Copper-Bearing Intrauterine Devices (IUDs)

Copper-Bearing Intrauterine Devices (IUDs) Adapted by Dr Rodica Comendant, based on Training Resource Package for Family Planning: https://www.fptraining.org/ Copper T 380A

Characteristics of IUDs

IUDs: Key Points for Providers and Clients Copper IUD

Copper IUDs Copper IUDs have a small plastic frame with copper sleeves or wire around it TCu-380A, “Copper T” is most widely used copper IUD Multiload 375 is another copper IUD commonly available in some countries Copper T-380A Multiload 375

Copper IUDs Effectiveness of IUDs In this progression of effectiveness, where would you place copper intrauterine devices (IUDs)? More effective Less effective

Relative Effectiveness of Family Planning Methods

Copper IUDs: Effectiveness Spermicides Female condom Standard Days Method Male condom Oral contraceptives DMPA IUD (TCu-380A) Pregnancy rate when used correctly and consistently Female sterilization Male sterilization Pregnancy rate as commonly used Implants 0 10 20 25 30 5 15 Percentage of women pregnant in first year of use Source: Trussell, 2011.

IUDs: Mechanism of Action Prevents fertilization by: Impairing the viability of the sperm Interfering with movement of the sperm Source: Ortiz, 1996

Copper IUDs: Characteristics • Safe and highly effective • Require no user action • Long-acting (up to 12 years) • Rapid return to fertility • No systemic effects • Have health benefits • Trained provider needed to insert and remove • Require pelvic exam • Possible pain or discomfort during insertion • Have potential side effects • Complications are rare, but may occur • Do not protect against STIs/HIV Source: CCP and WHO, 2011.

Copper IUDs: Health Benefits IUDs are known to: Prevent risks of pregnancy Help protect against endometrial cancer Reduce risk of ectopic pregnancy Rate in IUD users is 12 in 10,000 (2 in 10,000 for Copper T380A) Rate in women using no contraception is 65 in 10,000

Possible Side-Effects Copper IUD If a woman chooses this method, she may have some side-effects. They are not usually signs of illness. After insertion: Other common side-effects: Longer and heavier periods Some cramps for several days Bleeding or spotting between periods Some spotting for a few weeks More cramps or pain during periods May get less after a few months

Copper IUDs:Counseling about Side Effects Before insertion, describe common side effects: Heavier and/or prolonged menstrual bleeding Menstrual cramping Spotting between periods Explain that side effects: Are not signs of illness Usually become less within the first 3–6 months Encourage to come back with questions or concerns If client cannot tolerate side effects, treatment or discontinuation may be necessary

Who Can and Cannot Use IUDs? Copper T 380A

CopperIUD Is Safe for Most Women Most women can use the Copper T IUD safely, including women who: Have or have not had children Are not married Are of any age Have just had an abortion or miscarriage (no infection) Are breastfeeding Have had PID Have vaginal infections Are infected with HIV or have AIDS and on ARVs Source: CCP and WHO, 2011.

Who Can and Cannot Use the IUD Copper IUD Most women can safely use the IUD • But usually cannot use IUD if : Unusual vaginal bleeding recently Gave birth recently (more than 2 days ago) May be pregnant At high risk for STIs Infection or problem in female organs

WHO’s Medical Eligibility Criteria Categories for IUDs, Hormonal and Barrier Methods Source: WHO, 2010.

Category 1 and 2 Examples (not inclusive): Who Can UseCopper IUDs Source: WHO, 2010.

IUD Use by Women with HIV and AIDS IUDs safe for majority of women with HIV Initiation not recommended if woman has AIDS and is not on ARVs Encourage dual method use Source: WHO, 2010.

Category 3 and 4 Examples (not inclusive):Who Should Not UseCopper IUDs Source: WHO, 2010.

IUD Use by Postpartum Women Women less than 48 hours postpartum can have copper IUD inserted Women 48 hours to 4 weeks postpartum generally should not initiate IUDs No restrictions starting at 4 weeks postpartum Women with puerperal sepsis should not have IUD inserted Source: WHO, 2010.

Understanding the Copper IUD Checklist This set of questions identifies women who are not pregnant. Read questions 7–21 on the checklist and match them with the conditions and categories on the MEC quick reference chart. This set of questions identifies women who should not use IUDs. The provider uses these questions during the pelvic exam to identify any category 3 and 4 conditions.

Providing IUDs Copper T 380A

You May be Able to Get Your IUD Now Copper IUD

You May be Able to Get Your IUD Now Copper IUD Copper IUD

Correcting Rumors and Misconceptions IUDs: Rarely lead to PID Do not increase risk of STIs, including HIV Do not work by causing abortion Do not make women infertile Do not move to the heart or brain Do not cause birth defects Do not cause pain for woman or man during sex Significantly reduce risk of ectopic pregnancy Source: CCP and WHO, 2011.

What Will Happen When You Get Your IUD Steps: Pelvic examination Cleaning the vagina and cervix Placing IUD in the womb through the cervix    • May hurt at insertion • Please tell us if it hurts • Rest as long as you like afterwards • May have cramps for several days after insertion Afterwards: you can check your IUD from time to time if you want.

Explaining the IUD Insertion Procedure Cleans the cervix and vagina with an antiseptic Inserts a small rod into the uterus to measure the depth of the uterus Inserts the IUD through the vagina and into the uterus using a small applicator You may feel discomfort, like heavy menstrual cramps. The provider: • Performs a pelvic examination After the insertion, you will rest.

Post-Insertion Instructions Tell client to expect cramping and spotting for a few days If client wants to check strings, teach her how: Use clean hands Check after menses If convenient for client, schedule follow-up visit for 3–6 weeks Counsel to return immediately if there are any signs of complications. Source: CCP and WHO, 2011; WHO, 2004, updated 2008.

Complications of IUDs Potential complications of IUDs include perforations, pelvic inflammatory disease (PID), and expulsions. Biases in early research overstated risks of PID. Most research since the 1980s has concluded that serious complications are rare with modern IUDs.

Expulsion Rates are Higher for Postpartum Insertion Source: Chi, et al, 1985.

Explain Removal Procedure to Client The provider: Inserts a speculum to see the cervix and IUD strings. Cleans the cervix and vagina with an antiseptic. Asks the woman to take slow, deep breaths, and tell the provider if she feels pain during the procedure. Using forceps, pulls the IUD strings slowly and gently until the IUD is completely out of uterus. IUD removal is quick and usually quite painless. Source: CCP and WHO, 2011.

Copper IUDs: Summary Copper IUDs are: Safe, highly effective, convenient, reversible, long lasting, cost-effective, easy to use, and appropriate for the majority of women. Providers can ensure safety by: Informative counseling Careful screening Appropriate infection prevention practices Proper follow-up

Copper-Bearing Intrauterine Devices (IUDs)