstruation. Abortion and childbirth are more painful.

After installation of the intrauterine device

Ultrasound photo: Intrauterine device in the uterine cavity.

The uterus completely gets used to the IUD within several months, so during this period some changes in the women's health, you need to listen to your body.
In some cases a course will be required antibacterial therapy after insertion of the spiral, for example, if chlamydia is suspected, or if there is another chronic infection of the genitourinary system.
Bloody spotting and nagging pain in the lower abdomen or back may bother you for 1 week after insertion of the IUD. To relieve spasms, you can take No-shpa.
The hygiene regime is normal; you need to wash yourself with intimate hygiene products twice a day.
You can have sex only 8-10 days after the installation of the intrauterine device.
For several months, you should not lift weights, engage in intense physical activity, or overheat (sauna, bathhouse, hot baths).
It is necessary to periodically probe the spiral threads, control their length, it should not change.
After 2 weeks, it is better to visit a gynecologist to see if everything is normal.
Menstruation in the first months after installation of the IUD may be painful and heavy. Over time, menstruation normalizes.
When using hormonal intrauterine systems, after six months or several years, menstruation may disappear (amenorrhea). After the first loss of a cycle, it is necessary to exclude pregnancy. The menstrual cycle will be restored immediately after the IUD is removed.
If you have any complaints, you should consult a doctor.
In the future, examination by a gynecologist is necessary every 6-12 months, as for any healthy woman.

Can an intrauterine device fall out?

If the intrauterine device is not installed correctly or if it does not take root, the intrauterine device may fall out. We need to keep an eye on this. Most often, IUD loss occurs during menstruation or after heavy physical activity. Therefore, it is important to check whether the spiral threads are in place and inspect sanitary pads.

How long does it take to use an intrauterine device?

The deadline for which is set intrauterine contraception, differs depending on the type of spiral.

Inert IUDs are usually installed for 2-3 years.
Copper spirals – up to 5 years.
Copper spirals with silver and gold - 7-10 years or more.
Hormonal intrauterine systems – up to 5 years.

The issue of premature removal of the IUD is decided by the gynecologist.

It is not recommended to use an IUD after the expiration date due to the risk of the IUD growing into the uterine tissue. Hormonal IUDs lose their properties due to depletion of hormonal drug reserves. This reduces the effectiveness of the intrauterine device, which can lead to unplanned pregnancy.

Intrauterine devices (copper, hormonal): installation, operating principle, effectiveness (Pearl index), shelf life. How to check if the spiral is in place - video

Removal and replacement of the intrauterine device

Indications for IUD removal:

the period of use has expired, and it is possible to replace the intrauterine device;
a woman is planning a pregnancy;
there were side effects from the use of an intrauterine device.

The removal procedure, as well as the insertion of an intrauterine device, can only be performed by a gynecologist in a gynecological office. The ideal time to remove the IUD is the first days of menstruation; during this period, the cervix is soft, which makes manipulation easier. In principle, the IUD can be removed at any time during the menstrual cycle.

Removal of the IUD often does not require pain relief; local anesthesia will be required when removing or replacing hormonal IUDs. The doctor fixes the cervix with a gynecological speculum, and then using special tool(forceps) grabs the threads of the spiral and carefully pulls out the device, while gently stretching the cervix.

Usually this procedure goes without difficulty, the woman experiences less pain than with the introduction of a spiral. But there are situations when the spiral cannot be pulled out so easily, then the doctor widens the cervical canal and makes it easier to remove the IUD. You may also encounter the problem of broken threads, then the doctor inserts a special hook through the cervix, with the help of which the foreign body is removed from the uterine cavity.

But there are situations when the doctor simply does not detect the spiral threads. The question arises: is there a spiral in the uterus at all? If so, where is she? To do this, the woman is offered an ultrasound of the pelvic organs and, if necessary, radiography. Sometimes there are cases when the spiral is located outside the uterine cavity (due to perforation of its wall), then laparoscopic surgery is urgently needed to remove the foreign body.

Replacing the spiral intrauterine contraception can be performed immediately after removal of the old IUD; the risk of developing any complications does not increase.

Special instructions before removing and replacing the intrauterine device:

timely replacement of the IUD facilitates the procedure and guarantees continuous contraceptive action;
It is better to carry out the procedure during menstruation;
removing the IUD during or before ovulation increases the risk of pregnancy;
before replacing the IUD, it is necessary to use other methods of contraception (condom, oral contraceptives or spermicides) 7 days in advance to prevent an unwanted pregnancy.

Possible side effects

The intrauterine device is a modern, convenient and effective method of contraception. But this is also a foreign body to which our body can react unwanted reactions. In most cases, intrauterine contraception is well tolerated, but some women may experience intolerance this method and the development of side effects, some of which can have a very negative impact on health and lead to severe pathologies. Reducing the risk of developing these side effects will help by choosing the type of IUD that is suitable specifically for this woman, a detailed assessment of contraindications to its insertion, its timely removal and, of course, sufficient professionalism of the gynecologist who will install this device into the uterine cavity.

Possible side effects and complications when using an intrauterine device

"Nulliparous cervix";
irritation of the autonomic nervous system;
increased emotionality of a woman;
The size of the intrauterine device does not correspond to the size of the uterus.

Side effect	Reasons for development	How often does it occur?	Treatment of adverse reactions
Pain in the lower abdomen immediately after insertion of the IUD	Often.	Anesthesia local anesthetics cervix; correct selection of spiral sizes.
Loss of the IUD from the uterine cavity or expulsion	Violation of IUD installation technique; incorrect selection of spiral size; Features of a woman - foreign body immunity.	Often.	Adhere to all rules for the technique of inserting and selecting the size of the IUD; After expulsion, it is possible to replace the spiral with another one.
Painful and heavy periods	the first months after insertion of an IUD with copper are a normal reaction; non-infectious inflammation as a reaction to a foreign body; allergic reaction for copper; inflammation of the ovaries - adnexitis.	Up to 15%.	Removing the IUD and replacing the IUD with another type of contraception; replacing the copper IUD with a hormonal intrauterine system, in which heavy menstruation does not arise; prescribing antispasmodics (for example, No-shpa) and non-steroidal anti-inflammatory drugs (ibuprofen, indomethacin, nimesulide, etc.) or antibiotics.
Inflammation of the genital organs (colpitis, endometritis, salpingitis, adnexitis): unusual discharge from the vagina, often with an unpleasant odor; itching and burning in the vaginal area; possible spotting in the middle of the menstrual cycle; nagging pain lower abdomen and lumbar region; menstrual irregularities; increased body temperature and general malaise.	The spiral was installed for chronic inflammatory diseases of the genitourinary system; the IUD does not protect against sexually transmitted diseases, but increases the risk of the spread of sexually transmitted diseases from the vagina to the uterus and appendages; non-infectious inflammation that develops as a reaction to a foreign body increases the risk infectious inflammation caused by bacteria and fungi normally contained in bacterial microflora vagina.	Up to 1% of cases	Removing the spiral; prescription of anti-inflammatory and antibacterial therapy, according to the results of laboratory diagnostics.
Severe uterine bleeding	Damage (perforation) of the walls of the uterus by the IUD during its installation or operation; presence of uterine fibroids.	Very rarely	Removing the spiral urgently; emergency medical care.
Anemia: pale skin; changes in blood tests; weakness.	Uterine bleeding; long and heavy periods for more than 6 cycles.	Very rarely.	Individually, it is possible to remove the IUD or replace it with a hormonal IUD; iron supplements (Aktiferrin, Totema and others), vitamins and nutritional correction.
Development of fibroids	Damage to the endometrium during insertion or use of the IUD;	Rarely.	Removal of the IUD or replacement with a hormonal IUD; taking hormonal contraceptives.
Risk of ectopic pregnancy	The inflammatory process, which can be facilitated by the IUD, in some cases leads to obstruction of the fallopian tubes; one of the effects of the spiral is contraction and spasm of the smooth muscles of the fallopian tubes, which can cause a pathological pregnancy.	1:1000	Surgical treatment, removal of the fallopian tube.
Pain during sexual intercourse, difficulty achieving orgasm.	Inflammatory process in the genitourinary system; incorrect position and/or size of the device in the uterus; allergic reaction to the components of the spiral; damage to the walls of the uterus; ovarian cysts.	Up to 2%.	Removal of the IUD or replacement with a hormonal IUD.
Onset of pregnancy	The intrauterine device is not a 100% effective method.	From 2 to 15%.	Individual approach.
Perforation (puncture) of the uterine walls: sharp pain in the lower abdomen; uterine bleeding; deterioration general condition, up to loss of consciousness.	Damage to the walls of the uterus during insertion, operation and removal of the device. *Increase the risk of uterine perforation:* early postpartum period; scar on the uterus after cesarean section; abnormalities of the uterus;	Very rarely.	Surgical treatment and emergency medical care.
Ingrowth of the spiral into the wall of the uterus	inflammatory process in the endometrium; using the spiral for more than the recommended period.	Up to 1%.	Removal of the spiral through the cervix using special instruments. Sometimes laparoscopic surgery may be required.
Copper intolerance or Wilson's disease	individual intolerance or allergy to copper.	Extremely rare.	Replacing with another type of contraception or hormonal intrauterine device.

Additional side effects from the use of a hormonal intrauterine system (related to the hormone progestogen):

absence of menstruation (amenorrhea); after removal of the IUD, the menstrual cycle is restored;
functional ovarian cysts ( benign formations), will be required hormone therapy estrogen hormones;

Intrauterine device (IUD): composition, action, indications, possible negative consequences of use - video

Intrauterine device (IUD): mechanism of action, dangerous complications (therapist's opinion) - video

How can pregnancy proceed with an intrauterine device?

Basic principles of managing pregnancy with the IUD:

1. Difficulties arise with diagnosing pregnancy; the woman is confident in her contraception. And menstrual irregularities with an IUD are not uncommon; this leads to the fact that pregnancy can be diagnosed late, when abortion is already difficult. Therefore, it is very important to listen to your body and consult a doctor at the slightest deviations, changes or hints of pregnancy.
2. If a woman wishes, a medical abortion can be performed.
3. The IUD is not an indication for medical termination of pregnancy. The choice is up to the woman, because in most cases, pregnancy with the IUD proceeds normally and without complications. But still the doctor must evaluate possible risks pregnancy and may recommend terminating it.
4. The IUD can be removed during pregnancy. The copper coil is often not removed as it does not affect the development of the fetus. The hormonal IUD will release hormones throughout pregnancy that can lead to fetal developmental abnormalities. The gynecologist can remove the IUD if its threads are preserved and it is removed from the uterus easily and smoothly.
5. Such a pregnancy requires constant monitoring by doctors; regular monitoring of fetal ultrasound is necessary.

Possible risks of pregnancy with an intrauterine device:

High risk ectopic pregnancy, ultrasound monitoring is required.
Such a pregnancy may end in miscarriage early, which is associated with the effect of the spiral on the endometrium, to which the fertilized egg is attached.
IUD can cause intrauterine infection fetus, as well as intrauterine growth retardation and pregnancy loss.
High risk of fetal malformations during pregnancy with hormonal IUD.

How to choose a good intrauterine device? Which spiral is better?

individual characteristics

“Which IUD should I choose, copper or hormonal?” Here a woman needs to choose between efficiency and possible adverse reactions. The hormonal spiral has more possible side effects associated with gestagen, but they are temporary and stop after a few months. And the contraceptive effect of using such a device is much higher. If a woman has fibroids, then the hormonal IUD is a method of not only contraception, but also treatment. A copper IUD with silver and, especially, gold has higher efficiency than a conventional copper device, and the risk of side effects is lower; this is a kind of middle ground between a hormonal and a copper IUD.

“How much does an intrauterine device cost?” For many women, the issue of economy is great value and determines the choice of spiral. Copper IUDs are much cheaper than hormonal systems. Also high cost have spirals with silver and gold.

“Which coil is used the longest?” Spirals with silver and gold can be used the longest, up to 7-10 years or more. Hormonal IUDs are usually used for no more than 5 years.

"Which spiral will not affect next pregnancies?" Any IUD can lead to problems with future pregnancies, including ectopic pregnancy and infertility due to an inflammatory process. The risk of developing an ectopic pregnancy during IUD use is higher with hormonal IUDs due to the action of progestogen. Copper IUDs pose a greater risk of complications such as inflammation of the uterus and appendages. When an IUD is removed, ectopic pregnancy often occurs after the use of copper IUDs.

“Which coil is painless?” During installation and removal of the coil, the woman experiences some pain. But this should not fundamentally affect the choice of an IUD. When inserted hormonal system these painful sensations are more pronounced, which is why local anesthesia is used. Local anesthesia can be performed by introducing a copper spiral in women who are especially impressionable and emotional.

Review of various modern intrauterine devices: Juno, Mirena, Goldlily, Multiload, Vector extra, spirals with gold and silver

Name

Description

Validity period

Instructions

The contraceptive device is placed in a woman's uterus; after installation, it is not felt in the body. This system is small in size (three and a half centimeters in length) and weighs very little. The IUD contains the hormone levonorgestrel, and the system releases a small dose of it every day. Since the hormone immediately reaches its destination, the body only needs a really tiny amount. This hormone in a daily dose is seven and a half times less than in conventional contraceptives.

The intrauterine hormonal device acts in three directions at once. Under the influence of levonorgestrel, the mucus in the cervix thickens significantly, which prevents the penetration of infections. In addition, its thickening interferes with the movement of sperm. In addition, the hormone creates an uncomfortable environment for sperm in which they lose mobility, so that even if one of them managed to overcome the cervical mucus, it has very little chance of reaching the egg. In addition, under the influence of levonorgestrel, the inner layer of the uterus thins, to which the fertilized egg should attach. After installing the IUD, the uterus cleanses itself from the inside, which has a beneficial effect on its health; moreover, even if a tenacious sperm manages to fertilize the egg, it simply will have nowhere to attach. It should be noted that the moment is considered to be the moment of attachment of the fertilized egg to the wall of the uterus, since this does not happen, the hormonal IUD cannot be considered an abortifacient method.

A hormonal IUD is installed by a doctor for a period of three years. Please note that in the first months there will be an adaptation period, which may cause a number of inconveniences. First of all, this is due to the thinning of the endometrium (the inner layer of the uterus) and its removal to the outside, which affects menstrual flow. During the two to three months between periods, a large amount of additional discharge may be present. Don't be alarmed, this is a normal process. After the end of the adaptation period, they most often decrease, become less abundant and painful.

If you have installed such a device for the first time, it is advisable to check with a doctor during the adaptation period. It is best to do this after ten days to see with an ultrasound how well the spiral has “set up”, and then three months after the end of adaptation to check the condition of the body. After this, you need to visit a gynecologist once every six months for the purposes of prevention and health monitoring.

Today, the problem of contraception has many solutions, among which is the use of a contraceptive device, which avoids the use of hormonal drugs that negatively affect a woman’s body.

The contraceptive device is one of the most common intrauterine contraceptives which are introduced to prevent the onset.

The intrauterine contraceptive device (IUD) can be of a medicated or non-medicated type. A non-medicated IUD mechanically closes the entrance to the uterine cavity and thus prevents sperm from penetrating inside. However, today non-medicinal ones are not used.

The first type of spirals is a copper wire that wraps around an elastic rod. Its length is from 3 to 4 centimeters. Two nylon threads are attached to the ends, with the help of which the spiral is subsequently removed from the uterine cavity.

Contraceptive effect The drug spiral is determined by two components. Firstly, the IUD is a medicated type, being foreign body, mechanically prevent the penetration of sperm. Secondly, copper has a spermicidal effect and has a detrimental effect on the vital activity of sperm. Copper also shortens the stage at which the egg is ready for fertilization. Thirdly, the contraceptive device, touching the walls of the uterus and fallopian tubes, stimulates their contraction, which leads to a specially controlled inflammatory process. The silver contained in the IUD, which has an aseptic effect, does not allow any complications to develop due to this inflammation. Such specially created conditions prevent the fertilization of the egg and its attachment to the uterine mucosa.

However common problem copper-containing IUDs cause an allergic reaction, so many women are inclined to use an IUD with a synthetic hormone - levonorgestrel, which, in addition to the above effects, also affects the viscosity of mucus in the cervix. It becomes much thicker, which slows down the movement of sperm until they become immobilized.

A special feature of this type of contraception is that it is required by a gynecologist. In addition, before the procedure it is necessary to undergo an examination to ensure the absence of a transmissible infection.

Video on the topic