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How Long After Iud Insertion Can I Have Intercourse

Written By Thursday, 17 February 2022 Add Comment Edit

Form of birth control involving a device placed in the uterus

Intrauterine device
IUD with scale.jpg

Copper IUD (Paragard T 380A)
Background
Type Intrauterine
Showtime use 1800s[1]
Synonyms Intrauterine organisation
Failure rates (commencement twelvemonth)
Perfect use <1%[2]
Typical utilize <1%[ii]
Usage
User reminders None
Advantages and disadvantages
STI protection No
Periods Depends on the type
Weight No effect

An intrauterine device (IUD), likewise known as intrauterine contraceptive device (IUCD or ICD) or coil,[iii] is a small, ofttimes T-shaped nascence command device that is inserted into the uterus to forbid pregnancy. IUDs are one form of long-acting reversible nascency control (LARC).[4] I study found that female family unit planning providers choose LARC methods more often (41.7%) than the general public (12.one%).[5] Amongst birth control methods, IUDs, along with other contraceptive implants, result in the greatest satisfaction among users.[6]

IUDs are safe and effective in adolescents too as those who take not previously had children.[6] [vii] In one case an IUD is removed, fifty-fifty later long-term use, fertility returns to normal rapidly.[viii] Copper devices have a failure rate of about 0.8% while hormonal (levonorgestrel) devices neglect about 0.2% of the time within the kickoff yr of use.[ix] In comparison, male person sterilization and male condoms have a failure rate of about 0.15% and 15%, respectively.[x] Copper IUDs can also exist used as emergency contraception within five days of unprotected sex.[eleven]

Although copper IUDs may increase menstrual bleeding and result in painful cramps,[12] hormonal IUDs may reduce menstrual bleeding or stop menstruation birthday.[thirteen] Yet, women can have daily spotting for several months and it can take up to three months for at that place to be a ninety% subtract in bleeding.[xiv] Cramping can be treated with NSAIDs.[15] More than serious potential complications include expulsion (2–5%) and rarely perforation of the uterus (less than 0.7%).[13] [15] IUDs do not touch breastfeeding and tin exist inserted immediately later delivery.[13] They may likewise exist used immediately after an abortion.[xvi] [17]

The use of IUDs increased within the U.s.a. from 0.viii% in 1995 to 7.2% from the menstruum of 2006 to 2014.[18] [19] The use of IUDs every bit a form of nascence control dates from the 1800s.[1] A previous model known as the Dalkon shield was associated with an increased risk of pelvic inflammatory disease (PID). However, current models do not affect PID risk in women without sexually transmitted infections during the fourth dimension of insertion.[20]

Types [edit]

The types of intrauterine devices bachelor, and the names they go by, differ by location. In the United states, at that place are two types available:[21]

  • Nonhormonal: Copper-containing IUD (ParaGard and others)
  • Hormonal: Progestogen-releasing IUD (Mirena and others)

The WHO ATC labels both copper and hormonal devices as IUDs. In the U.k., in that location are more than 10 different types of copper IUDs bachelor. In the United Kingdom, the term IUD refers only to these copper devices. Hormonal intrauterine contraception is labeled with the term intrauterine arrangement (IUS).[22] [23]

Copper[24] Mirena[25] Skyla[26] Liletta[27] Kyleena[28]
Hormone (total in device) None 52 mg

levonorgestrel

13.5 mg

levonorgestrel

52 mg

levonorgestrel

19.5 mg levonorgestrel
Initial corporeality released None 20 μg/day 14 μg/mean solar day 18.six μg/day 16 μg/day
Approved effectiveness ten years (12 years) five years (7 years) three years iii years (5 years) 5 years
Mechanism of action Copper toxic to sperm -Levonorgestrel thickens cervical fungus to forestall sperm from reaching egg

-Prevents ovulation at times

Advantages amongst IUDs -No hormones

-Emergency contraception

-Diverse hormone level options

-Lighter periods after 3 months; some users feel amenorrhea

Disadvantages among IUDs Heavier menstrual menstruum and cramps Ovarian cysts (although they tin can exist asymptomatic)

Not-hormonal [edit]

Copper [edit]

A copper T-shaped IUD with removal strings

An IUD as seen on pelvic Ten ray

About copper IUDs have a T-shaped frame that is wound around with pure electrolytic copper wire and/or has copper collars (sleeves). The arms of the frame hold the IUD in place near the top of the uterus. The Paragard TCu 380a measures 32 mm (ane.26") horizontally (pinnacle of the T), and 36 mm (ane.42") vertically (leg of the T). Copper IUDs have a kickoff year failure rate ranging from 0.1 to 2.2%.[29] They piece of work by damaging sperm and disrupting their motility so that they are not able to bring together an egg. Specifically, copper acts every bit a spermicide within the uterus by increasing levels of copper ions, prostaglandins, and white blood cells within the uterine and tubal fluids.[12] [30] The increased copper ions in the cervical mucus inhibit the sperm's motility and viability, preventing sperm from traveling through the cervical fungus, or destroying it every bit information technology passes through.[31] Copper can besides modify the endometrial lining, just studies show that while this alteration tin can prevent implantation of a fertilized egg ("blastocyst"), it cannot disrupt one that has already been implanted.[32]

Advantages of the copper IUD include its power to provide emergency contraception upwards to five days afterward unprotected sex. It is the virtually effective form of emergency contraception available.[33] It works past preventing fertilization or implantation only does not affect already implanted embryos.[32] Information technology contains no hormones, so it tin can be used while breastfeeding, and fertility returns apace afterward removal.[34] Copper IUDs also last longer and are available in a wider range of sizes and shapes compared to hormonal IUDs.[14] Disadvantages include the possibility of heavier menstrual periods and more painful cramps.[12]

IUDs that contain gold or argent also exist.[22] [35] Other shapes of IUD include the so-called U-shaped IUDs, such as the Load and Multiload, and the frameless IUD that holds several hollow cylindrical minuscule copper chaplet. It is held in identify by a suture (knot) to the fundus of the uterus. It is mainly available in China and Europe. A framed copper IUD called the IUB SCu300 coils when deployed and forms a iii-dimensional spherical shape. Information technology is based on a nickel titanium shape retention alloy core.[36] In addition to copper, noble metal and progestogen IUDs; people in China can get copper IUDs with indomethacin. This non-hormonal compound reduces the severity of menstrual haemorrhage, and these coils are popular.[37]

Inert [edit]

Inert IUDs practice non take a bioactive component. They are made of inert materials like stainless steel (such as the stainless steel ring (SSR), a flexible ring of steel coils that tin deform to be inserted through the cervix) or plastic (such as the Lippes Loop, which tin be inserted through the neck in a cannula and takes a trapezoidal shape inside the uterus). They are less constructive than copper or hormonal IUDs, with a side effect contour similar to copper IUDs. Their chief mechanism of action is inducing a local foreign trunk reaction, which makes the uterine environment hostile both to sperm and to implantation of an embryo.[38] They may have college rates of preventing pregnancy later on fertilization, instead of earlier fertilization, compared to copper or hormonal IUDs.[39]

Inert IUDs are not yet canonical for use in the Us, Uk, or Canada. In Mainland china, where IUDs are the almost common form of contraception, copper IUD production replaced inert IUD production in 1993.[40] However, equally of 2008, the most common IUD used by immigrants presenting to Canadian clinics for removal of IUDs placed in Red china was still the SSR. Considering the SSR has no string for removal, information technology can present a claiming to healthcare providers unfamiliar with IUD types not available in their region.[41]

Hormonal [edit]

Hormonal IUDs (referred to equally intrauterine systems in the UK) piece of work past releasing a small amount of levonorgestrel, a progestin. Each type varies in size, corporeality of levonorgestrel released, and elapsing. The primary mechanism of action is making the inside of the uterus uninhabitable for sperm.[42] They can also thin the endometrial lining and potentially impair implantation simply this is not their usual function.[43] [44] Because they thin the endometrial lining, they can besides reduce or even forestall menstrual bleeding. Every bit a event, they are used to treat menorrhagia (heavy menses), one time pathologic causes of menorrhagia (such as uterine polyps) have been ruled out.[45]

The progestin released by hormonal IUDs primarily acts locally; use of Mirena results in much lower systemic progestin levels than other very-low-dose progestogen just contraceptives.[46]

Adverse effects [edit]

Regardless of IUD type, there are some potential side effects that are similar for all IUDs. Some of these side effects include bleeding pattern changes, expulsion, pelvic inflammatory disease (especially in the first 21 days later on insertion), and rarely uterine perforation. A small probability of pregnancy remains after IUD insertion, and when information technology occurs there's a greater run a risk of ectopic pregnancy.[47]

IUDs with progestogen confer an increased risk of ovarian cysts,[48] and IUDs with copper confer an increased take a chance of heavier periods.

Menstrual cup companies recommend that women with IUDs who are because using menstrual cups should consult with their gynecologists before employ. There accept been rare cases in which women using IUDs dislodged them when removing their menstrual cups, however, this can also happen with tampon use.[49]

Unlike condoms, the IUD does non protect against sexually transmitted infections.[50]

Myth Fact
IUDs tin crusade infertility. IUDs do not atomic number 82 to infertility or brand it harder for a woman to become significant. Some prior studies that found an association between IUDs and infertility were investigating the Dalkon Shield which is no longer used.[51]
IUDs cause infections. IUDs do non cause increased infection. Over again, this is likely referring to the Dalkon Shield which is no longer used. That IUD contained multifilament strings, which provided bacteria a space to abound and movement up the string. IUDs as of 2008 utilize monofilament strings in order to forbid this from happening.[52] However, as with any medical intervention, IUDs tin lead to increased risk of infection immediately subsequently the insertion.
IUDs should only be used by older and/or monogamous women. IUDs are not solely for older and/or monogamous women. According to the U.S. Medical Eligibility Criteria for Contraceptive Utilise, women who have not had children and adolescents are classified as a category 2 for IUD use.[53] This ways that the benefits generally outweigh the risks although more conscientious attention may exist required.[54]
A woman is supposed to have her period regularly to be healthy. Women do not need to have periods regularly. A period signifies the end of a woman'south trunk preparing for pregnancy. If a woman does not desire pregnancy, and then she does non need a period. There is a condition known as polycystic ovarian syndrome (PCOS) which causes women to miss their periods and tin atomic number 82 to an increased take a chance of endometrial cancer.[55] However, an IUD causes the endometrial lining of a uterus to thin, which is the opposite of what occurs with PCOS.
IUDs prevent pregnancy past causing abortions. In the bulk of cases, IUDs piece of work by preventing fertilization. The copper-begetting IUD acts as a spermicide, killing or impairing sperm so they cannot reach the egg. IUDs that contain progestin crusade the cervical fungus to thicken, which stops sperm from inbound the uterus. Thus, the current evidence suggests that the main mechanisms of action of IUDs occur prior to fertilization.[56]

Insertion and removal [edit]

Removal strings of an intrauterine device exiting the cervical bone of a nulliparous woman. Epitome was taken immediately after insertion and injection of lidocaine.

It is difficult to predict what a woman will experience during IUD insertion or removal. Some women depict the insertion as cramps, some every bit a pinch, and others practice non feel anything. But 9% of nulliparous women considered the procedure painless, 72% moderately painful, and substantial pain with insertion that needs agile management occurs in approximately 17% of nulliparous women[57] and approximately 11% of parous women.[58] In such cases, NSAIDs are effective.[58] Topical lidocaine has been found equally an effective pain management drug when applied before the procedure.[59]

IUD insertion can occur at multiple timepoints in a woman's reproductive lifespan:

  1. interval insertion, the most common, occurs remote from pregnancy;
  2. mail service-ballgame or post-miscarriage insertion occurs following an abortion or miscarriage when the uterus is known to be empty;
  3. postpartum insertion occurs subsequently a woman gives nascence either immediately, while the adult female is still in the hospital, or delayed, up to vi-weeks following delivery, following either vaginal delivery or cesarean delivery. Insertion timing changes the risk of IUD expulsion.[lx] [61] [62] [63] [64]

Procedure [edit]

During the insertion process, wellness care providers use a speculum to detect the cervix (the opening to the uterus), compression the cervix to stabilize it open with a tenaculum,[65] and and so use an insertion device to place the IUD in the uterus. The insertion device goes through the cervix. The procedure itself, if uncomplicated, should take no more than than five to 10 minutes.[66]

For immediate postpartum insertion, the IUD is inserted following the removal of the placenta from the uterus. The uterus is larger than baseline following nascence, which has important implications for insertion. Afterward vaginal deliveries, insertions can exist done using placental forceps, a longer inserter specialized for postpartum insertions, or manually, where the provider uses their hand to insert the IUD in the uterus. After cesarean deliveries, the IUD is placed in the uterus with forceps or manually during surgery prior to suturing the uterine incision.[64] [61] [67]

Generally, the removal is elementary and reported to be not as painful as the insertion because in that location is no instrument that needs to go through the neck.[68] This process requires the health intendance provider to find the cervix with a speculum and then use band forceps, which simply go into the vagina, to grasp the IUD strings and then pull the IUD out.

IUD placement and removal tin can exist taught both by manufacturers and other grooming facilities.[69]

Mechanism [edit]

Analogy of intrauterine device

IUDs primarily piece of work by preventing fertilization.[70] The progestogen released from hormonal IUDs mainly works past thickening the cervical fungus, preventing sperm from reaching the fallopian tubes. IUDs may as well role by preventing ovulation from occurring only this only occurs partially.[71] [72]

Copper IUDs do not contain any hormones, but release copper ions, which are toxic to sperm. They also cause the uterus and fallopian tubes to produce a fluid that contains white claret cells, copper ions, enzymes, and prostaglandins, which is also toxic to sperm.[71] The very high effectiveness of copper-containing IUDs as emergency contraceptives implies they may likewise act past preventing implantation of the blastocyst.[73] [74]

History [edit]

The history of intrauterine devices dates back to the early on 1900s. Dissimilar IUDs, early interuterine devices crossed both the vagina and the uterus, causing a loftier rate of pelvic inflammatory disease in a time menses when gonorrhea was more common. The first IUD was developed in 1909 by the German language doctor Richard Richter, of Waldenburg. His device was made of silkworm gut and was not widely used.[75]

Ernst Gräfenberg, another German physician (after whom the G-spot is named), created the first Ring IUD, Gräfenberg's ring, fabricated of silver filaments. His work was suppressed during the Nazi government, when contraception was considered a threat to Aryan women.[75] He moved to the United states, where his colleagues H. Hall and Grand. Stone took up his work after his death and created the stainless steel Hall-Stone Ring. A Japanese medico named Tenrei Ota also developed a silver or gold IUD called the Precea or Pressure Band.[75]

Jack Lippes helped begin the increase of IUD use in the The states in the tardily 1950s. In this time, thermoplastics, which can bend for insertion and retain their original shape, became the textile used for first-generation IUDs. Lippes besides devised the improver of the monofilament nylon cord, which facilitates IUD removal. His trapezoid shape Lippes Loop IUD became one of the near popular commencement-generation IUDs. In the following years, many different shaped plastic IUDs were invented and marketed.[75] These included the infamous Dalkon Shield, whose poor design caused bacterial infection and led to thousands of lawsuits. Although the Dalkon shield was removed from the marketplace, it had a lasting, negative impact on IUD use and reputation in the United States.[76] Lazar C. Margulies adult the offset plastic IUD using thermoplastics in the 1960s.[77] His innovation allowed insertion of the IUD into the uterus without the demand to dilate the cervix.[78]

The invention of the copper IUD in the 1960s brought with information technology the capital letter 'T' shaped blueprint used by most modern IUDs. U.S. physician Howard Tatum determined that the 'T' shape would piece of work better with the shape of the uterus, which forms a 'T' when contracted. He predicted this would reduce rates of IUD expulsion.[75] Together, Tatum and Chilean physician Jaime Zipper discovered that copper could be an effective spermicide and developed the first copper IUD, TCu200. Improvements by Tatum led to the cosmos of the TCu380A (ParaGard), which is currently the preferred copper IUD.[75]

The hormonal IUD was also invented in the 1960s and 1970s; initially the goal was to mitigate the increased menstrual haemorrhage associated with copper and inert IUDs. The commencement model, Progestasert, was conceived of by Antonio Scommegna and created past Tapani J. Five. Luukkainen, merely the device just lasted for one yr of employ.[76] Progestasert was manufactured until 2001.[79] One commercial hormonal IUD which is currently available, Mirena, was likewise developed past Luukkainen and released in 1976.[75] The manufacturer of the Mirena, Bayer AG, became the target of multiple lawsuits over allegations that Bayer failed to adequately warn users that the IUD could pierce the uterus and migrate to other parts of the body.[80]

China [edit]

In China, the use of IUDs past state health services was part of the government'southward efforts to limit birth rates. From 1980 to 2014, 324 1000000 women were inserted with IUDs, in addition to the 107 million who had tubal ligation. Women who refused could lose their authorities employment and their children could lose access to public schools. The IUDs inserted in this manner were modified such that they could not be removed in a doctor's function (meant to exist left indefinitely), and surgical removal is usually needed.[81] Until the mid-1990s, the state-preferred IUD was a stainless steel ring,[82] [83] which had a higher rate of complications compared to other types of IUD. It gave rise to the idiom 上环 ( Shànghuán ) meaning "insert a loop". Present, the IUDs include T and Five shapes, the old being the near common and easiest to remove.

To implement the ii-child policy, the regime announced that IUD-removals would be paid for by the regime.[81] IUD removals are complimentary for women "who are immune to accept another child" (run into 1-child policy) or "who cannot continue to accept the IUD for health reasons."[84]

Cost [edit]

In the The states, the price of an IUD may range from $0 to $1,300.[85] [ clarification needed ] The cost includes medical exams, insertion, and follow-upwards visits. Under the Affordable Care Act, about insurance plans are required to cover all forms of birth command, including IUDs, although they may non comprehend all IUD brands.[86]

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    Mechanism of action
    The contraceptive action of all IUDs is mainly in the intrauterine cavity. Ovulation is not afflicted, and the IUD is not an abortifacient.58–sixty It is currently believed that the mechanism of action for IUDs is the product of an intrauterine environment that is spermicidal.
    Nonmedicated IUDs depend for contraception on the full general reaction of the uterus to a foreign body. Information technology is believed that this reaction, a sterile inflammatory response, produces tissue injury of a minor degree but sufficient to exist spermicidal. Very few, if any, sperm attain the ovum in the fallopian tube.
    The progestin-releasing IUD adds the endometrial action of the progestin to the foreign body reaction. The endometrium becomes decidualized with cloudburst of the glands.65 The progestin IUD probably has 2 mechanisms of action: inhibition of implantation and inhibition of sperm capacitation, penetration, and survival.
  43. ^ ESHRE Capri Workshop, Group (2008). "Intrauterine devices and intrauterine systems". Human being Reproduction Update. 14 (iii): 197–208. doi:x.1093/humupd/dmn003. PMID 18400840. Both copper IUDs and levonorgestrel releasing IUSs may interfere with implantation
  44. ^ Hatcher, Robert A. (2011). Contraceptive technology (20th rev. ed.). [New York, N.Y.]: Agog Media. p. 162. ISBN978-1-59708-004-0. Although the precise mechanism of action is not known, currently available IUCs piece of work primarily past preventing sperm from fertilizing ova.26 IUCs are not abortifacients: they do non interrupt an implanted pregnancy.27 Pregnancy is prevented by a combination of the "foreign body effect" of the plastic or metal frame and the specific activeness of the medication (copper or levonorgestrel) that is released. Exposure to a strange torso causes a sterile inflammatory reaction in the intrauterine environment that is toxic to sperm and ova and impairs implantation.28,29 The product of cytotoxic peptides and activation of enzymes pb to inhibition of sperm motility, reduced sperm capacitation and survival, and increased phagocytosis of sperm.30,31… The progestin in the LNg IUC enhances the contraceptive action of the device by thickening cervical mucus, suppressing the endometrium, and impairing sperm function. In improver, ovulation is often impaired every bit a outcome of systemic absorption of levonorgestrel
  45. ^ Luis Bahamondes; Grand Valeria Bahamondes; Ilza Monteiro. (2008), "Levonorgestrel-releasing intrauterine system: uses and controversies.", Expert Review of Medical Devices, v (4): 437–45, doi:x.1586/17434440.5.iv.437, PMID 18573044, S2CID 659602
  46. ^ Malik S (Jan 2013). "Levonorgestrel-IUS organization and endometrial manipulation". Journal of Mid-Life Health. 4 (one): six–7. doi:10.4103/0976-7800.109625. PMC3702070. PMID 23833526.
  47. ^ "ParaGard (copper IUD)". Mayo Clinic . Retrieved xxx November 2018.
  48. ^ Bahamondes L; Hidalgo M; Petta CA; Diaz J; Espejo-Arce X; Monteiro-Dantas C. (2003), "Enlarged ovarian follicles in users of a levonorgestrel-releasing intrauterine system and contraceptive implant", J. Reproduc. Med., 48 (8): 637–640, PMID 12971147
  49. ^ "Menstrual Cup utilize and IUDs". Feminine Wearable. Archived from the original on thirteen July 2017. Retrieved 22 Dec 2013.
  50. ^ "What Are the Side Effects & Complications of the IUD?". www.plannedparenthood.org . Retrieved 21 November 2017.
  51. ^ Shoupe, Donna; Jr, Daniel R. Mishell (2015-09-28). The Handbook of Contraception: A Guide for Applied Management. Humana Press. ISBN9783319201856.
  52. ^ Gibbs, Ronald South. (2008). Danforth'south Obstetrics and Gynecology. Lippincott Williams & Wilkins. ISBN9780781769372.
  53. ^ "Summary Chart of U.South. Medical Eligibility Criteria for Contraceptive Utilise" (PDF). www.cdc.gov . Retrieved 25 March 2018.
  54. ^ Curtis, Kathryn M.; Tepper, Naomi G.; Jatlaoui, Tara C.; Berry-Bibee, Erin; Horton, Leah G.; Zapata, Lauren B.; Simmons, Katharine B.; Pagano, H. Pamela; Jamieson, Denise J. (2016). "U.S. Medical Eligibility Criteria for Contraceptive Use, 2016". MMWR. Recommendations and Reports. 65 (3): ane–103. doi:10.15585/mmwr.rr6503a1. ISSN 1057-5987. PMID 27467196.
  55. ^ Dumesic, Daniel A.; Lobo, Rogerio A. (August 2013). "Cancer take chances and PCOS". Steroids. 78 (eight): 782–785. doi:10.1016/j.steroids.2013.04.004. ISSN 1878-5867. PMID 23624028. S2CID 10185317.
  56. ^ "Myths and facts nearly... the Intra-Uterine Device (IUD)". IPPF. 2012-02-17. Retrieved 2021-01-xviii .
  57. ^ Marions, Lena; Lövkvist, Lena; Taube, Annika; Johansson, Monica; Dalvik, HÃ¥kan; Øverlie, Inger (2011-04-01). "Use of the levonorgestrel releasing-intrauterine system in nulliparous women – a non-interventional study in Sweden". The European Journal of Contraception & Reproductive Health Care. 16 (2): 126–134. doi:10.3109/13625187.2011.558222. ISSN 1362-5187. PMID 21417562.
  58. ^ a b Gemzell-Danielsson, K.; Mansour, D.; Fiala, C.; Kaunitz, A. M.; Bahamondes, Fifty. (2013). "Management of pain associated with the insertion of intrauterine contraceptives". Human Reproduction Update. nineteen (4): 419–427. doi:ten.1093/humupd/dmt022. PMC3682672. PMID 23670222.
  59. ^ Karasu, Yetkin; Cömert, Duygu Kavak; KaradaÄŸ, Burak; Ergün, Yusuf (June 2017). "Lidocaine for hurting control during intrauterine device insertion". The Periodical of Obstetrics and Gynaecology Research. 43 (6): 1061–1066. doi:10.1111/jog.13308. ISSN 1447-0756. PMID 28503818.
  60. ^ "Long-Interim Reversible Contraception: Implants and Intrauterine Devices". www.acog.org . Retrieved 2020-04-13 .
  61. ^ a b Okusanya, Babasola O; Oduwole, Olabisi; Effa, Emmanuel E (2014-07-28). "Immediate postabortal insertion of intrauterine devices". Cochrane Database of Systematic Reviews (7): CD001777. doi:10.1002/14651858.cd001777.pub4. ISSN 1465-1858. PMC7079711. PMID 25101364.
  62. ^ "Early on Pregnancy Loss". www.acog.org . Retrieved 2020-04-thirteen .
  63. ^ Lopez, Laureen M; Bernholc, Alissa; Hubacher, David; Stuart, Gretchen; Van Vliet, Huib AAM (2015-06-26). "Immediate postpartum insertion of intrauterine device for contraception". Cochrane Database of Systematic Reviews (half dozen): CD003036. doi:x.1002/14651858.cd003036.pub3. ISSN 1465-1858. PMID 26115018.
  64. ^ a b Jatlaoui, Tara C.; Whiteman, Maura Thou.; Jeng, Gary; Tepper, Naomi M.; Berry-Bibee, Erin; Jamieson, Denise J.; Marchbanks, Polly A.; Curtis, Kathryn M. (October 2018). "Intrauterine Device Expulsion After Postpartum Placement". Obstetrics & Gynecology. 132 (4): 895–905. doi:10.1097/aog.0000000000002822. ISSN 0029-7844. PMC6549490. PMID 30204688.
  65. ^ Johnson, Brett A. (2005-01-01). "Insertion and Removal of Intrauterine Devices". American Family Doc. 71 (1): 95–102. ISSN 0002-838X.
  66. ^ "What's an IUD insertion like?". www.plannedparenthood.org . Retrieved 2018-03-29 .
  67. ^ Whitaker, Amy Yard.; Chen, Beatrice A. (January 2018). "Society of Family Planning Guidelines: Postplacental insertion of intrauterine devices". Contraception. 97 (1): 2–13. doi:x.1016/j.contraception.2017.09.014. ISSN 0010-7824. PMID 28987293.
  68. ^ Barnes, Zahra. "This Is What to Expect After Getting Your IUD Removed". Cocky . Retrieved 2018-03-xxx .
  69. ^ "Clinical Instruction and Preparation". world wide web.acog.org . Retrieved 2019-08-21 .
  70. ^ Steven G. Gabbe; et al., eds. (2012-01-01). Obstetrics : normal and problem pregnancies (6th ed.). Philadelphia: Elsevier/Saunders. p. 528. ISBN9781437719352.
  71. ^ a b "Archived re-create". Archived from the original on 2013-08-08. Retrieved 2013-08-08 . {{cite web}}: CS1 maint: archived copy equally title (link)
  72. ^ "Mirena (DIU hormonal) - Mayo Dispensary". Mayo Dispensary.
  73. ^ Trussell, James; Schwarz, Eleanor Bimla (2011). "Emergency contraception". In Hatcher, Robert A.; Trussell, James; Nelson, Anita 50.; Cates, Willard Jr.; Kowal, Deborah; Policar, Michael Due south. (eds.). Contraceptive applied science (20th revised ed.). New York: Ardent Media. pp. 113–145. ISBN978-1-59708-004-0. ISSN 0091-9721. OCLC 781956734. p. 121:

    Mechanism of action
    Copper-releasing IUCs
    When used as a regular or emergency method of contraception, copper-releasing IUCs act primarily to prevent fertilization. Emergency insertion of a copper IUC is significantly more effective than the use of ECPs, reducing the risk of pregnancy post-obit unprotected intercourse by more than 99%.2,3 This very high level of effectiveness implies that emergency insertion of a copper IUC must prevent some pregnancies afterward fertilization.
    Emergency contraceptive pills
    To brand an informed choice, women must know that ECPs—like the birth control pill, patch, ring, shot, and implant,76and fifty-fifty similar breastfeeding77—prevent pregnancy primarily past delaying or inhibiting ovulation and inhibiting fertilization, but may at times inhibit implantation of a fertilized egg in the endometrium. However, women should too be informed that the all-time bachelor evidence indicates that ECPs prevent pregnancy by mechanisms that practise non involve interference with postal service-fertilization events.
    ECPs do non cause ballgame78 or harm an established pregnancy. Pregnancy begins with implantation according to medical government such as the US FDA, the National Institutes of Health79 and the American Higher of Obstetricians and Gynecologists (ACOG).lxxx
    Ulipristal acetate (UPA). One study has demonstrated that Upwardly can delay ovulation.81... Another written report institute that UPA altered the endometrium, just whether this change would inhibit implantation is unknown.82
    p. 122:
    Progestin-only emergency contraceptive pills. Early on treatment with ECPs containing only the progestin levonorgestrel has been show to impair the ovulatory process and luteal function.83–87
    p. 123:
    Combined emergency contraceptive pills. Several clinical studies take shown that combined ECPs containing ethinyl estradiol and levonorgestrel can inhibit or delay ovulation.107–110

  74. ^ RCOG Faculty of Sexual; Reproductive Healthcare; Clinical Effectiveness Unit (January 2012). "Clinical guidance: emergency contraception" (PDF). Clinical Guidance. London: Royal College of Obstetricians and Gynaecologists. ISSN 1755-103X. Retrieved 2012-04-thirty . p.3:

    How does EC work?
    In 2002, a judicial review ruled that pregnancy begins at implantation, not fertilisation.8 The possible mechanisms of action should be explained to the patient as some methods may not be adequate, depending on individual beliefs about the onset of pregnancy and abortion.
    Copper-bearing intrauterine device (Cu-IUD). Copper is toxic to the ovum and sperm and thus the copper-bearing intrauterine device (Cu-IUD) is effective immediately afterward insertion and works primarily past inhibiting fecundation.ix–11 A systematic review on mechanisms of activeness of IUDs showed that both pre- and postfertilisation effects contribute to efficacy.elevenIf fertilisation has already occurred, it is accepted that there is an anti-implantation effect,12,13
    Levonorgestrel (LNG). The precise mode of activity of levonorgestrel (LNG) is incompletely understood but it is thought to work primarily past inhibition of ovulation.16,17
    Ulipristal acetate (UPA). UPA's primary mechanism of activity is thought to exist inhibition or delay of ovulation.2

  75. ^ a b c d e f grand Thiery, Michel (March 1997). "Pioneers of the intrauterine device" (PDF). European Journal of Contraception and Reproductive Health Care. ii (ane): xv–23. doi:10.1080/13625189709049930. PMID 9678105. Archived from the original (PDF) on August 20, 2006.
  76. ^ a b Thiery Thou (June 2000), "Intrauterine contraception: from silver band to intrauterine contraceptive implant", Eur. J. Obstet. Gynecol. Reprod. Biol., 90 (2): 145–52, doi:10.1016/s0301-2115(00)00262-1, PMID 10825633
  77. ^ Thiery, M. (March 1997). "Pioneers of the Intrauterine Device" (PDF). The European Journal of Contraception and Reproductive Health Care. two (1): 15–23. doi:ten.1080/13625189709049930. PMID 9678105. Archived from the original (PDF) on xx Baronial 2006. Retrieved 24 March 2016.
  78. ^ Reed, James (1984). The Birth Command Movement and American Society: From Private Vice to Public Virtue. Princeton University Printing. p. 306. ISBN9781400856596.
  79. ^ Smith (pseudonym), Sydney (March eight, 2003). "Contraceptive Concerns". medpundit: Commentary on medical news by a practicing physician . Retrieved 2006-07-16 .
  80. ^ "Legal Electric current Events | Westlaw Practitioner Insights".
  81. ^ a b Wee, Sui-lee (seven January 2017). "After One-Kid Policy, Outrage at China'due south Offering to Remove IUDs". The New York Times . Retrieved 8 Jan 2017.
  82. ^ "Chinese ring". www.obgyn.net. July 14, 2011.
  83. ^ "Intrauterine Devices (IUDs)". www.fhi360.org.
  84. ^ "1 Child Policy Leaves Millions of Chinese Women With Unwanted IUDs". Radio Gratuitous Asia. Jan 13, 2017.
  85. ^ "IUD Birth Control | Info Well-nigh Mirena & ParaGard IUDs". world wide web.plannedparenthood.org . Retrieved 2018-12-02 .
  86. ^ "Where Can I Buy the IUD & How Much Volition It Cost?". world wide web.plannedparenthood.org . Retrieved 2019-03-27 .

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