IUCD

Intra uterine contraceptive device.
Types :-
1) Non medicated :-
  a) 1st generation IUCD :- these r inert and made up of polyethylene. Eg- lippes loop.
  b) 2nd generation IUCD :- these contain copper which has strong anti fertility effect. Eg :- copper - 7 copper T-200,
  c) 3rd generation :- these release hormones . Progestasert is most widely used device which release progesterone.
2] Medicated:-
 these release either hormones or metal ions

MECHANISM :-
 - IUD causes foreign body reaction causing biochemical changes in endometrium and uterine fluid,
 impairing the viability of gamete and thus reduce its chance of fertilization , rather than its implantation
- medicated IUD cause changes in biochemical composition of cervical mucous and affect sperm motility , capacitation, and survival.

IDEAL CANDIDATE FOR IUCD
1) who has borne at least 1 child
2) has no history of pelvic disease
3) has normal menstrual period
4) has monogamous relationship
5) willing to check the IUD tail

TIME OF INSERTION :-
- during menstruation or within 10 days of the begining of menstrual period

Advantages :-
1) simplicity
2) ones inserted stays for long
3) insertion require few minute
4) inexpensive
5) effect is reversible after removal
6) free of side effect of hormonal pills

CONTRA-INDICATION :-
1) ABSOLUTE :- suspected pregnancy , pelvic inflammatory diseases , vaginal bleeding of unknown etiology, cancer of cervix & uterus , previous ectopic pregnancy ,
2) RELATIVE :- anaemia , menorrhagia , history of PID since last pregnancy , purulent cervical discharge, distortion of uterine cavity due to congenital malformation, fibroid.

COMPLICATION :-
1) Bleeding
2) Pain
3) Pelvic infection
4) Uterine perforation
5) Pregnancy
6) Ectopic pregnancy
7) Expulsion
8) Cancer and teratogenesis
9) Fertility can be affected
10) Mortality can occure sometimes.