MOA

• copper is toxic to ovum and sperm

  • inhibit fertilisation

• endometrial inflammatory reaction

  • anti-implantation effect

  • alterations in copper of cervical mucous inhibit sperm penetration

• failiure rates very low (1-2% at 5yrs)

• licensed for at least 5 years use

• insert any time in menstrual cycle if not pregnant

  • effective immediately

• Insert 4 weeks post partum

• check threads after each menstruation (regular intervals0

• higher risk of STI

  • sexually active \<25yo

  • >25yo and new sexual partner or >1 sexual partner in last year or if sexual partner has other partners

  • if swab results are unavailable at time of insertion - prophylactic abx should be considered

• unacceptable risk: (UKMEC 4)

  • pregnancy, puerpural sepsis, septic abortion

  • initiation with unexplained vaginal bleeding

  • Uterine fibroids/uterine anatomic abnormality distorting uterine cavity

  • current PID

  • Pelvic Tb

• Risks > benefits

  • 48hrs and \<4wk post partum

  • Current VTE on anticoagulants

  • ovarian cancer

Risks

• rate of uterine perforation is low

  • 0-2.3 per 1000 insertion

• expulsion

  • 1/20

  • first 3 months

• ectopic pregnancy

  • no increase risk of ectopic pregnancy with current Cu-IUD

  • 0.02/100 woman years

  • 0.3/100 for those not using contractption

• return to fertility

  • doesn’t cause delay in return to fertility

  • mean time to pregnancy = 3/12

• Pelvic infection

  • most strongly related to insertion procedure adn to background risk of STI

  • 1.6/1000 women years

• spotting, light bleeding, heavier or prolonged bleeding common in first 3-6 months of CuIUD

• seek medical attention if:

  • pelvic pain

  • infection

  • persistent menstrual abnormaliteis

  • missed period

  • nonpalpable threads

  • feel stem of IUD