Missing intra-uterine contraceptive device

Dr Maxwell Adeyemi -
Dr Maxwell Adeyemi -

Contraception is an attempt to stop the eggs from being produced or preventing the sperm from getting to the eggs. One method of contraception is the intra-uterine device (IUD) - a small T-shaped plastic device that when inserted into a woman’s uterus, makes it difficult or nearly impossible for fertilisation and implantation of an egg to occur.

IUDs prevent conception by causing a brief localised inflammation in the uterus that starts about 24 hours after insertion. This inflammatory reaction inside the uterus attracts white blood cells (lymphocytes), which then produce substances that are toxic to sperm, thereby making it impossible for the sperm to get to the egg, preventing the whole process of conception.

Types of IUD devices

1. Hormonal: progestogen releasing IUD works by slowly releasing small amounts of the hormone known as progestin, which prevents the sperm from reaching the egg. Other functions of hormonal IUDs include:

• Prevention of ovulation (the release of an egg from the ovary)

• Thickening of the cervical mucus to prevent sperm from swimming to the egg

• Thinning of the uterine lining to stop a fertilised egg from implanting

Apart from preventing pregnancies, hormonal IUDs lighten one’s menstruation and reduce cramps.

2. Non-hormonal: This type of IUD contains a small amount of copper which is toxic to sperm cells and disrupt their motility so that they are not able to swim or join with an egg, preventing pregnancy. Once it is inserted, it can last for up to 12 years. It contains no hormones, so breastfeeding mothers should have no fear of any side effects, and fertility resumes immediately after removal. It is 99.9 per cent effective in preventing pregnancy. It may cause heavier bleeding and more cramps during a period.

IUD insertion and removal

Inserting and removing IUDs should be done by a health-care professional. The process of inserting the device is safe and reliable, and for many women the most difficult part is overcoming the psychological fear of the procedure. A well-trained professional can perform the procedure in a hospital or a health centre in less than 15 minutes. IUDs can be removed at any time and studies show that the removal process is a less invasive with minimal pain when compared to insertion. The health care professional must find the cervix using a speculum, insert a special ring forceps or clamp into the vagina and grasp the IUD strings by using gentle traction to pull out the device.

In situations where the strings of the IUD cannot be located because they may have slid higher into the cervical canal, a health-care professional can use special instruments to locate the strings and remove the IUD. Complications of IUD removal are rare, and removal during the menstrual period is easier because a woman’s cervix is thought to be softer during this time.

Benefits of IUDs

-An IUD is more than 99 per cent effective in preventing pregnancy.

-It can last up to ten years and begins to work immediately once inserted properly.

-It does not disturb or interrupt sexual activities.

-It is safe to be used when breastfeeding.

-Medications cannot alter the function of an IUD.

-The chances of getting pregnant go back to normal after removal.

-It can be removed at any time by an appropriate health care professional.

-Almost all women can use an IUD, including those who have never been pregnant.

Side effects of using IUDs

These vary depending on the type of IUD one decides to use.

Hormonal IUDs may cause the following side effects:

Reduced or absent menstrual periods, acne, headache, breast pain, mood swing, irregular bleeding, weight gain, pelvic pain and cramping.

The copper IUD may cause the following side effects:

Anaemia, backache, bleeding between periods, cramping, vaginitis, painful sex, severe menstrual pain, heavy bleeding, vaginal discharge.

Causes of missing/displaced IUDs

• The strings may sometimes curl themselves up against the cervix, making it impossible to feel them.

• The IUD may have fallen out of the cervix completely or partially; although it’s not very common.

• On rare occasions the IUD may have punctured the cervix or the uterus. This can cause severe pelvic pain, as well as pain and bleeding during sex

.

Signs and symptoms of a displaced IUDs

A slight shift in the position of the IUD may cause no noticeable signs. But if the IUD gets displaced or lost, the following signs and symptoms may arise:

• Inability to feel the strings of the IUD with your fingers.

• Discomfort because the plastic of the IUD is being felt.

• Your partner may feel the IUD during sexual activities.

•Intra-menstrual bleeding

• Abnormal heavy vaginal bleeding.

• Intense cramps beyond what is usually experienced during normal period.

• Soreness or pain in the lower abdomen.

• Unusual/abnormal vaginal discharge.

• Random infections.

Diagnosis of a missing IUD

The missing IUDs may be symptomatic or asymptomatic. A simple examination of the vagina will confirm the diagnosis. It can be detected by hysteroscopy, uterine ultrasound, abdominopelvic ultrasound, hysterosalpingogram (HSG), laparoscopy, Spencer well’s forceps, sponge holding forceps and plain abnormal X-ray with a marker in the uterus.

Treatment of missing IUDs

• If pregnant with IUD, it can be treated with sonographic guided IUD removal.

• If there is an infection with an IUD in place, the device is removed and antibiotics can be used to treat the infections.

• If an IUD is perforated, it should be removed laparoscopically.

Contact Dr Maxwell on 363-1807 or 757-5411.

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