銅付加IUD（英語版）「
パラガード（英語版）」T 380A
黄体ホルモン付加IUD（英語版）「ミレーナ」。IUSに分類される場合もある
子宮内避妊器具（英: intrauterine device; IUD）は子宮頸部の中に留置して用いられる避妊器具である。妊娠が望まれない間はずっと子宮内に留め置かれる。連続して装着できる期間は5年から10年ほどで、IUDの種類により異なる（銅付加型のT 380Aでは12年）[1]。IUDの子宮への装着と除去は医療の専門家、通常は婦人科医、によって行われなければならない。IUDは医療機器であるため、その国や地域で定められている医療上の基準を満たしている必要があり、例えばヨーロッパにおいてはCEマークを取得しなければならない。
IUDは2001年の時点で世界で最も多く用いられている可逆的な避妊手段であり[2]、およそ1.6億人の女性が使用している。そのうち2/3は中華人民共和国の女性であり、中国では不妊手術よりも多く用いられている[3]。
目次
- 1 歴史
- 2 分類
- 3 有効性
- 4 機序
- 5 禁忌
- 6 脚注
- 7 関連項目
歴史
紀元前4世紀の医者ヒポクラテスは動物（ラクダが用いられた可能性がある）の子宮に異物を入れると避妊効果があることを発見し、IUDの先駆者と考えられている。しかしながら、現代的な子宮内避妊は1928年にドイツのリヒャルト・リヒターによって始められたもので、以後効率と持続期間の改良が重ねられている[4]。
分類
IUDには化学的に不活性な銅タイプ（銅付加IUD（英語版））と、プロゲストゲン（英語版）を放出することで機能するホルモンタイプ（黄体ホルモン付加IUD（英語版））の2種類がある。例えばアメリカ合衆国では、銅タイプの「パラガード（英語版）」とホルモンタイプの「ミレーナ」の2種のみが製造されている[5]。イギリスでは7種類の銅タイプのIUDがあり、銅タイプのもののみがIUDと呼ばれている。ホルモンを用いる子宮内での避妊はIUDとは別のものと見做されており、子宮内避妊システム（英: intrauterine system; IUS）と呼ばれている[6]。
ホルモンを用いない、非活性のIUDの大多数はプラスチック製でT字型をしており、純粋な銅の電解ワイヤが巻き付けられているか、銅製の「襟」もしくは「袖」が取り付けられている。一例として、パラガードの水平部分（T字の上の棒）は32mm、垂直部分は36mmである。Nova T 380のような一部のIUDでは線の破損を防ぐために純粋な銅線に銀の芯を入れている[7]。フレームの腕の部分が器具の子宮の底部近くの位置を保持する。GyneFixのように、T字型はなくさまざまな銅のチューブからなる輪となっているものもある。全ての銅付加IUDの名前には、銅を含む部分の表面積を平方ミリメートルで表した番号が付けられている。
有効性
第2世代の、銅タイプのT字型IUD全体での避妊失敗率は1年あたりで1%、10年通算では2-6%である[8]。世界保健機関が行った大規模調査では、T380Aの12年間通算での避妊失敗率は2.2%、1年あたりでは0.18%であり、これは10年間で1.8%の失敗率となる卵管結紮（英語版）に匹敵する[1]。フレームなしのタイプであるGyneFixの失敗率も1年あたり1%未満である[9]。世界的に、有効性の劣る旧式モデルのIUDはもはや市場では生産されていない[10]。
機序
子宮内に器具が存在することで、異物への反応の一部として子宮内膜からの白血球とプロスタグランジンの放出が促進される。これらの物質は精子と受精卵の双方にとって有害である。銅の存在は精子を殺す (Spermicide) 効果を高め、また着床を妨げることで効果的で信頼できる妊娠中絶薬ともなる[11][12]。
IUDには性行為感染症や骨盤内炎症性疾患の予防効果はない[13]。ホルモン剤を使用しない銅付加IUDは授乳の際にも安全であると考えられている。
IUDは精子と卵子を殺すことで機能するのであり、一部の医師や妊娠中絶反対のキリスト教グループらは受精後の機序がIUDの有効性に大きく寄与していると考えている[14][15]。受精を妊娠の開始と定義している団体もあり、妊娠中絶に反対する人々や団体の一部は受精後の機序のためにIUDを妊娠中絶薬と見做している。
禁忌
世界保健機関とその「避妊薬使用のための医療的適格性基準」および英国産婦人科医師会・家族計画とリプロダクティブヘルス部会はIUDの挿入が推奨されない条件（カテゴリ3）と忌避される条件（カテゴリ4）を定義した以下のリストを作成している[16][17]。
カテゴリ3
理論上、もしくは立証済のリスクがIUDによる恩恵よりも大きいと考えられる条件――
- 分娩後48時間から4週間。子宮から排出されてしまう可能性が高まるため。
- 良性妊娠性絨毛性疾患（英語版）
- 卵巣腫瘍
- 最近、性行為を介して淋病もしくはクラミジアに感染した可能性が高い人
- 後天性免疫不全症候群（抗レトロウイルス療法がよく確立されている場合を除く）
カテゴリ4
IUDの挿入に許容できないリスクが伴う条件――
- 妊娠中
- 分娩後の敗血症
- 感染流産の直後
- 重大な疾患が疑われる子宮出血（英語版）があるとき
- 悪性の妊娠性絨毛性疾患
- 子宮体癌
- 子宮筋腫もしくは解剖学的な異常のために子宮腔が歪んでいる場合
- 進行中の骨盤内炎症性疾患
- クラミジアもしくは淋病に感染し化膿性子宮頸管炎が進行している場合
- 骨盤結核
銅もしくはニッケルに過敏な女性の場合にはIUDの副作用が現れる懸念がある。IUDに使用される金属は99.99%が銅であるが、研究によれば最大で0.001%のニッケルが含まれる。ニッケルはアレルギー性が高いため、これほどの少量であっても問題を引き起こす可能性があると一部の研究者は示唆している。銅とニッケルを含むIUDを装着している患者のグループに、全身的吸収による湿疹（英語版）性皮膚炎や蕁麻疹が見られる場合があることをいくつかの研究が示している。しかしながら、IUDから1日に体内に吸収される金属の量は食事による摂取量よりも遥かに少ないため、多くの皮膚科医たちはこうした症例で記述されている症状が金属の過敏症であるかは疑わしいとしている[18] [19][20]。
出産を経験したことのない女性（未産婦）は副作用のリスクが高くなるが、このことはIUDの使用を忌避する理由とはならない。一部の医療専門家は挿入時に妊娠していないことを確認するために月経中にIUDを挿入することを好む。しかしながら、妊娠中もしくは受精の可能性がある時を除けばIUDは月経周期（英語版）のどの時点でも挿入可能である[21]。子宮頸部が自然に広がる月経中期に挿入を行えばより楽である[22]。
脚注
- ^ a b World Health Organization(世界保健機関) (1997). “=Long-term reversible contraception. Twelve years of experience with the TCu380A and TCu220C”. Contraception 6: 341-52. PMID 9494767.
- ^ Institut national d'études démographiques (INED): “What are the most widely used contraceptive methods across the world?”. Births / Birth control (2006年). 16-11-2006閲覧。
- ^ 世界保健機関 (2002). “The intrauterine device (IUD)-worth singing about”. Progress in Reproductive Health Research 60: 1–8. http://www.who.int/reproductive-health/hrp/progress/60/news60.html. （アーカイブ）
- ^ Historia de la anticoncepción, en Portal de la Sociedad Canaria de Medicina de Familia y Comunitaria, España
- ^ Treiman K, Liskin L, Kols A, Rinehart W (1995). “IUDs—an update”. Popul Rep B (6): 1–35. PMID 8724322. http://www.infoforhealth.org/pr/b6/b6.pdf.
- ^ French, R (2004). “Hormonally impregnated intrauterine systems (IUSs) versus other forms of reversible contraceptives as effective methods of preventing pregnancy”. Cochrane Database of Systematic Reviews (3). PMID 15266453.
- ^ Schering (2003年5月). “Nova T380 Patient information leaflet (PIL)”. 27-04-2007閲覧。
- ^ IUDs-An Update. Chapter 2.3: Effectiveness.
- ^ O'Brien, PA; Marfleet C (25 de enero de 2005). “Frameless versus classical intrauterine device for contraception”. Cochrane Database of Systematic Reviews (1). PMID.
- ^ IUDs—An Update. Chapter 1: Background.
- ^ “Mechanisms of the Contraceptive Action of Hormonal Methods and Intrauterine Devices (IUDs)”. Family Health International (2006年). 05-07-2006閲覧。
- ^ Keller, Sarah (Winter 1996, Vol. 16, No. 2). Family Health International: “IUDs Block Fertilization”. Network. 05-07-2006閲覧。
- ^ Farley TM, Rosenberg MJ, Rowe PJ, Chen JH, Meirik O (1992). “Intrauterine devices and pelvic inflammatory disease: an international perspective”. Lancet 339 (8796): 785–8. PMID 1347812.
Grimes DA (2000). “Intrauterine device and upper-genital-tract infection”. Lancet 356 (9234): 1013–9. PMID 11041414.
Mishell Jr., Daniel R. (2004). “Contraception”. In Elsevier Saunders. Yen and Jaffe's Reproductive Endocrinology (5th ed. ed.). Philadelphia. pp. 899–938. ISBN 0-7216-9546-9.
Grimes, David A. (2004). “Intrauterine Devices (IUDs)”. In Ardent Media. Contraceptive Technology (18th rev. ed. ed.). New York. pp. 495–530. ISBN 0-9664902-5-8.
Speroff, Leon; Darney, Philip D. (2005). “Intauterine Contraception: The IUD”. In Lippincott Williams & Wilkins. A Clinical Guide for Contraception (4th ed. ed.). Philadelphia. pp. 221–257. ISBN 0-7817-6488-2.
Hall, Janet E. (2005). “Infertility and Fertility Control”. In McGraw-Hill. Harrison's Principles of Internal Medicine (16th ed. ed.). New York. pp. 279-83. ISBN 0-07-139140-1.
Soper, David E.; Mead, Philip B. (2005). “Infections of the Female Pelvis”. In Elsevier Chuchill Livingston. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases (6th ed. ed.). Philadelphia. pp. 1372–81. ISBN 0-443-06643-4.
Glasier, Anna (2006). “Contraception”. In Elsevier Saunders. Endocrinology (5th ed. ed.). Philadelphia. pp. 2993–3003. ISBN 0-7216-0376-9. Stubblefield, Phillip G.; Carr-Ellis, Sacheen; Kapp, Nathalie (2007). “Family Planning”. In Lippincott Williams & Wilkins. Berek & Novak's Gynecology (14th ed. ed.). Philadelphia. pp. 247–311. ISBN 0-7817-6805-5.
- ^ Stanford J, Mikolajczyk R (2002). “Mechanisms of action of intrauterine devices: update and estimation of postfertilization effects”. Am J Obstet Gynecol 187 (6): 1699-708. PMID 12501086. , which cites: :Smart Y, Fraser I, Clancy R, Roberts T, Cripps A (1982). “Early pregnancy factor as a monitor for fertilization in women wearing intrauterine devices”. Fertil Steril 37 (2): 201-4. PMID 6174375.
- ^ Marquette University Press, ed. “Arguments against contraception--do they make sense to the general public? Importance of ethics, religion and "natural morality" in choice of family planning methods”. Milwaukee. ISBN 0874620112.
- ^ 世界保健機関 (2004). “Intrauterine devices (IUDs)”. In Reproductive Health and Research, WHO. Medical Eligibility Criteria for Contraceptive Use (3rd ed. ed.). Geneva. ISBN 92-4-156266-8.
- ^ Royal College of Obstetricians and Gynaecologists (2006年). “The UK Medical Eligibility Criteria for Contraceptive Use (2005/2006)”. unknown時点のオリジナルよりアーカイブ。11-01-2007閲覧。
- ^ Jouppila P, Niinimäki A, Mikkonen M (1979). “Copper allergy and copper IUD”. Contraception 19 (6): 631-7. PMID 487812.
- ^ Frentz G, Teilum D (1980). “Cutaneous eruptions and intrauterine contraceptive copper device”. Acta Derm Venereol 60 (1): 69-71. PMID 6153839.
- ^ Wohrl S, Hemmer W, Focke M, Gotz M, Jarisch R (2001). “Copper allergy revisited”. J Am Acad Dermatol 45 (6): 863-70. PMID 11712031.
- ^ IUDs-An Update. Chapter 3: Insertion.
- ^ “Understanding IUDs”. Planned Parenthood Federation of America (2005年7月). 22-07-2006閲覧。
関連項目
Copper IUD (Paragard T 380A)
An intrauterine device (IUD or coil)[1] is a small contraceptive device, often 'T'-shaped, often containing either copper or levonorgestrel, which is inserted into the uterus. They are one form of long-acting reversible contraception which are the most effective types of reversible birth control.[2] Failure rates with the copper IUD is about 0.8% while the levonorgestrel IUD has a failure rate of 0.2% in the first year of use.[3] Among types of birth control, they along with birth control implants result in the greatest satisfaction among users.[4] As of 2007, IUDs are the most widely used form of reversible contraception, with more than 180 million users worldwide.[5]
Evidence supports effectiveness and safety in adolescents[4] and those who have and have not previously had children.[6] IUDs do not affect breastfeeding and can be inserted immediately after delivery.[7] They may also be used immediately after an abortion.[8] Once removed, even after long term use, fertility returns to normal immediately.[9]
While copper IUDs may increase menstrual bleeding and result in more painful cramps[10] hormonal IUDs may reduce menstrual bleeding or stop menstruation altogether.[7] Cramping can be treated with NSAIDs.[11] Other potential complications include expulsion (2–5%) and rarely perforation of the uterus (less than 0.7%).[7][11] A previous model of the intrauterine device (the Dalkon shield) was associated with an increased risk of pelvic inflammatory disease, however the risk is not affected with current models in those without sexually transmitted infections around the time of insertion.[12]
Contents
- 1 Types
- 1.1 Copper
- 1.2 Hormonal
- 1.3 Inert
- 2 Adverse effects
- 3 Mechanism
- 4 History
- 5 Additional images
- 6 References
Types
The types of intrauterine devices available and the names they go by differ by location.
In the United States, there are two types available:[13]
- Nonhormonal copper IUD — ParaGard
- Hormonal IUD — Mirena or Skyla
The WHO ATC labels both copper and hormonal devices as IUDs. In the United Kingdom, there are over 10 different types of copper IUDs available. In the UK, the term IUD refers only to these copper devices. Hormonal intrauterine contraception is considered to be a different type of birth control and is labeled with the term intrauterine system (IUS).[14][15]
Copper
Main article: IUD with copper
A copper T shaped IUD with removal strings
An IUD as seen on pelvic X ray
Copper IUDs primarily work by disrupting sperm mobility and damaging sperm so that they are prevented from joining with an egg. Copper acts as a spermicide within the uterus, increasing levels of copper ions, prostaglandins, and white blood cells within the uterine and tubal fluids.[10][16] The increased copper ions in the cervical mucus inhibit the sperm's motility and viability, preventing sperm from traveling through the cervical mucus or destroying it as it passes through.[17] Copper IUDs have a first year failure rate ranging from 0.1 to 2.2%.[18]
Most copper IUDs have a plastic 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 (1.26") horizontally (top of the T), and 36 mm (1.42") vertically (leg of the T).
Copper IUDs are becoming increasingly popular because they are more resistant to corrosion. In the "Gold T IUD", which is made in Spain and Malaysia, there is a gold core, which further prevents the copper from fragmenting or corroding. GoldringMedusa is a differently-shaped German version of the Gold T.[19] Another form of AuCu IUD is called Goldlily which is made by the Hungarian company, Radelkis. Goldlily consists of a layer of copper wires wrapped around an original layer of gold wires, and it provides electrochemical protection in addition to ionic protection.[20]
Silver IUDs also exist. Radelkis also makes Silverlily, which is similar to Goldlily, and GoldringMedusa is available in an AgCu version as well. Nova-T 380 contains a strengthening silver core, but does not incorporate silver ions themselves to provide electrochemical protection.
[14][21] 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 beads. It is held in place by a suture (knot) to the fundus of the uterus. It is mainly available in China, Europe, and Germany, although some clinics in Canada can provide it. A framed copper IUD called the IUB SCu300A coils during deployment to form a three dimensional spherical shape and is based on a shape memory alloy core.[22]
Advantages of the copper IUD include its ability to provide emergency contraception up to five days after unprotected sex. It is the most effective form of emergency contraception available.[23] It contains no hormones, so it can be used while breastfeeding, and fertility returns quickly after removal.[24] Copper IUDs are also available in a wider range of sizes and shapes than hormonal IUDs. Disadvantages include the possibility of heavier menstrual periods and more painful cramps.[10]
In addition to copper, noble metal and progestogen IUDs, patients in China can get copper IUDs with indomethacin. This non-hormonal compound reduces the severity of menstrual bleeding, and these coils are popular.[25]
Hormonal
Main article: IUD with progestogen
Hormonal IUDs (brand names Mirena and Skyla in the US; referred to as intrauterine systems in the UK) work by releasing a small amount of levonorgestrel, a progestin. The primary mechanism of action is thickening of cervical mucus, making it impenetrable to sperm. They also inhibit ovulation in some users, decrease the ability of sperm to penetrate the ovum, and thin the endometrial lining.[26] Because they thin the endometrial lining, they reduce or even prevent menstrual bleeding, and can be used to treat menorrhagia (heavy menses), once pathologic causes of menorrhagia (such as uterine polyps) have been ruled out.[27]
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 only contraceptives.[28]
Mirena is approved for use up to five years in the US, though studies support its efficacy for up to seven years.[29] Skyla uses the same mechanism of action, but is smaller and releases a lower dose of levonorgestrel, and is only approved for up to three years.
Inert
Inert IUDs are IUDs with no bioactive components; they are made of inert materials like stainless steel (such as the stainless steel ring, or SSR, a flexible ring of steel coils that can deform to be pushed through the cervix) or plastic (such as the Lippes Loop, which can be inserted through the cervix in a cannula and takes a trapezoidal shape within the uterus). They are less effective than copper or hormonal IUDs, with a side effect profile similar to copper IUDs. Their primary mechanism of action is inducing a local foreign body reaction, which makes the uterine environment hostile both to sperm and to implantation of an embryo. [26] They may have higher rates of preventing pregnancy after fertilization, instead of before fertilization, compared to copper or hormonal IUDs.[26]
No inert IUDs are approved for use by the healthcare authorities in the USA, UK, or Canada. In China, where IUDs are the most common form of contraception, copper IUD production replaced inert IUD production in 1993.[30] However, as of 2008, the most common IUD used by immigrants presenting to Canadian clinics for removal of IUDs placed in China was still the SSR. As the SSR has no string for removal, it can present a challenge to healthcare providers unfamiliar with IUD types not available in their region.[31]
Adverse effects
Further information: IUD with progestogen and IUD with copper
Regardless of containing progestogen or copper, potential side effects of intrauterine devices include expulsion, uterus perforation, pelvic inflammatory disease (especially in the first 21 days after insertion), as well as irregular menstrual pattern. A small probability of pregnancy remains after IUD insertion, and when it occurs there's a greater risk of ectopic pregnancy.
Substantial pain that needs active management occurs in approximately 17% of nulliparous women and approximately 11% of parous women.[32] In such cases, NSAID are evidenced to be effective.[32] However, no prophylactic analgesic drug have been found to be effective for routine use for women undergoing IUD insertion.[32]
Also, IUDs with progestogen confer an increased risk of ovarian cysts[citation needed], and IUDs with copper confer an increased risk of heavier periods.
Menstrual Cup companies recommend that women with IUDs who are considering using menstrual cups should consult with their gynecologists before use. There have been rare cases in which women using IUDs dislodged them when removing their menstrual cups, however this can also happen with tampon use.[33]
Mechanism
IUDs primarily work by preventing fertilization.[34] The progestogen released from the hormonal IUDs may prevent ovulation from occurring but only partially.[35][36] The hormone also thickens the cervical mucus so that sperm cannot reach the fallopian tubes. The copper IUDs contain no hormones, but the copper ions in the cervical mucus are toxic to sperm. They also cause the uterus and fallopian tubes to produce a fluid that contains white blood cells, copper ions, enzymes, and prostaglandins, a combination that is also toxic to sperm.[35] The very high effectiveness of copper-releasing IUDs as emergency contraceptives implies they may also act by preventing implantation of the blastocyst.[37][38] In non-emergency use, prevention of implantation is at most an exceptional method of action, not a typical mechanism of action.[17]
History
The history of IUDs dates back to the interuterine devices of the early 1900s. Unlike IUDs, interuterine devices crossed both the vagina and the uterus, causing a high incidence of pelvic inflammatory disease in a time period when gonorrhea was endemic. The first IUD was developed by the German physician, Dr. Richter of Waldenburg. His device was made of silkworm gut and was not widely used.[39]
Dr. Ernst Gräfenberg, another German physician after whom the G-spot is named, created the first Ring IUD, Gräfenberg's ring, made of silver filaments. His work was suppressed during the Nazi regime, when contraception was considered a threat to Aryan women.[39] He moved to the United States, where his colleagues Dr. H. Hall and Dr. M. Stone took up his work after his death and created the stainless steel Hall-Stone Ring. A Japanese doctor named Tenrei Ota also developed a silver or gold IUD called the Precea or Pressure Ring.[39]
Dr. Jack Lippes helped begin the increase of IUD use in the United States in the late 1950s. In this time, thermoplastics, which can bend for insertion and retain their original shape, became the material used for first-generation IUDs. Lippes also devised the addition of the monofilament nylon string, which facilitates IUD removal. His trapezoid shape Lippes Loop IUD became one of the most popular first generation IUDs. In the following years, many different shaped plastic IUDs were invented and marketed.[39] 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 market, it had a lasting, negative impact on IUD use in the United States.[40]
The invention of the copper IUD in the 1960s brought with it the capital 'T' shaped design used by most modern IUDs. US physician, Dr. Howard Tatum determined that the 'T' shape would work better with the shape of the uterus, which forms a 'T' when contracted. He predicted this would reduce rates of IUD expulsion.[39] Together, Tatum and Chilean physician Jaime Zipper discovered that copper could be an effective spermicide and developed the first copper IUD, TCu200. Improvements by Dr. Tatum led to the creation of the TCu380A (ParaGard), which is currently the preferred copper IUD.[39]
The hormonal IUD was also invented in the 1960s and 1970s; initially the goal was to mitigate the increased menstrual bleeding associated with copper and inert IUDs. The first model, Progestasert, was conceived of by Dr. Antonio Scommengna and created by Dr. Tapani J.V. Luukkainen, but the device only lasted for one year of use.[40] Progestasert was manufactured until 2001.[41] One commercial hormonal IUD which is currently available, Mirena, was also developed by Dr. Luukkainen and released in 1976.[39] 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.[42]
Additional images
-
Illustration of intrauterine device (IUD)
References
- ^ "IUD (intrauterine device)". Contraception guide. NHS Choices. Retrieved 2 March 2014. "the intrauterine device, or IUD (sometimes called a coil)"
- ^ Winner, B; Peipert, JF; Zhao, Q; Buckel, C; Madden, T; Allsworth, JE; Secura, GM. (2012). "Effectiveness of Long-Acting Reversible Contraception". New England Journal of Medicine 366 (21): 1998–2007. doi:10.1056/NEJMoa1110855. PMID 22621627.
- ^ Hurt, K. Joseph, et al. (eds.); Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland (2012-03-28). The Johns Hopkins manual of gynecology and obstetrics. (4th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. p. 232. ISBN 978-1-60547-433-5.
- ^ a b Committee on Adolescent Health Care Long-Acting Reversible Contraception Working Group, The American College of Obstetricians and, Gynecologists (October 2012). "Committee opinion no. 539: adolescents and long-acting reversible contraception: implants and intrauterine devices.". Obstetrics and gynecology 120 (4): 983–8. doi:10.1097/AOG.0b013e3182723b7d. PMID 22996129.
- ^ Darney, Leon Speroff, Philip D. (2010). A clinical guide for contraception (5th ed. ed.). Philadelphia, Pa.: Lippincott Williams & Wilkins. pp. 242–243. ISBN 9781608316106.
- ^ Black, K; Lotke, P; Buhling, KJ; Zite, NB; Intrauterine contraception for Nulliparous women: Translating Research into Action (INTRA), group (October 2012). "A review of barriers and myths preventing the more widespread use of intrauterine contraception in nulliparous women.". The European journal of contraception & reproductive health care : the official journal of the European Society of Contraception 17 (5): 340–50. doi:10.3109/13625187.2012.700744. PMID 22834648.
- ^ a b c Gabbe, Steven (2012). Obstetrics: Normal and Problem Pregnancies. Elsevier Health Sciences. p. 527. ISBN 9781455733958.
- ^ Steenland, MW; Tepper, NK; Curtis, KM; Kapp, N (November 2011). "Intrauterine contraceptive insertion postabortion: a systematic review.". Contraception 84 (5): 447–64. doi:10.1016/j.contraception.2011.03.007. PMID 22018119.
- ^ Hurd, [edited by] Tommaso Falcone, William W. (2007). Clinical reproductive medicine and surgery. Philadelphia: Mosby. p. 409. ISBN 9780323033091.
- ^ a b c Grimes, D.A., MD (2007). ""Intrauterine Devices (IUDs)" In:Hatcher, RA; Nelson, TJ; Guest, F; Kowal, D". Contraceptive Technology 19th ed. (New York: Ardent Media).
- ^ a b Marnach, ML; Long, ME; Casey, PM (March 2013). "Current issues in contraception.". Mayo Clinic proceedings. Mayo Clinic 88 (3): 295–9. doi:10.1016/j.mayocp.2013.01.007. PMID 23489454.
- ^ "Popularity Disparity: Attitudes About the IUD in Europe and the United States". Published by Policy Review Published Fall 2007. Retrieved 2010-04-27.
- ^ Treiman K, Liskin L, Kols A, Rinehart W (1995), "IUDs – an update" (PDF), Popul Rep B (6): 1–35, PMID 8724322, retrieved 2006-01-01
- ^ a b "Contraceptive coils (IUDs)". NetDoctor.co.uk. 2006. Retrieved 2006-07-05.
- ^ French R, Van Vliet H, Cowan F, et al. (2004). "Hormonally impregnated intrauterine systems (IUSs) versus other forms of reversible contraceptives as effective methods of preventing pregnancy". In Sorhaindo, Annik M. Cochrane Database of Systematic Reviews (3): CD001776. doi:10.1002/14651858.CD001776.pub2. PMID 15266453.
- ^ "Mechanisms of the Contraceptive Action of Hormonal Methods and Intrauterine Devices (IUDs)". Family Health International. 2006. Retrieved 2006-07-05.
- ^ a b Oritz ME, Croxatto HB (2007). "Copper-T intrauterine device and levonorgestrel intrauterine system: biological bases of their mechanism of action". Contraception 75 (6 Suppl): S16–S30. doi:10.1016/j.contraception.2007.01.020. PMID 17531610.
- ^ Kulier R, O'Brien PA, Helmerhorst FM, Usher-Patel M, D'Arcangues C (2007), "Copper containing, framed intra-uterine devices for contraception", Cochrane Database Syst Rev (4): CD005347, doi:10.102/14651858.CD005347, PMID 17943851
- ^ http://www.viomed.de/de/medusa
- ^ http://www.radelkis.hu/en/orvos/huv/frames.html
- ^ Schering (May 13, 2003). "Nova T380 Patient information leaflet (PIL)". Retrieved 2007-04-27.
- ^ Baram I, Weinstein A, Trussell J (February 2014), "The IUB, a newly invented IUD: a brief report", Contraception 89 (2): 139–141, doi:10.1016/j.contraception.2013.10.017, PMID 24309220
- ^ Cleland K, Zhu H, Goldstuck N, Cheng L, Trussell J (July 2012), "The efficacy of intrauterine devices for emergency contraception: a systematic review of 35 years of experience", Hum. Reprod. 27 (7): 1994–2000, doi:10.1093/humrep/des140, PMID 22570193
- ^ Belhadj H, Sivin I, Diaz S, et al. (September 1986), "Recovery of fertility after use of the levonorgestrel 20 mcg/d or Copper T 380 Ag intrauterine device", Contraception 34 (3): 261–7, doi:10.1016/0010-7824(86)90007-7, PMID 3098498
- ^ Li Y, Zhang SM, Chen F, et al. (December 2011). "[A multi-center randomized controlled trial of intrauterine device use in Chinese women]". Zhonghua Yi Xue Za Zhi (in Chinese) 91 (45): 3172–5. PMID 22333096.
- ^ a b c Ortiz, ME; Croxatto HB (June 2007). "Copper-T intrauterine device and levonorgestrel intrauterine system: biological bases of their mechanism of action.". Contraception 75 (6): S16–30. doi:10.1016/j.contraception.2007.01.020. PMID 17531610.
- ^ Luis Bahamondes, M Valeria Bahamondes, Ilza Monteiro. (2008), "Levonorgestrel-releasing intrauterine system: uses and controversies.", Expert Review of Medical Devices 4: 437, doi:10.1586/17434440.5.4.437
- ^ Malik S (January 2013). "Levonorgestrel-IUS system and endometrial manipulation". J Midlife Health 4 (1): 6–7. doi:10.4103/0976-7800.109625. PMC 3702070. PMID 23833526.
- ^ Sivin I, Stern J, Coutinho E, et al. (November 1991). "Prolonged intrauterine contraception: a seven-year randomized study of the levonorgestrel 20 mcg/day (LNg 20) and the Copper T380 Ag IUDS". Contraception 44 (5): 473–80. doi:10.1016/0010-7824(91)90149-a. PMID 1797462.
- ^ Bilian X (June 2007). "Chinese experience with intrauterine devices". Contraception 75 (6 Suppl): S31–4. doi:10.1016/j.contraception.2006.12.007. PMID 17531613.
- ^ Cheung VY (June 2010). "A 10-year experience in removing Chinese intrauterine devices". Int J Gynaecol Obstet 109 (3): 219–22. doi:10.1016/j.ijgo.2009.12.018. PMID 20219193.
- ^ a b c Gemzell-Danielsson, K.; Mansour, D.; Fiala, C.; Kaunitz, A. M.; Bahamondes, L. (2013). "Management of pain associated with the insertion of intrauterine contraceptives". Human Reproduction Update 19 (4): 419. doi:10.1093/humupd/dmt022. edit
- ^ "Menstrual Cup use and IUDs". Feminine Wear. Retrieved 22 December 2013.
- ^ al.], [edited by] Steven G. Gabbe ... [et. Obstetrics : normal and problem pregnancies (6th ed. ed.). Philadelphia: Elsevier/Saunders. p. 528. ISBN 9781437719352.
- ^ a b http://center4research.org/medical-care-for-adults/birth-control/understanding-the-iud/
- ^ http://www.mayoclinic.org/tests-procedures/mirena/basics/definition/prc-20012867
- ^ Trussell, James; Schwarz, Eleanor Bimla (2011). "Emergency contraception". In Hatcher, Robert A.; Trussell, James; Nelson, Anita L.; Cates, Willard Jr.; Kowal, Deborah; Policar, Michael S. Contraceptive technology (20th revised ed.). New York: Ardent Media. pp. 113–145. ISBN 978-1-59708-004-0. 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 following 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 after fertilization.
Emergency contraceptive pills
To make an informed choice, women must know that ECPs—like the birth control pill, patch, ring, shot, and implant,76and even like breastfeeding77—prevent pregnancy primarily by delaying or inhibiting ovulation and inhibiting fertilization, but may at times inhibit implantation of a fertilized egg in the endometrium. However, women should also be informed that the best available evidence indicates that ECPs prevent pregnancy by mechanisms that do not involve interference with post-fertilization events.
ECPs do not cause abortion78 or harm an established pregnancy. Pregnancy begins with implantation according to medical authorities such as the US FDA, the National Institutes of Health79 and the American College of Obstetricians and Gynecologists (ACOG).80
Ulipristal acetate (UPA). One study has demonstrated that UP can delay ovulation.81... Another study found that UPA altered the endometrium, but whether this change would inhibit implantation is unknown.82
p. 122:
Progestin-only emergency contraceptive pills. Early 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 have shown that combined ECPs containing ethinyl estradiol and levonorgestrel can inhibit or delay ovulation.107–110
- ^ RCOG Faculty of Sexual & Reproductive Healthcare, Clinical Effectiveness Unit (January 2012). Clinical guidance: emergency contraception. London: Royal College of Obstetricians and Gynaecologists. ISSN 1755-103X. Retrieved 2012-04-30. 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 acceptable, 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 after insertion and works primarily by inhibiting fertilisation.9–11 A systematic review on mechanisms of action of IUDs showed that both pre- and postfertilisation effects contribute to efficacy.11If fertilisation has already occurred, it is accepted that there is an anti-implantation effect,12,13
Levonorgestrel (LNG). The precise mode of action of levonorgestrel (LNG) is incompletely understood but it is thought to work primarily by inhibition of ovulation.16,17
Ulipristal acetate (UPA). UPA’s primary mechanism of action is thought to be inhibition or delay of ovulation.2
- ^ a b c d e f g Thiery, Michel (March 1997). "Pioneers of the intrauterine device". European Journal of Contraception and Reproductive Health Care 2 (1): 15–23. doi:10.1080/13625189709049930. PMID 9678105. Archived from the original on August 13, 2006.
- ^ a b Thiery M (June 2000), "Intrauterine contraception: from silver ring to intrauterine contraceptive implant", Eur. J. Obstet. Gynecol. Reprod. Biol. 90 (2): 145–52, doi:10.1016/s0301-2115(00)00262-1, PMID 10825633
- ^ Smith (pseudonym), Sydney (March 8, 2003). "Contraceptive Concerns". medpundit: Commentary on medical news by a practicing physician. Retrieved 2006-07-16.
- ^ http://newsandinsight.thomsonreuters.com/Legal/News/2013/05_-_May/Judge_calls_for_female_lawyers_on_plaintiffs__committee_in_Mirena_MDL/
|
Birth control methods (G02B, G03A)
|
|
| Comparison |
- Comparison of birth control methods
- Long-acting reversible contraception
|
|
| Behavioral |
- Avoiding vaginal intercourse: Abstinence
- Anal sex
- Masturbation
- Non-penetrative sex
- Oral sex
Including vaginal intercourse: Breastfeeding infertility (LAM)
- Calendar-based methods (rhythm, etc.)
- Fertility awareness (Billings ovulation method
- Creighton Model, etc.)
- Withdrawal
|
|
Barrier and / or
spermicidal |
- Cervical cap
- Condom
- Contraceptive sponge
- Diaphragm
- Female condom
- Spermicide
|
|
Hormonal
(formulations) |
|
Combined
|
- Contraceptive patch
- Extended cycle
- Injectable
- NuvaRing
- Oral / 'the pill'
|
|
|
Progestogen-only
|
- LARC (Depo-Provera
- Implanon/Nexplanon
- Norplant/Jadelle)
- Progestogen-only pill / 'minipill'
|
|
|
| Anti-estrogen |
- Ormeloxifene (Centchroman)
|
|
| Post-intercourse |
- Emergency contraception (pills or copper IUD) (Ulipristal acetate
- Yuzpe regimen)
|
|
| Intrauterine device |
- IUD with copper
- IUD with progestogen (Mirena)
|
|
| Abortion |
- Medical (RU-486/abortion pill)
- Surgical
|
|
| Sterilization |
- Female: Essure
- Tubal ligation
Male: Vasectomy
|
|
| Experimental |
- Reversible inhibition of sperm under guidance (Vasalgel)
|
|
|
|
|
noco/cong/npls, sysi/epon
|
proc/asst, drug (G1/G2B/G3CD)
|
|
|
|
|
Hormonal contraceptives (G02B, G03A)
|
|
| Androgen |
- Male-only: Testosterone undecanoate
- Trestolone
|
|
| Estrogen |
- Diethylstilbestrol
- Estradiol
- Estradiol benzoate
- Estradiol cypionate
- Estradiol enanthate
- Estradiol valerate
- Ethinyl estradiol
- Mestranol
- Ormeloxifene
|
|
| Progestogen |
- 1st gen.: Estranes: Ethisterone
- Etynodiol diacetate
- Lynestrenol
- Norethindrone/Norethisterone
- Norethisterone acetate
- Norethisterone enanthate
- Norethynodrel
- Quingestanol
- 2nd gen.: Estranes: Norethisterone enanthate
- Norgestrienone; Gonanes: Levonorgestrel
- Norelgestromin
- Norgestrel
- 3rd gen.: Gonanes: Desogestrel
- Etonogestrel
- Gestodene
- Norgestimate
- 4th gen.: Estranes: Dienogest; Norpregnanes: Demegestone
- Nomegestrol acetate
- Promegestone
- Trimegestone; Spironolactone derivatives: Drospirenone
- Others: Pregnanes: Chlormadinone acetate
- Cyproterone acetate
- Medrogestone
- Medroxyprogesterone acetate
- Megestrol acetate; Miscellaneous: Mifepristone
- Ulipristal acetate; Ungrouped: Algestone acetophenide
- Dydrogesterone
- Gestrinone
- Progesterone
- Proligestone
|
|
|
Routes of administration / Dosage forms
|
|
| Oral |
|
Digestive tract (enteral)
|
|
Solids
|
- Pill
- Tablet
- Capsule
- Time release technology
- Osmotic delivery system (OROS)
|
|
|
Liquids
|
- Decoction
- Elixir
- Electuary
- Emulsion
- Extended-release syrup
- Effervescent powder or tablet
- Herbal tea
- Hydrogel
- Molecular encapsulation
- Powder
- Softgel
- Solution
- Suspension
- Syrup
- Syrup Concentrate for dilution and/or addition of carbonated water
- Tincture
|
|
|
|
Buccal (Sublabial) Sublingual
|
|
Solids
|
- Orally disintegrating tablet (ODT)
- Film
- Lollipop
- Sublingual drops
- Lozenges
- Effervescent buccal tablet
- Chewing gum
|
|
|
Liquids
|
- Mouthwash
- Toothpaste
- Ointment
- Oral spray
|
|
|
|
Respiratory
tract
|
|
Solids
|
- Smoking device
- Dry powder inhaler (DPI)
|
|
|
Liquids
|
- Anaesthetic vaporizer
- Vaporizer
- Nebulizer
- metered-dose inhaler (MDI)
|
|
|
Gas
|
- Oxygen mask and Nasal cannula
- Oxygen concentrator
- Anaesthetic machine
- Relative analgesia machine
|
|
|
|
|
Ophthalmic /
Otologic / Nasal |
- Nasal spray
- Ear drops
- Eye drops
- Ointment
- Hydrogel
- Nanosphere suspension
- Insufflation
- Mucoadhesive microdisc (microsphere tablet)
|
|
| Urogenital |
- Ointment
- Pessary (vaginal suppository)
- Vaginal ring
- Vaginal douche
- Intrauterine device (IUD)
- Extra-amniotic infusion
- Intravesical infusion
|
|
| Rectal (enteral) |
- Ointment
- Suppository
- Enema
- Murphy drip
- Nutrient enema
|
|
| Dermal |
- Ointment
- Topical cream
- Topical gel
- Liniment
- Paste
- Film
- DMSO drug solution
- Electrophoretic dermal delivery system
- Hydrogel
- Liposomes
- Transfersome vesicles
- Cream
- Lotion
- Lip balm
- Medicated shampoo
- Dermal patch
- Transdermal patch
- Contact (rubbed into break in the skin)
- Transdermal spray
- Jet injector
|
|
Injection / Infusion
(into tissue/blood) |
|
Skin
|
- Intradermal
- Subcutaneous
- Transdermal implant
|
|
|
Organs
|
- Intracavernous
- Intravitreal
- Intra-articular injection
- Transscleral
|
|
|
Central nervous system
|
- Intracerebral
- Intrathecal
- Epidural
|
|
|
Circulatory / Musculoskeletal
|
- Intravenous
- Intracardiac
- Intramuscular
- Intraosseous
- Intraperitoneal
- Nanocell injection
- Patient-Controlled Analgesia pump
- PIC line
|
|
|
|
Routes of administration by organ system
|
|
| Gastrointestinal |
- Oral
- Buccal
- Sublabial
- Sublingual
- Rectal
|
|
| Respiratory system |
|
|
Visual system /
Auditory system |
- Ocular (Ocular-topical / Intravitreal / Transscleral)
- Otologic (Oto-topical)
|
|
| Reproductive system |
- Intracavernous
- Intravaginal
- Intrauterine (Extra-amniotic)
|
|
| Urinary system |
|
|
| Peritoneum |
|
|
| Central nervous system |
- Intracerebral
- Intrathecal
- Epidural
|
|
| Circulatory system |
|
|
| Musculoskeletal system |
- Intramuscular
- Intraosseous
|
|
| Skin |
- Epicutaneous
- Intradermal
- Subcutaneous
|
|
