Exploring Intrauterine Contraception

Intrauterine contraception involves the placement of specialized devices, known as pessaries or spirals, into the uterine cavity. Unlike some other methods, it offers the advantage of being a permanent contraceptive solution that isn’t reliant on intercourse.

Types of Pessaries

There are two main types of pessaries: inert and bioactive.

Inert Pessaries: These have lower efficiency and a higher frequency of side effects but can remain in the uterine cavity indefinitely.

Bioactive Pessaries: These contain embedded metals (copper, silver) or hormones. Their effectiveness depends on the release of these ingredients and they typically last from 3 to 5 years.

Almost all pessaries feature a rounded end in their lower part, usually in the form of a loop, to prevent tissue trauma. They also come with a thread attached to the loop for positioning control and removal if needed.

How Does the Intrauterine Device (IUD) Work?

The intrauterine device operates through several mechanisms:

1. Local Inflammatory Reaction: The presence of the pessary induces a constant local inflammatory reaction in the uterus, attracting immune cells that destroy sperm and fertilized eggs. The release of copper and silver from some pessaries enhances this response.
2. Release of Prostaglandins: The IUD stimulates the release of prostaglandins, substances involved in inflammation, which damage the endometrial surface cells, making it unsuitable for the implantation of fertilized eggs.
3. Changes in Cervical Mucus: The pessary alters the biochemical composition of cervical mucus, slowing down or halting the movement of sperm.
4. Hormonal Influence: Hormone-containing pessaries thin the endometrium, making it unfavorable for the implantation of fertilized eggs.

Factors to Consider

When to Avoid IUD Placement

An intrauterine pessary should not be inserted in cases of:

• Acute or chronic pelvic inflammation
• Pregnancy
• Suspicious evidence of genital malignancy
• Unexplained uterine bleeding
• Congenital anomalies of the genital apparatus that interfere with spiral attachment

Insertion and Removal

The pessary can be inserted at any time during the menstrual cycle, immediately after abortion or childbirth. However, the end of menstruation is often preferred by specialists due to the larger uterine cavity and wider cervical canal.

During insertion, a gynecological examination is performed, and aseptic and antiseptic procedures are followed. Despite precautions, the procedure may cause discomfort or adverse reactions such as pain, dizziness, nausea, or fainting.

Removal can occur at any time during the menstrual cycle. Fertility is restored immediately after removal, but due to biochemical changes in the endometrium, pregnancy is not recommended within the first 3 months post-removal.