Indications And Dose
Contraception ▶BY INTRA-UTERINE ADMINISTRATION ▶Females of childbearing potential: (consult product literature)
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Drug reference
Contraception ▶BY INTRA-UTERINE ADMINISTRATION ▶Females of childbearing potential: (consult product literature)
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Active trophoblastic disease (until return to normal of urine and plasma-gonadotrophin concentration). genital malignancy. medical diathermy. pelvic inflammatory disease. post-abortion sepsis. postpartum sepsis. recent sexually transmitted infection (if not fully investigated and treated). severe anaemia. unexplained uterine bleeding. Wilson’s disease
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Anaemia. anatomical abnormalities—seek specialist advice. anticoagulant therapy. cardiac disease— seek specialist advice. endometriosis. epilepsy (risk of seizure at time of insertion). immunosuppression (risk of infection)—seek specialist advice. menorrhagia (progestogen intra-uterine system might be preferable). postpartum—seek specialist advice. risk of sexually transmitted infections. severe primary dysmenorrhoea. young age CAUTIONS, FURTHER INFORMATION The Faculty of Sexual and Reproductive Healthcare advises if removal is after day 3 of the menstrual cycle, intercourse should be avoided or another method of contraception used for at least 7 days before removal of device—emergency contraception may need to be considered if recent intercourse has occurred and the intra-uterine device is removed after day 3 of the menstrual cycle. ▶Sexually transmitted infections and pelvic inflammatory disease The main excess risk of pelvic infection occurs in the first 20 days after insertion and is believed to be related to existing carriage of a sexually transmitted infection. Women are considered to be at a higher risk of sexually transmitted infections if: . they are under 25 years old or . they are over 25 years old and . have a new partner or . have had more than one partner in the past year or . their regular partner has other partners. The Faculty of Sexual and Reproductive Healthcare advises pre-insertion screening (for chlamydia and, depending on sexual history and local prevalence of disease, Neisseria gonorrhoeae) be performed in these women. If results are unavailable at the time of fitting an intra-uterine device for emergency contraception, consider appropriate prophylactic antibacterial cover. The woman should be advised to attend as an emergency if she experiences sustained pain during the next 20 days.
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Contra-indicated if patient has a copper allergy.
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TT380 ® SLIMLINE For uterine length 6.5–9 cm; replacement every 10 years. LOAD ® 375 For uterine length over 7 cm; replacement every 5 years. NOVAPLUS T 380 ® AG ‘ Mini’ size for minimum uterine length 5 cm; ‘ Normal’ size for uterine length 6.5–9 cm; replacement every 5 years. MULTILOAD ® CU375 For uterine length 6–9 cm; replacement every 5 years. GYNEFIX ® Suitable for all uterine sizes; replacement every 5 years. IUB BALLERINE MIDI ® For uterine length over 6 cm; replacement every 5 years. UT380 STANDARD ® For uterine length 6.5–9 cm; replacement every 5 years. UT380 SHORT ® For uterine length 5–7 cm; replacement every 5 years. MULTI-SAFE ® 375 For uterine length 6–9 cm; replacement every 5 years. ANCORA ® 375 CU For uterine length over 6.5 cm; replacement every 5 years. T-SAFE ® 380A QL For uterine length 6.5–9 cm; replacement every 10 years. NEO-SAFE ® T380 For uterine length 6.5–9 cm; replacement every 5 years. MINI TT380 ® SLIMLINE For minimum uterine length 5 cm; replacement every 5 years. COPPER T380 A ® For uterine length 6.5–9 cm; replacement every 10 years. NOVAPLUS T 380 ® CU ‘ Mini’ size for minimum uterine length 5 cm; ‘ Normal’ size for uterine length 6.5–9 cm; replacement every 5 years. NOVA-T ® 380 For uterine length 6.5–9 cm; replacement every 5 years. FLEXI-T ®+ 380 For uterine length over 6 cm; replacement every 5 years. FLEXI-T ® 300 For uterine length over 5 cm; replacement every 5 years.
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MHRA/CHM ADVICE (JUNE 2015) INTRA-UTERINE CONTRACEPTION: UTERINE PERFORATION—UPDATED INFORMATION ON RISK FACTORS Uterine perforation most often occurs during insertion, but might not be detected until sometime later. The risk of uterine perforation is increased when the device is inserted up to 36 weeks postpartum or in patients who are breastfeeding. Before inserting an intra-uterine contraceptive device, inform patients that perforation occurs in approximately 1 in every 1000 insertions and signs and symptoms include: . severe pelvic pain after insertion (worse than period cramps); . pain or increased bleeding after insertion which continues for more than a few weeks; . sudden changes in periods; . pain during intercourse; . unable to feel the threads. Patients should be informed on how to check their threads and to arrange a check-up if threads cannot be felt, especially if they also have significant pain. Partial perforation may occur even if the threads can be seen; consider this if there is severe pain following insertion and perform an ultrasound.
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Device complications. epilepsy (on insertion). haemorrhage (on insertion). hypersensitivity. menstrual cycle irregularities. pain (on insertion— alleviated by NSAID such as ibuprofen 30 minutes before insertion). pelvic infection exacerbated. presyncope (on insertion). uterine injuries SIDE-EFFECTS, FURTHER INFORMATION Advise the patient to seek medical attention promptly in case of significant symptoms—very small risk of uterine perforation, ectopic pregnancy and pelvic inflammatory disease.
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If an intra-uterine device fails and the woman wishes to continue to full-term the device should be removed in the first trimester if possible. Remove device; if pregnancy occurs, increased likelihood that it may be ectopic.
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Not known to be harmful.
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Gynaecological examination before insertion, 6–8 weeks after insertion, then annually.
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The timing and technique of fitting an intra-uterine device are critical for its subsequent performance. The healthcare professional inserting (or removing) the device should be fully trained in the technique and should provide full counselling backed, where available, by the patient information leaflet. Devices should not be fitted during the heavy days of the period; they are best fitted after the end of menstruation and before the calculated time of implantation.
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There can be variation in the licensing of different medicines containing the same drug. Intra-uterine contraceptive devices ▶Intra-uterine contraceptive devices (R.F. Medical Supplies Ltd, Farla Medical Ltd, Durbin Plc, Williams Medical Supplies Ltd, Bayer Plc, Organon Laboratories Ltd) IUB Ballerine MIDI intra-uterine contraceptive device | 1 device £25.00 Copper T380 A intra-uterine contraceptive device | 1 device £8.95 Steriload intra-uterine contraceptive device | 1 device £9.65 Load 375 intra-uterine contraceptive device | 1 device £8.52 Novaplus T 380 Ag intra-uterine contraceptive device mini | 1 device £12.50 T-Safe 380A QL intra-uterine contraceptive device | 1 device £10.55 UT380 Standard intra-uterine contraceptive device | 1 device £11.22 Nova-T 380 intra-uterine contraceptive device | 1 device £15.20 Flexi-T+ 380 intra-uterine contraceptive device | 1 device £10.06 Mini TT380 Slimline intra-uterine contraceptive device | 1 device £12.46 Flexi-T 300 intra-uterine contraceptive device | 1 device £9.47 Multi-Safe 375 intra-uterine contraceptive device | 1 device £8.96 Multiload Cu375 intra-uterine contraceptive device | 1 device £9.24 Optima TCu 380A intra-uterine contraceptive device | 1 device £9.65 Novaplus T 380 Ag intra-uterine contraceptive device normal | 1 device £12.50 GyneFix intra-uterine contraceptive device | 1 device £27.11 Novaplus T 380 Cu intra-uterine contraceptive device mini | 1 device £10.95 TT380 Slimline intra-uterine contraceptive device | 1 device £12.46 Ancora 375 Cu intra-uterine contraceptive device | 1 device £7.95 Novaplus T 380 Cu intra-uterine contraceptive device normal | 1 device £10.95 Neo-Safe T380 intra-uterine contraceptive device | 1 device £13.40 UT380 Short intra-uterine contraceptive device | 1 device £11.22
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