DEVELOPMENT IN
INTRAUTERINE DEVICES
( IUD )
Presented BY :
AHMAD NOOR, PHARM.D
AHMED ALTAYAR, PHARM.D
Lecture outlines :
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What is the IUD ?how does it work ?
The types of IUD’s
Advantages & disadvantages
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History & development of IUD’s
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The most IUD’s used today
Insertion of the IUD’s
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Introduction
At the beginning as you know it is a happiness for every
parent’s to have a baby , but in the same time it is very
important to put in mind all other factors that may effect the
family life either : health , economical or even social problems
,which increase in cases of a large and uncontrolled number of
family members , from this point of view the need for a way to
control the number of birth was established , to improve the
population life-style
Our responsibility as pharmacists appear in development and
searching for different techniques to control pregnancy ,and
we will talk today about one of this ways and its development
What is an ( IUD ) ?
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It is a small, flexible, plastic device that
contains either metal e.g. copper or
hormones e.g. progesterone and is
inserted into the uterus to prevent
pregnancy.
How dose it work ?
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It may :
-Block sperm from reaching or fertilizing the
egg
-Make the lining of the uterus unsuitable for
implantation .
-interfere with the ovulation process
We do not know which of these actions is most
important for preventing pregnancy and most
likely all of them work together.
Types of ( IUD ) :
There are two main categories of IUD’s:
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1. Medicated: These forms of IUD use
hormones or metals to prevent conception.
progesterone and Copper plated IUDs are
considered medicated because they have
abilities to hinder fertilization.
2. Non Medicated: This category includes all
other forms of IUD no matter shape or size.
Advantages and the Disadvantages of ( IUD )
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Advantages:
- Once inserted , remain in place .
- Remains effective while in place.
- it prevents pregnancy for long period
- does not interfere with sexual activity.
Disadvantages :
- May cause bleeding and cramping .
- Increased risk of octopic pregnancy.
- Doesn't prevent sexual transmitted diseases.
- it is not recommended for women who have
heavy or long period
What is the history of (IUD) ?
- Camel riders in the Middle East are the
first recorded users of the IUD or
Intrauterine Device. It was common
knowledge that if you placed small stones
in the uterus of your camel, it would not
become pregnant even during its periods of
high sexual activity .
Hippocrates, the original Greek doctor, also
wrote : small piece that could be put into
the uterus of a woman with the help of a
small tube can prevent pregnancy .
In 1909 a German physician named Richard
Richter began to build IUDs from small
bronze rings and silk thread. Richter, as
well as many other doctors versions of the
IUD was too large for widespread use and
caused painful infections.
In 1930, Ernest Grafenberg improved
Richter's idea making the contraptions
smaller, avoiding most infections and
making the device more comfortable.
By the early 1960’s many other
forms/designs of IUD were invented and
were constructed of safer materials .
- Since 1998 worldwide, several new
intrauterine devices (IUDs) are under
development or in the early marketing
phase.
These new devices contain various
modifications designed to improve
patient continuation and physician
satisfaction. Modifications include
those designed to facilitate easier
insertion and removal, decrease the
rates of accidental expulsion, and
reduce complaints of pain or bleeding
a. Lippes-Loop
b. Saf-T-Coil
c. Dana-Super
Dana cuprum
d. Copper-T
e. Copper-7
f. Multiload
g. Progesterone
IUD
What are the most cu ( IUD ) used today ?
Today two types of cu IUD are used mostly Multiload
(left) and cupper T (right) :
What is the hormonal (IUD) used today?
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Late last year the FDA approved the
intrauterine device (IUD) Mirena. Mirena is a Tshaped that releases small amounts of the
hormone (levonorgestrel) to block conception,
Mirena only needs to be replaced once every
five years. The others, in contrast, must be
changed yearly.
A new IUD available in Europe & US uses a
synthetic hormone to achieve a high rate of
long-acting contraception.
WHAT ARE THE NEW
DEVELOPMENT IN
( IUD ) ?
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Developers are designing devices to
address the disadvantages issue by
modifying IUD size, shape, and flexibility.
At least six new devices are under
development, or have recently been
introduced, outside the US.
These devices include:
Cu
safe
300
Fincoid350 Soft-T
Multiload
mark 2
Gynefix ICFD
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CuSafe 300
The CuSafe 300 is a T-shaped copper IUD with flexible,
uniquely shaped arms.
Both ends of the device's transverse arms curve inward
to reduce uterine tissue irritation. In addition, its mono
filament tail is welded into the shaft, instead of knotted,
to reduce ectocervical abrasion
device's flexible design facilitate easier ,less painful
insertion and removal, aslo the curved "fundalseeking" arms resist expulsion.
carries a recommended life span of 5 years.
Advantages in comparison to copper T 380A IUD:
the inserter is about one third smaller than that of the
copper T 380A IUD.
These improvements should make the CuSafe 300 easy
to insert and remove.
pain and bleeding occurred significantly less frequently
among CuSafe IUD users, also the CuSafe had low and
statistically significant decrease rates of pregnancy and
expulsion
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Fincoid-350
The Fincoid-350, devised in Finland, is also
designed to resist accidental expulsion.
The IUD has a plastic skeleton comprised of
two parts: curved horizontal arms, and a
copper coated vertical stem. The resultant
movable joint easily constricts and expands
with uterine contractions, adjusting to
variations in uterine size and shape. The
Fincoid-350 comes in two sizes: standard
and short.
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Sof-T
The Sof-T, manufactured and approved for use only in
Switzerland, is a copper IUD with a unique shape to
enhance effectiveness. The device has soft, flexible
knobs, or occlusion bodies, on each end of its flexible
transverse arms. These knobs theoretically block the
entrances into the fallopian tubes.
Two dimensional ultrasound must be used for
insertion , however, to ensure exact placement of the
device. The device's potential ability to occlude the
fallopian tubes could, in theory, reduce the incidence
of tubal infection and ectopic pregnancy.On the other
hand, the knobs may incompletely block the fallopian
tubes and result in higher rates of ectopic pregnancy.
About 1,200 women currently wear the device.
Limited data indicate that the annual expulsion rate
ranges between 0.3% and 3.5%, removals for pain or
bleeding range from 0% to 1.4%
Multiload Mark II
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The Multiload Mark II is an updated version of the
original Multiload 375 (ML 375).
The original device has a record of dependability, with
low patient cessation rates due to pregnancy, expulsion
or bleeding and pain. The ML 375 has been associated
with problematic insertions, however, because its arms
do not fit into the inserter; the arms are open during
insertion, making placement more difficult.
the new inserter's diameter is smaller than the original
model.
In addition, the inserter has three other improvements:
its design prevents the IUD from getting pushed beyond
the inserter; it can function as a uterine sound; and it
has a one handed expulsion action.
These innovations may help limit the risk of uterine
perforation.
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GyneFix®
The GyneFix, a "frameless" IUD, consists of
six 5 mm copper sleeves. This device was
originally called the Cu-Fix 390, then later
the FlexiGard 330®.
The device has undergone 10 years of
testing and several modifications to its
inserter and anchoring mechanisms. The
upper and lower copper sleeves are crimped
onto the suture thread to prevent slippage.
The proximal end of the suture contains a
knot that is pierced 1 cm into the fundal
myometrium to anchor the device into the
uterine muscle.
Variations of the device for postpartum use
include a larger knot and a cone shaped
biodegradable tip that help anchor it
securely.
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Due to its frameless design, flexibility, and
minimal presence in the uterine cavity, the
GyneFix is associated with few expulsions. In
addition, the device has a high continuation
rate at 1 year (90%) due to few removals for
complaints of bleeding or pain.
Effectiveness depends upon proper insertion
technique because the device must be securely
anchored into the uterine myometrium or it will
be expelled.In addition, the device has very low
expulsion rates among nulliparous women.
Intracervical Fixing Device (ICFD)
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The intracervical fixing device differs substantially in both
construction and placement from other IUDs.
The device consists of a rod shaped, copper coated
polyethylene frame that is about 4 cm long with a 5 mm
projection at the distal end. Through this projection, the ICFD
is anchored (fixed) to the inner cervical wall using a modified
tenaculum.
Investigators believe the ICFD's anchoring mechanism could be
improved.
Better anchoring mechanisms could help to prevent expulsions.
One potential advantage of the device is that the insertion
procedure is not blind. In addition, because of the intracervical
location, the device will likely be associated with less spotting,
bleeding and pain.
Conclusion
Developers are designing new IUDs with
modifications to help enhance patient and
physician acceptance.
Modifications to the devices aim to decrease
removals due to pain and bleeding, make
insertion and removal easier, and limit the risk
of expulsion and prolong the life span of the
device .
HOW TO INSERT ( IUD )?
THANKS FOR YOUR ATTENTION!!
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Presented by :
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AHMAD NOOR, PHARM.D
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AHMED ALTAYAR, PHARM.D