Intrauterine contraceptives

Intrauterine contraception is achieved by placing a particular device in the uterine cavity – a pessary, also known in Bulgaria as an IUD. The advantage of the method is that it is permanent – a spiral placed in the uterine cavity acts as a permanent barrier, preventing the implantation (clamping) of a possibly fertilized egg in the uterine mucosa. The installation itself takes place on an outpatient basis for no more than 5 minutes. It is useful for a woman to discuss with her obstetrician-gynecologist what models of pessaries are, as well as to conduct a microbiological examination of the vagina and, if there is an infection in it, it should be treated before the pessary is installed. inserted. Otherwise, there is a risk of infection in utero.

Depending on the material, pessaries are divided into two types: inert and bioactive.

Inert ones are less effective than bioactive ones but may stay longer in the uterus. New generation bioactive pessaries contain built-in bioactive metal (copper, silver) or hormone (progestogen). Of the pessaries with hormones, Mirena is the most common on the market, which, in addition to being a “foreign body” barrier, also releases a progestogen – levonorgestrel in an amount sufficient to suppress the proliferation (growth) of the endometrium, but not enough to lead to a systemic effect on a woman.

All intrauterine contraceptives are a foreign body for the uterus and cause a local sterile inflammatory reaction with subsequent cellular and biochemical changes in the endometrium (mucosa) and intrauterine contents. In addition, intrauterine pessaries placed in the uterine cavity stimulate the release of prostaglandins from the endometrium. This leads to uterine contractions, and the endometrium itself becomes an unfavorable environment for the implantation of a fertilized egg. The pessary slows down the movement of spermatozoa, and the thread, which is passed through the cervical canal (cervical canal), impairs the flow, motility, and capacitation of spermatozoa.

There are absolute and relative contraindications to the installation of the IUD. Absolute signs include acute or chronic pelvic inflammatory disease, pregnancy, malignancy, uterine bleeding of unknown origin, and congenital or acquired anomalies of the uterus that make placement difficult.

Relative contraindications are a history of ectopic pregnancy, a violation of blood clotting, heart valve defects, a history of heavy menstruation, etc.

Complications of an intrauterine pessary:

• Pain is usually immediate after injection and is colicky. This is due to contractions that want to push out the pessary.
• Bleeding. Bleeding after insertion of a pessary is normal, more like a spotting discharge that can last from 3 to 4 or even 20 days. This current should not be abundant, so as not to dislodge the pessary. The cause of bleeding is the presence of vascular erosions in the endometrial region, which are in direct contact with the pessary. There are three types of bleeding in nature: increased menstrual blood loss, lengthening of the duration of menstruation, and increased intermenstrual bleeding or spotting.
• Infections: the risk increases with frequent changes in sexual partners, polygamy and a woman’s low social status. Most often, we are talking about superficial colonization of the cervix with opportunistic Actinomyces israelii, which can also occur in healthy women without an intrauterine device. Under the right conditions, actinomycetes, resembling bacteria, can rise up (enter the uterine cavity) and cause purulent tubo-ovarian formations. Detection of actinomycetes requires the removal of spiracles and treatment with penicillin.
• Perforation (piercing) of the uterus is the most serious, but, fortunately, the least common complication. Occurs at the time of the introduction of the IUD and is due to incorrect and inaccurate orientation in the depth and direction of the uterine cavity. During the perforation, a woman may have severe pain and collapse, but there may be no complaints since the migration of the spiral through the myometrium (the muscular layer of the uterus) is usually not accompanied by pain. When the control examination using a mirror does not reveal the passage of the IUD thread through the cervical canal, several options are possible:

• Spontaneous and imperceptible exile by a woman;
• change in the position of the pessary in the uterus and the entry of the thread into the uterine cavity;
• The onset of pregnancy (more often observed with inert pessaries);
• There was a perforation, and the pessary passed from the uterus into the pelvis.