Intrauterine devices.

Generic and proprietary names
- Flexi-T 300.

- Gynefix.

- Multi-Load Cu 375.

- Nova T 380.

- T-Safe 380 A.

Action
- Induces a sterile inflammatory response that causes changes to the composition of uterine and tubal fluids, reducing the viability of both sperm and ova, making fertilisation unlikely.

Classification
- Contraceptive devices.

Indications
- Contraception in older women who have had children.

- Emergency contraception.

Contraindications
- Pregnancy.

- Severe anaemia.

- Sexually transmitted infection.

- Unexplained uterine bleeding.

- Structural uterine abnormality.

- Genital malignancy.

- Pelvic inflammatory disease.

- Copper devices - copper allergy.

Cautions
- Anaemia.

- Menorrhagia.

- Endometriosis.

- Severe primary dysmenorrhoea.

- A history of pelvic inflammatory disease.

- Previous ectopic pregnancy.

- Diabetes.

- Fertility problems.

- Nulliparous women.

- Young age.

- Valvular heart disease.

- Anticoagulation therapy.

Common side-effects
- Menorrhagia.

- Dysmenorrhoea.

- Pain on insertion.

- Expulsion or displacement.

Rare side-effects
- Perforation of the uterus.

- Infections are a little more common in IUD users.

- Ectopic pregnancy.

Administration
- Usually inserted at the end of a period and before estimated time of ovulation.

Nursing considerations
- The risk of infection in the first 20 days following insertion is thought to be related to existing carriage of sexually transmitted infection. Therefore, prescreening is recommended.

- IUDs should not be removed mid-cycle unless additional contraceptives have been used for the previous seven days.

- Pain on insertion can be alleviated by taking a non-steroidal anti-inflammatory drug 30 minutes before insertion.

- Occasionally epileptic seizure or vaso-vagal attack on insertion.

- Gynaecological examination before insertion, six to eight weeks after, then annually.

- Insertion of an IUD is more effective as emergency contraception than hormonal methods and can be undertaken up to five days after unprotected intercourse. Testing for sexually transmitted infection and performing antibacterial prophylaxis is important.

Patient teaching
- The importance of seeking urgent medical attention for sustained pain in the first 20 days following insertion should be emphasised.

- Patients should be taught to check for threads after each period. If these are not found, they should seek medical attention and use an alternative form of contraception until the IUD has been located.

- It is safe to use tampons with an IUD in situ.

Nurses should refer to manufacturer's summary of product characteristics and to appropriate local guidelines

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