Intrauterine device

Intrauterine devices (Latin intra, within; uterus, uterus), colloquially referred to as spirals, are medical devices for contraception that are inserted into the uterus. Today there are two different types, which differ according to the operating principle: The treated here copper or copper-gold spiral and the IUS, which is also referred to as intrauterine system ( IUS ). In the past, rings of metal wire wound (for example Grafenberg ring) and models that were only made ​​of plastic were (eg, Lippes loop) used.

History

The use of intrauterine contraceptive devices is now the world's most widely used method of reversible contraception. At the beginning of the 20th century first products were designed from silk or silver wire, including by the German gynecologist Ernst Grafenberg. With development of thermoplastic materials in the late 1950s many forms and models came on the market. From this period as the Lippes Loop and the Margulies spiral, after the intrauterine devices are now named colloquial. In the Dalkon Shield occurred in the 1970s due to specific structural defects lead to severe inflammation, but this sustained earning all IUDs reputation as a high risk. Since the 1970s, intrauterine devices contain a copper content after the contraceptive effect of copper was known. In Germany there are now no more intrauterine devices, which consist exclusively of plastics; the last ( Goldlily sensitive) was withdrawn from the market because the Pearl index far above that of the copper-containing intrauterine devices.

Construction

The copper IUD is made of a wrapped with fine copper wire or a copper -gold alloy plastic structure from 2.5 to 3.5 centimeters in size. There are also copper spirals with small gold clips that have no independent effect. However, the gold clips are designed to improve the visibility of the spiral in the ultrasound. Many today used copper spirals have the shape of a T. However, other variants, such as grinding or the shape of number 7 are possible. Sense of these different forms is a secure possible hold the spiral in the uterine cavity and yet easy to remove. Chain in the copper, which is sold under the trade name GyneFix, an anchorage in the uterine muscle, so that an additional frame for fixing is not required ( Frameless IUP). At the bottom of intrauterine devices is an eyelet attached to the retrieval threads that stick out about 1 to 2 cm from the cervix. So-called inert intrauterine devices, which have neither a copper content nor a hormone reservoir are not currently marketed in Germany.

Action principle

The principle of action is not clear in every detail. It discusses several different mechanisms:

  • Copper ions show a toxic and inhibitory effect on sperm that lead to a reduction in the mobility and lifetime. The effect of copper is locally limited to the uterus, fallopian tubes and cervix. Increased serum concentrations of copper are not found.
  • In addition, the spiral caused as a foreign body, a sterile inflammation of the uterine lining so that an altered composition and produced by it are cytotoxic enzymes prevent nidation ( implantation ), which is why it sometimes comes as " emergency contraceptive " for use.
  • Inflammatory cells such as macrophages, can also directly reduce sperm ( phagocytosis )
  • Influencing the fallopian tube function leads to obstruction of the oocyte and sperm transport.
  • The use of a gold-copper alloy in the so-called gold - copper-gold or spirals spirals is reduced by a bacteria and fungus-inhibiting effect by means of the traces of dissolved gold and copper ions, the risk of infection and inflammation.
  • Through a micro- galvanic effect in the gold-copper alloys are also orientation ability and sperm motility are reduced, so that as the active principle is not the anti-implantation effect, but the prevention of egg fertilization is considered.

Application

The insertion of the coil is carried out by a gynecologist, and is usually carried out during the menstrual period, as the cervix naturally slightly open at that time. An elongation of the cervical canal, for example with Hegarstiften is rarely necessary. Thereafter, the correct positioning of the coil by means of ultrasound is checked.

The spiral can also be used directly after an abortion or miscarriage.

A deposit no later than five days after unprotected intercourse as a spiral then is possible and especially worth considering when the 72 - hour period for the pill has been exceeded then or for medical reasons any hormonal Nachverhütung is possible.

Even young women who have not been born yet, can apply the spiral. Here, however, are described Ausstoßungsraten up to 10 percent. Since the uterus in these women is usually smaller, then correspondingly smaller spiral models can be used.

Length of stay of the spirals

The hospital stay of the spirals depends on the specifications of the manufacturer of the IUD, which is recommended use a maximum of three or five years for most copper spirals. However, these can also be removed before the expiry of laytime. The removal may cause slight pain, but the decay in the normal course, directly after the procedure. After removal of an IUD can be inserted directly for a copy. After removing the copper IUD, the woman is a regular way in the next cycle fertile again.

Effectiveness

The copper IUD is a very effective means of contraception. In particular, the fact that no interaction on the part of the woman or her partner is required to avoid application errors, which are the main cause of failure of most contraceptives.

According to Planned Parenthood is the Pearl index of the copper coil at about 0.3 to 0.8, that of a gold-copper spiral ( Goldlily ) about 0.5-1.0. The variation of the copper chain ( in Germany under the trade name GyneFix ) whose operating principles are similar to those of the copper spiral, has - according to the study - the same or an even better Pearl index of 0.1-0.3 at.

Risks

  • Women wearing a spiral, have towards women without spiral in the first month increased by a factor of 8 risk of infection. In the first four months after insertion, the risk is increased by a factor of 4. After that there is no increased risk of infection in a period up to eight years. Infection occurring at a spiral should be removed in each case.
  • The risk of cervical cancer is not increased by a large study, but reduced.
  • The well-known outdated copper-free spirals increase the likelihood of ectopic pregnancies is in the copper IUD significantly lower, as the active principle prevents relatively safe and extrauterine pregnancies.
  • Bleeding disorders usually occur in the form of increased menstrual flow, and increased menstrual cramps as side effects frequently. This occurs with Frameless IUD on the same frequency as in conventional spirals.
  • In the first two to three months, the risk of expulsion of intrauterine devices is increased.
  • When inserting the spiral, the uterine wall can be pierced in rare cases. The risk is increased shortly after giving birth at a deposit.
  • The retrieval threads can turn up in the uterus, so that removal usually requires a surgical procedure ( hysteroscopy ).

Contraindications

A spiral may be inserted in any case, if:

  • Pregnancy or suspected pregnancy is
  • Not available Undiagnosed bleeding disorders
  • Inflammation present in the genital area
  • The suspicion of a malignant disease of the uterus is present.

In the case of:

  • Diabetes mellitus
  • Kidney disease
  • Receiving immunosuppressive
  • Treatment with anticoagulants
  • Uterine fibroids

Should be the contribution of a spiral only in individual cases, taking all risks.

Costs and reimbursement

The copper IUD usually cost 120 to 200 euros for a period of application of three to five years. A hormone-containing spiral around 300 to 400 euros, for an application period of up to five years. This price is including consultation, examination and insertion. The costs are covered SGB XII (help for family planning ) by the appropriate welfare agency for statutory health insured women in Germany according to § 24a SGB V up to the age of 20 by the health insurance and social assistance for eligible women according to § 49.

Ethical issues

In some cultures, it is not possible for the woman self-determination to decide about contraception. With a corresponding reduction in the retrieval threads wearing a spiral is not obvious why a " contraceptive anonymity " is guaranteed.

Some groups object to the use of intrauterine devices from because of nidationshemmenden effect for ideological reasons.

→ Main article pro-life movement.

IUD with progestogen Pearl-Index Ectopic pregnancy#Tubal pregnancy Salpingitis Nephropathy Sozialamt Digital Object Identifier
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