Медьсодержащие внутриматочные спирали: эффективность, применение и особенности использования.

Birth control and emergency contraceptive device
non hormone based IUDs

Copper IUDs are a form of long acting reversible contraception and are one of the most effective forms of birth control available. The type of frame and amount of copper can affect the effectiveness of different copper IUD models. Worldwide, older IUD models with lower effectiveness rates are no longer produced. Unlike other forms of reversible contraception, the typical use failure rate and the perfect use failure rate for the copper IUDs are the same because the IUD does not depend on user action.

It was first discovered in 1976 that the copper IUD could be used as a form of emergency contraception (EC). The copper IUD is the most effective form of emergency contraception. It is more effective than the hormonal EC pills currently available. The pregnancy rate among those using the copper IUD for EC is 0.09%. It can be used for EC up to five days after the act of unprotected sex and does not decrease in effectiveness during the five days. An additional advantage of using the copper IUD for emergency contraception is that it can be used as a form of birth control for 10–12 years after insertion.

Expulsion: Sometimes, the copper IUD can be spontaneously expelled from the uterus. Unusual vaginal discharge, cramping or pain, spotting between periods, postcoital (after sex) spotting, dyspareunia, or the absence or lengthening of the strings can be signs of a possible expulsion. Magnetic resonance imaging (MRI) may cause dislocation of a copper IUD, and it is therefore recommended to check the location of the IUD both before and after MRI. Perforation: Very rarely, the IUD can move through the wall of the uterus. Proper infection prevention procedures have little or no effect on the course of gonorrhea or chlamydia infections but are important in helping protect both clients and providers from infection in general. as the use of a local anaesthetic. Misoprostol 6 to 12 hrs before insertion can help with cervical dilation.

There are a number of models of copper IUDs available around the world. Most copper devices consist of a plastic core that is wrapped in a copper wire. Many of the devices have a T shape similar to the hormonal IUD. However, there are "frameless" copper IUDs available as well. ParaGard is the only model currently available in the United States. At least three copper IUD models are available in Canada, two of which are slimmer T shape versions used for women who have not had children. Early copper IUDs had copper around only the vertical stem, but more recent models have copper sleeves wrapped around the horizontal arms as well, increasing effectiveness. Some newer models also contain a silver core instead of a plastic core to delay copper fragmentation as well as increase the lifespan of the device. The lifespan of the devices range from 3 years to 10 years; however, some studies have demonstrated that the TCu 380A may be effective through 12 years. Its ATC code is .

The frameless IUD eliminates the use of the frame that gives conventional IUDs their signature T shape. This change in design was made to reduce discomfort and expulsion associated with prior IUDs; without a solid frame, the frameless IUD should mold to the shape of the uterus. It may reduce expulsion and discontinuation rates compared to framed copper IUDs. Gynefix is the only frameless IUD brand currently available. It consists of hollow copper tubes on a polypropylene thread. It is inserted through the cervix with a special applicator that anchors the thread to the fundus (top) of the uterus; the thread is then cut with a tail hanging outside of the cervix, similar to framed IUDs, or looped back into the cervical canal for patient comfort. When this tail is pulled, the anchor is released and the device can be removed. This requires more force than removing a T shaped IUD and results in comparable discomfort during removal.

The copper IUD's primary mechanism of action is to prevent fertilization. Copper acts as a spermicide within the uterus. The presence of copper increases the levels of copper ions, prostaglandins, and white blood cells within the uterine and tubal fluids. especially when used for emergency contraception. Despite this, there has been no definitive evidence that IUD users have higher rates of embryonic loss than women not using contraception. The most recent data indicates that there are 169 million IUD users around the world. This includes both the nonhormonal and hormonal IUDs. IUDs are most popular in Asia, where the prevalence is almost 30%. In Africa and Europe, the prevalence is around 20%.

According to popular legend, Arab traders inserted small stones into the uteruses of their camels to prevent pregnancy during long desert treks. The story was originally a tall tale to entertain delegates at a scientific conference on family planning; although it was later repeated as truth, it has no known historical basis. Precursors to IUDs were first marketed in 1902. Developed from stem pessaries (where the stem held the pessary in place over the cervix), the 'stem' on these devices actually extended into the uterus itself. Because they occupied both the vagina and the uterus, this type of stem pessary was also known as an intrauterine device. The use of intrauterine devices was associated with high rates of infection; for this reason, they were condemned by the medical community. The first intrauterine device (contained entirely in the uterus) was described in a German publication in 1909, although the author appears to have never marketed his product. In 1929, Ernst Gräfenberg of Germany published a report on an IUD made of silk sutures. He had found a 3% pregnancy rate among 1,100 women using his ring. In 1930, Gräfenberg reported a lower pregnancy rate of 1.6% among 600 women using an improved ring wrapped in silver wire. Unbeknownst to Gräfenberg, the silver wire was contaminated with 26% copper. Copper's role in increasing IUD efficacy would not be recognized until nearly 40 years later. In 1934, Japanese physician Tenrei Ota developed a variation of Gräfenberg's ring that contained a supportive structure in the center. The addition of this central disc lowered the IUD's expulsion rate. These devices still had high rates of infection, and their use and development were further stifled by World War II politics: contraception was forbidden in both Nazi Germany and Axis allied Japan. The Allies did not learn of the work by Gräfenberg and Ota until well after the war ended. and widely used in China because of low manufacturing costs. The Chinese government banned production of steel IUDs in 1993 due to high failure rates (up to 10% per year). Howard Tatum, in the US, conceived the plastic T shaped IUD in 1968. Shortly thereafter Jaime Zipper, in Chile, introduced the idea of adding copper to the devices to improve their contraceptive effectiveness. It was found that copper containing devices could be made in smaller sizes without compromising effectiveness, resulting in fewer side effects such as pain and bleeding. Robins stopped international sales of the Dalkon Shield in April 1975. Tatum developed many different models of the copper IUD. He created the TCu220 C, which had copper collars as opposed to a copper filament, which prevented metal loss and increased the lifespan of the device. Second generation copper T IUDs were also introduced in the 1970s. These devices had higher surface areas of copper, and for the first time consistently achieved effectiveness rates of greater than 99%. It is the only copper containing intrauterine device approved for use in the U. S. (four hormonal uterine devices, Mirena, Skyla, Liletta, and Kyleena are also approved). The Paragard consists of a T shaped polyethylene frame wound with copper wire, along with two monofilament threads to aid in the removal of the IUD. The Paragard T 380A was developed in the 1970s by the Population Council and Finishing Enterprises Inc. (FEI). The Population Council's Paragard new drug application (NDA) was approved by the U. S. Food and Drug Administration (FDA) and FEI began manufacturing it for distribution outside the United States in 1984. GynoPharma (originally GynoMed) began marketing it in the U. S. in May 1988. On August 2, 1995, Ortho McNeil acquired GynoPharma and began marketing Paragard in the U. S. On January 1, 2004, FEI Women's Health acquired the patent from the Population Council and U. S. marketing rights from Ortho McNeil. On November 10, 2005, Duramed Pharmaceuticals, a subsidiary of Barr Pharmaceuticals, acquired FEI Women's Health and Paragard. On July 18, 2008, it was announced that Teva Pharmaceutical Industries Ltd. would acquire Barr Pharmaceuticals. On November 1, 2017, The Cooper Companies acquired Paragard from Teva Pharmaceutical Industries for approximately $1.1 billion. The original FDA approval of Paragard in 1984 was for 4 years continuous use, this was later extended to 6 years in 1989, then 8 years in 1991, then 10 years in 1994. (ATC code )