Intrauterine contraceptive devices (IUCDs) are the world’s most widely used method of reversible birth control. Their modern use dates from 1909, but a high rate of intrauterine infection led to their withdrawal until redesigned from inert materials and reintroduced in the late 1950s.
What are the basic actions of IUD?
1. prevent sperm and egg from meeting, thereby preventing conception/fertilization.
2. In cases of breakthrough fertilization, a secondary action, post-fertilization, prevents the fertilized ovum from implantation.’
In the past, it was assumed that the IUD’s action only include (1) above. More recent research and studies show that the IUD, in fact, has post-fertilization effects via breakthrough ovulation and ectopic pregnancies. Note also that IUD failure as contraceptive is a significant contributor to abortions in China.
Moreover, studies have also shown that the IUD is not as harmless a device as many would have us believe.
LITIASIS VESICAL SECUNDARIA A MIGRACIÓN DE DISPOSITIVO INTRAUTERINO. REPORTE DE UN CASO — Translation: Bladder Lithiasis Secondary to Intrauterine Device Migration: A Case Report. CONCLUSION. Although uncommon, intravesical migration of an IUD should be suspected in all patients who have used it and cannot locate it, especially if patient has chronic symptoms of urinary infection, persistently unresponsive to treatment.
You would think that after decades of use, IUD insertion would be relatively safe. Why do these IUD migrations happen? A hard object does not belong in a soft body. Spontaneous uterine contractions, peristalsis — these normal movements in the body cause IUDs to migrate.
From Foreign body granuloma in the anterior abdominal wall mimicking an acute appendicular lump and induced by a translocated copper-T intrauterine contraceptive device: a case report: Primary iatrogenic uterine perforation usually occurs at the time of IUCD insertion but an IUCD may become embedded in the uterus and later be forced through the wall by spontaneous uterine contractions. However, other possible translocatory mechanisms such as urinary bladder contractions, gut peristalsis and movement of peritoneal fluid may also play a significant role.
From Vesical calculus resulting from forgotten intrauterine contraceptive device: Bladder calculi are uncommon in adults and usually result either from obstruction or foreign bodies. The present case report describes a 45 year old lady presenting with cystitis. Investigations revealed a bladder calculus encrusted on an intrauterine device (IUD), which was probably inserted 20 years back at the time of medical termination of pregnancy. Ballistic lithotripsy of the bladder stone with cystoscopic extraction of the IUD was successfully carried out.
Complications include pain, bleeding, a failure rate in the order of 4% (conception despite correct deployment or accidental expulsion from the uterus—usually along the trajectory of insertion, via the cervix and vagina), an increased rate of pelvic inflammatory disease (PID) and toxic shock syndrome. Colonic obstruction has also been described in the context of severe pelvic inflammatory disease (PID) with prolonged IUCD use.
Incidence of uterine perforation is estimated to be less than 0.1%, and is a consequence of uterine injury at the time of insertion in most cases. Early puerperal insertion (within 12 weeks of delivery) and pregnancy in the presence of an IUCD have been advanced as putative risk factors for uterine perforation, in addition to insertion technique.
While 85% of reported cases of uterine perforation have not caused major complications at the time of diagnosis, 15% have presented with serious complications of visceral perforation, with IUCD eroding partially or completely into the bladder, small bowel, appendix, colon, or rectum. Recto-uterine fistula and rectal stricture have also been reported. Ectopic IUCD in the presence of fever, abdominal pain, or diarrhoea should alert the clinician to the possibility of bowel perforation. Small bowel obstruction is an extremely rare presentation of open loop IUCD.
Visceral complications have been reported at a median time interval of 17 months (varying from four weeks to 13 years). This case demonstrates that small bowel obstruction can occur as late as 31 years following intra-abdominal translocation of an inert and ‘open loop’ Saf-T-Coil IUCD, due to direct strangulation of the bowel by the device.
In the case of partial uterine perforation or other visceral involvement, careful pre-operative CT imaging and planning is of great value. When IUCD ectopy is diagnosed in an as yet asymptomatic patient, one should be aware that late complications can occur in rare cases, and consider elective removal.
From JSLS (2010)14:456–458 Laparoscopic Removal of an Intrauterine Device Following Colon Perforation by Arie Bitterman, MD, Oleg Lefel, MD, Yakir Segev, MD, MSc, Ofer Lavie, MD:
Migration intra-vésicale de dispositif intra-utérin compliquée de lithiase
Tratamento Laparoscópico de Periapendicite Causada por Dispositivo Intra-Uterino
Ovarian Embedding of a Transmigrated Intrauterine Device: A Case Report and Literature Review
Actinomycosis of the appendix and pelvis: a case report.
Pseudomonas aeruginosa-infected IUD associated with pelvic inflammatory disease. A case report.
Educate Yourself: Contraindications to IUD Use:
- Pelvic inflammatory disease (current or within the past 3 months)
- Sexually transmitted diseases (current)
- Puerperal or postabortion sepsis (current or within the past 3
- Purulent cervicitis
- Undiagnosed abnormal vaginal bleeding
- Malignancy of the genital tract
- Known uterine anomalies or fibroids distorting the cavity in a way incompatible with intrauterine device (IUD) insertion
- Allergy to any component of the IUD or Wilson’s disease (for copper-containing IUDs)
[Data from The intra-uterine device. Canadian Consensus Conference on Contraception. J SOGC 1998;20:769–73; IMAP statement on intrauterine devices. International Planned Parenthood Federation (IPPF). International Medical Advisory Panel (IMAP). IPPF Med Bull 1995;29:1–4; and World Health Organization. Medical eligibility criteria for contraceptive use. 3rd ed. Geneva: WHO; 2004]
(Note that use of data from IPPF/WHO does not imply an endorsement of their advocacies and methods.)
There is also some controversy as to whether IUDs cause infertility. Here’s one Guttmacher study that suggests a first pregnancy may be difficult to achieve after long-term use of an IUD.
…they conclude that “long-term use of an intrauterine device by a nulliparous woman increases the risk of impairment of fertility to a clinically important extent,” and cite the well-established link between IUD use and pelvic inflammatory disease, a known cause of infertility. They conclude that “intrauterine devices should be used sparingly in nulliparous women and, in particular, that use for many years should be avoided.”
And yet the WHO is concerned that our teens ages 15-19 are not as aware of IUDs as they’d like them to be.
Why aren’t these things publicized by RH advocates? The way they talk about contraceptives and IUDs, they make it sound as if these are run of the mill procedures, nothing to sneeze at. They are anything but. Not only do RH advocates never speak about the dangers of IUDs, they are complicit in promoting the IUD alongside international organizations that would like to see our women become infertile. Look at Marie Stopes’ report:
The number of IUD users, some RH advocates say, is small. But this report from USAID says 776,000 IUD units were received and inserted from 1995-2003: 776,000 is small? USAID, UNFPA, etc. continue to promote IUD here. Increasing social acceptance of contraceptives is a common theme. Another USAID-sponsored 1998 publication from the East-West Center on Population indicates that 35% of the women in this 3-year study received the IUD. This 2010 Likhaan/DOH presentation details the distribution plan for 350,000 remaining IUDs received from a donor. Likhaan even proposes immediate insertion of an IUD post-abortion. Is this part of their post-abortion management scheme via the RH bill? Likhaan’s Melgar, in a December 2010 report to the UNFPA, bemoans what she considers an unstable upward trend of IUD usage, which costs 30-33% less than permanent sterilization.
Women in rural areas are especially susceptible to these side effects from IUD use because they are the ones that don’t get medical attention often enough or soon enough. Before they undergo such an invasive procedure to implant a foreign body, several tests need to be performed. Absolute contraindications including gynecological diseases and disorders need to be ruled out. An underlying malignancy or a large myoma, for instance, can only be detected by imaging (ultrasound, xray, MRI etc). Do we have funds to provide all these? In addition, follow-up examinations are essential. We need to resolve these issues before we consider supporting this bill. If we truly want health for our Filipino women, then we owe them at least that much, if not more.