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Safia Mehmood

Long-Acting Contraception Devices

What is PPIUCD?

Introduction

According to the WHO, out of the 1.9 billion women of reproductive age (15-49 years) worldwide in 2021, 1.1 billion need family planning. Of these, 874 million use modern contraceptives, while 164 million still lack access to the contraception they need.

Postpartum intrauterine contraceptive device (PPIUCD) is a form of long-acting reversible contraception inserted into the uterus within 48 hours of childbirth, either immediately after the placenta is delivered or within the first 48 hours after childbirth. This period is advantageous because the cervix is still dilated, making the procedure easier and less painful for new mothers who wish to space their future pregnancies.

The insertion of a PPIUCD is a medical procedure that requires specialized instruments. The primary tool used is the Kelly forceps, which are curved and long, allowing for safe and precise placement of the IUD in the uterus. 
&nbsp;

Understanding PPIUCD

PPIUCDs are over 99% effective in preventing pregnancy. Once inserted, no daily or monthly action is required by the user.

<ol>
	<li>Long-Acting: PPIUCDs protect for up to 10 years, depending on the type of device used.</li>
	<li>Immediate Contraception: Since fertility can return quickly after childbirth, immediate insertion ensures continuous contraception without a gap.</li>
	<li>A Non-Hormonal Option: Copper IUDs do not affect breastfeeding, making them ideal for new mothers.</li>
	<li>Cost-Effective: Over the long term, PPIUCDs are more cost-effective compared to other forms of contraception.</li>
	<li>Reversible: Fertility returns quickly once the device is removed. 
	&nbsp;</li>
</ol>

Common side effects include:

<ol>
	<li>Mild-to-moderate cramping</li>
	<li>Heavier periods</li>
	<li>Spotting between periods, especially in the first few months</li>
	<li>Pain or discomfort during and immediately after insertion</li>
	<li>Pain or discomfort during intercourse 
	&nbsp;</li>
</ol>

While PPIUCDs are usually safe and effective, there are potential complications that users should be aware of.

<ul>
	<li>Uterine Perforation &ndash; A rare but serious complication; the device punctures the uterine wall during insertion, causing pain and requiring surgical intervention</li>
	<li>Infection &ndash; The risk of infection is generally low but slightly higher immediately after childbirth</li>
	<li>Expulsion &ndash; Risk increases if the device is not inserted correctly or the uterus contracts strongly postpartum</li>
</ul>

Heavier and prolonged menstrual bleeding can be a significant drawback for some women. Additionally, some women may experience persistent discomfort or pain. The device becomes embedded in the uterine wall in rare instances, making it difficult to remove.

Discuss any previous health conditions, such as pelvic infections or heavy menstrual bleeding, with your healthcare provider to ensure PPIUCD is a suitable option. Regular follow-up visits with your healthcare provider can help manage any side effects and ensure the IUD is properly in place. 
&nbsp;

Conclusion

It offers numerous advantages, including immediate contraception and high efficacy. However, like any medical procedure, it comes with its own set of potential side effects and complications. Understanding these can help women make informed decisions about their postpartum contraception choices.

[1] Family planning/contraception methods. World Health Organization. Accessed July 12, 2024.

[2] Najan A, Dixit P, Bhalerao A. The Acceptance of Postpartum Intrauterine Contraceptive Devices Among Women Who Receive Focused Family Planning Counseling in the Antenatal Period Compared to Those Who Receive Routine Counseling: A Randomized Controlled Trial. Cureus. 2023;15(6):e40344. Published 2023 Jun 12.

Staff Writer

Types Of Contraception

There are various types of contraception available, each with its own set of benefits and considerations. 
&nbsp;

Understanding Types Of Contraception

Hormonal contraception works by regulating hormones to prevent ovulation, thicken cervical mucus, or thin the uterine lining. The most common hormonal methods include:

<ol>
	<li>Birth Control Pills: Oral contraceptives are taken daily and come in two forms: combination pills (containing estrogen and progestin) and progestin-only pills. They are highly effective when taken consistently but require daily adherence.</li>
	<li>Birth Control Patch: A small adhesive patch on the skin releases hormones to prevent pregnancy. It should be replaced every week for 3 weeks. This phase will then be followed by a patch-free week.</li>
	<li>Birth Control Ring: The vaginal ring is a flexible ring inserted into the vagina, releasing hormones over 3 weeks. Then, it is removed for a week to allow for menstruation.</li>
	<li>Birth Control Shot: The shot, or injection, is administered every 3 months and provides long-term protection without daily attention.</li>
	<li>Birth Control Implant: A small, rod-like implant is inserted under the skin of the upper arm. It releases progestin and is effective for up to 3 years. 
	&nbsp;</li>
</ol>

Barrier methods prevent sperm from reaching the egg. These methods are often used in conjunction with spermicide for increased effectiveness:

<ol>
	<li>Condoms: Condoms are sheaths worn over the penis (male condom) or inserted into the vagina (female condom) to prevent sperm from entering the reproductive tract. Moreover, condoms are useful in preventing sexually transmitted infections.</li>
	<li>Diaphragm: A diaphragm is a shallow, dome-shaped cup inserted into the vagina to cover the cervix. It is recommended to use a diaphragm with spermicide and leave it in place for at least 6 hours after intercourse.</li>
	<li>Cervical Cap: Similar to the diaphragm, the cervical cap is a smaller, thimble-shaped cup that covers the cervix and is used with spermicide.</li>
	<li>Sponge: The contraceptive sponge is a soft, disk-shaped device that contains spermicide and is inserted into the vagina to cover the cervix. 
	&nbsp;</li>
</ol>

IUDs, or small, T-shaped devices inserted into the uterus, can be divided into:

<ol>
	<li>Copper IUD: The copper IUD is hormone-free. It acts as a spermicide and can prevent pregnancy for up to 10 years.</li>
	<li>Hormonal IUD: Hormonal IUDs release progestin. They can last from 3-7 years depending on the type. They thicken cervical mucus and sometimes prevent ovulation. 
	&nbsp;</li>
</ol>

Permanent contraception methods are suitable for individuals who are certain they do not want future pregnancies:

<ol>
	<li>Tubal Ligation: This surgical procedure involves tying, sealing, or cutting the fallopian tubes. he aim is to prevent eggs from reaching the uterus.</li>
	<li>Vasectomy: This surgical procedure involves cutting or sealing the vas deferens, the tubes that carry sperm from the testicles to the urethra. 
	&nbsp;</li>
</ol>

Natural contraception methods involve tracking fertility and abstaining from intercourse during fertile periods. These methods require careful monitoring and discipline:

<ol>
	<li>Fertility Awareness: This method involves tracking menstrual cycles, basal body temperature, and cervical mucus to determine fertile days.</li>
	<li>Withdrawal: Withdrawing the penis from the vagina before ejaculation requires considerable control and is less effective than other methods.</li>
	<li>Lactational Amenorrhea Method (LAM): Breastfeeding can naturally suppress ovulation. If the mother is exclusively breastfeeding and has not resumed menstruation, then LAM can be effective for up to 6 months postpartum. 
	&nbsp;</li>
</ol>

This is the last resort to prevent pregnancy after unprotected intercourse or contraceptive failure:

<ol>
	<li>Emergency Contraceptive Pills: These pills can be taken within 72-120 hours after unprotected sex. They work by delaying ovulation.</li>
	<li>Copper IUD: The copper IUD can be inserted up to 5 days after unprotected intercourse and is the most effective form of emergency contraception. 
	&nbsp;</li>
</ol>

A healthcare provider can help determine the right contraception method depending on individual preferences, health considerations, and lifestyle.

[1] Department of Health & Human Services. Contraception - choices. Better Health Channel. September 29, 1999. Accessed July 12, 2024.

[2] Queensland Health. 9 types of contraception you can use to prevent pregnancy. Queensland Health. April 11, 2024. Accessed July 12, 2024.

[3] Dawn Stacey P. An overview of birth control. Verywell Health. August 15, 2023. Accessed July 12, 2024.

Emergency Contraception: What You Need To Know

Emergency contraception is a critical aspect of reproductive health, offering a safety net for individuals who need to prevent pregnancy after unprotected sex, contraceptive failure, or sexual assault. 
&nbsp;

Understanding about Emergency Contraception

There are primarily two types of emergency contraception: 
&nbsp;

<ol>
	<li>
	<h5>Emergency Contraceptive Pills (ECPs)</h5>
	</li>
</ol>

Commonly known as the &quot;morning-after pill,&quot; ECPs prevent the ovaries from releasing an egg, ensuring there is no egg available for fertilization by sperm. It&rsquo;s important to note that ECPs neither terminate an existing pregnancy nor are effective if you are already pregnant. There are different types of ECPs, such as those containing levonorgestrel and ulipristal acetate, which can be taken up to 72 and 120 hours after unprotected sex, respectively. 
&nbsp;

<ol start="2">
	<li>
	<h5>Copper IUD</h5>
	</li>
</ol>

The copper IUD is a good option when inserted within 5 days of unprotected intercourse. It provides long-term contraceptive protection for up to 10 years and is the most effective form of emergency contraception. The copper acts as a spermicide, preventing sperm from fertilizing the egg and inhibiting implantation. 
&nbsp;

<h5>Important!</h5>

While safe for multiple uses, emergency contraceptive methods are less effective than regular contraceptive methods (e.g., condoms) and should not replace them. They are designed for occasional use in situations where primary contraceptive methods fail or are not used. 
 
&nbsp;

It&rsquo;s better to be prepared beforehand &ndash; know where and how to access emergency contraception before an emergency arises.

ECPs can be purchased over the counter at pharmacies with or without a prescription, depending on local regulations. Some brands may be available directly from healthcare providers or clinics.

Alternatively, copper IUDs must be inserted by a healthcare provider, requiring a visit to a clinic or healthcare facility. This may involve additional costs and an appointment, so planning ahead is beneficial. 
&nbsp;

<ul>
	<li>Beyond emergency contraception, the copper IUD can serve as a long-term birth control method, reducing the need for repeated interventions. It is hormone-free, making it suitable for those who prefer non-hormonal options.</li>
	<li>Some women may experience side effects like nausea, fatigue, headache, dizziness, breast tenderness, or changes in their next menstrual period. Most of these side effects are mild and temporary.</li>
</ul>

Healthcare providers can also provide guidance on proper usage and address any concerns about side effects or complications. 
&nbsp;

Understanding the types, how they work, their effectiveness, and where to obtain emergency contraception ensures individuals can make informed choices about their reproductive health. Always consult healthcare providers to address ongoing contraceptive needs. Having emergency contraception readily available and knowing how to use it can significantly reduce the risk of unintended pregnancies.

[1] Morning-after pill. Mayo Clinic. July 2, 2024. Accessed July 12, 2024.

[2] Emergency contraception. World Health Organization. Accessed July 12, 2024.

Long-acting contraception devices are birth control methods that provide effective pregnancy prevention for an extended period, typically ranging from several months to several years.

Unlike daily pills or barrier methods like condoms, long-acting contraception requires little to no daily attention once placed or administered. They are a highly effective option, allowing individuals to manage their reproductive health with confidence. 
&nbsp;

Understanding  Long Acting Contraception Devices

<ul>
	<li>
	<h5>Intrauterine Devices (IUDs)</h5>

	<ol>
		<li>
		Hormonal IUDs: These devices release a small amount of progestin hormone into the uterus, which thickens cervical mucus to block sperm and thins the uterine lining to prevent implantation. They can last from 3-8 years.
		</li>
		<li>Copper IUDs: Copper IUDs do not contain hormones. Instead, they use copper to create an inhospitable environment for sperm, preventing fertilization for up to 10 years. 
		&nbsp;</li>
	</ol>
	</li>
	<li>
	<h5>Contraceptive Implants</h5>
	</li>
</ul>

This small, flexible rod is inserted under the skin of the upper arm and releases a steady dose of progestin. It prevents ovulation and thickens cervical mucus, effective for up to 3 years. 
&nbsp;

<ul>
	<li>
	<h5>Injectable Contraceptives</h5>
	</li>
</ul>

This injection contains the hormone progestin and is administered once every 3 months. It provides effective contraception for 13 weeks by preventing ovulation and thickening the cervical mucus. 
&nbsp;

<ul>
	<li>Efficient: Long-acting contraception devices are among the most effective forms of birth control available. IUDs and implants have a failure rate of less than 1%, making them more reliable than pills, patches, or condoms.</li>
	<li>Convenience: Once placed or administered, long-acting contraception requires minimal maintenance. There is no need for daily attention or frequent visits to the pharmacy, making it an ideal choice for busy individuals or those who prefer a &quot;set it and forget it&quot; approach.</li>
	<li>Reversible: Long-acting contraception methods are reversible. Fertility typically returns quickly after the removal of the device, allowing individuals to plan pregnancies according to their schedules.</li>
	<li>Cost-Effective: While the initial cost of long-acting contraception devices may be higher than other methods, their long-term use makes them cost-effective. Over time, they can be more affordable than continually purchasing pills, patches, or condoms.</li>
	<li>Discreet: These devices do not interfere with sexual activity. There is no need to remember to use birth control at the moment, which can enhance spontaneity and intimacy. 
	&nbsp;</li>
</ul>

<ol>
	<li>Insertion And Removal: The insertion and removal of IUDs and implants must be performed by a healthcare professional. While the procedure is generally quick, some individuals may experience discomfort or mild pain.</li>
	<li>Side Effects: Side effects vary depending on the type of device used. For instance, hormonal IUDs and implants can cause irregular bleeding, mood changes, and acne. On the other hand, copper IUDs may increase menstrual bleeding and cramping, while injectable contraceptives can lead to weight gain and changes in menstrual cycles.</li>
	<li>Medical Conditions: Not all long-acting contraception methods are suitable for everyone. Individuals with certain medical conditions, such as active pelvic infections, unexplained vaginal bleeding, or a history of breast cancer, should discuss their options with a healthcare provider. 
	&nbsp;</li>
</ol>

<ul>
	<li>Consider Your Lifestyle: Think about your daily routine and preferences. If you prefer not to worry about daily pills or monthly refills, long-acting contraception might be a suitable choice.</li>
	<li>Review The Benefits And Risks: Weigh the benefits and potential side effects of each method. Understanding the pros and cons can help you choose a device that aligns with your needs.</li>
	<li>Think About Your Future Plans: Consider your future reproductive plans. If you want a reversible method that allows for the quick return of fertility, an IUD or implant might be ideal.</li>
</ul>

Discuss your options with a healthcare provider. They can provide personalized recommendations based on your health, lifestyle, and reproductive goals. 
&nbsp;

Long-acting contraception devices offer a convenient, reliable, and cost-effective solution for individuals seeking long-term birth control. With various options available, including hormonal and non-hormonal IUDs, contraceptive implants, and injectables, there is a method to suit different needs and preferences. Consulting a healthcare provider and understanding the benefits and potential side effects can help you make an informed decision that aligns with your reproductive goals.