Intrauterine device

Overview: 

Paragard is a contraceptive device placed in the uterus to prevent pregnancy. It provides long-term contraception for almost up to 10 years. It is also called the nonhormonal intrauterine device (IUD). It is a T-shaped plastic device that is placed in the uterus for birth control. 

About ParaGard:

IUDs are of two types. They are hormonal and copper IUDs. Hormonal IUDs use progestin hormones for contraception whereas copper IUDs do not contain hormones and hence use copper for contraception. 

Copper IUDs are made of plastic T wrapped in a copper coil. As the sperm cannot withstand copper and cannot go beyond the copper frame, it prevents fertilization with the egg thus preventing pregnancy. Copper also alters the uterine environment making it difficult for the sperm to reach the egg. It alters the lining of the uterus and thickens the cervical mucosa thus making it difficult for the sperm to reach the egg for fertilization. 

Indications: 

ParaGard can be used for long-term birth control. This is indicated when one wants to have uninterrupted sex for a long duration. This can be used when an individual does not want to have a daily or weekly routine of using contraception during sex. This can be used when an individual plans the pregnancy later and does not plan the pregnancy immediately. 

Contraindications: 

ParaGard is not indicated in certain conditions. It is not indicated when there are uterine disorders like fibroids, or growths as they interfere with the placement of the device. It is not indicated in pelvic inflammatory diseases. It is not indicated in cancers of the uterus or cervix or any unknown bleeding from the vagina. It is also contraindicated in allergies to ParaGard or copper. It is also not indicated in disorders of copper metabolism. 

Advantages:

ParaGard has many advantages. 

• It eliminates the interruption in the pleasure of intercourse. 
• It can be in place for a long duration of almost 10 years. 
• It can be removed at any time when one wants to get pregnant. 
• It can be used while breastfeeding. 
• It has the advantage of being a non-hormonal way of contraception. 
• It can be successfully used for emergency contraception. In case of unprotected sex, if the ParaGard is inserted within 5 days it can reduce the chance of pregnancy. 
• It does not carry the risk of side effects like the hormonal birth control methods. 
• It has the advantage of non-surgical placement which can be done immediately

Before the procedure: 

Before using the Paragard inform the healthcare provider (HCP) of all the medical conditions, medications, allergies, and surgeries. Based on the health condition the health care provider may prescribe the copper T or may advise other birth control methods. HCP will evaluate the overall health through some tests and a pelvic examination will also be done to rule out any abnormalities. A pregnancy test will also be done before inserting ParaGard. Screening for cancers or sexually transmitted infections will also be done. 

During the procedure: 

Before inserting a Paragard, a special device called a speculum is inserted into the vagina to open the vagina and increase the visibility. The vagina and cervix are thoroughly cleaned with an antiseptic solution. Using an instrument the cervical canal and uterine cavity will be aligned. 

Folding the horizontal arms of the Paragard it is placed in a tube. This tube is now inserted into the cervical canal, carefully placed in the uterus, and slowly retracted leaving the ParaGrad in position. The strings of the ParaGard are slightly trimmed so that they do not extend too long into the vagina. The length of the strings is measured to check for placement. 

After the procedure: 

One may experience dizziness, low blood pressure, nausea, fainting, and decreased heartbeat after the placement of ParaGard. Hence, it is advisable to lie down for some time. A month after the placement of Paragard, a follow-up checkup is done to confirm the position and to cross-check for the development of infections. Instructions are given regarding the ParaGard which include: 

• Checking for pregnancy
• Unusual bleeding
• Smelly discharge from the vagina
• Severe pelvic pain, abdominal pain or tenderness
• Sudden fever 
• Development of sexually transmitted infections

One has to Check the ParaGard position every month by feeling the threads. By placing the fingers in the vagina the threads or arms of the ParaGard must be felt. If the threads are not in position one has to visit the HCP immediately and use a backup birth control. 

Removal of ParaGard: 

Paragard is removed from the doctor’s office. Using forceps, the string’s arms are grasped and gently pulled. It is removed from the uterus with its arms up folding. Mild cramping and bleeding can occur during the removal. 

Effectiveness of ParaGard:

ParaGard is 99% effective if it is placed correctly. It can provide birth control for as long as 10 years. 

Side effects, Risks, and complications: 

One of the risks associated with the ParaGard placement is getting pregnant. About <1% chance of getting pregnant is associated with ParaGard placement but with long-term use, it decreases. The chance of ectopic pregnancy is high when one gets pregnant while using ParaGard. 

Side effects associated with ParaGard are severe cramps and bleeding in between periods associated with severe menstrual pain and bleeding. Sometimes ParaGard can get expelled from the body if one has heavy and prolonged periods, severe menstrual pain, young age, and had the IUD inserted immediately after giving birth. 

One of the complications associated with ParaGard is the possibility of perforation of the intrauterine wall during the placement of the IUD. ParaGard does not offer protection from sexually transmitted infections or transmission of HIV. 

Conclusion: 

ParaGard is a non-hormonal birth control device that prevents unwanted pregnancy. It is safe to use as it does not alter the body's hormones. It can be used for a long duration of almost 10 years and hence is called the “set it and forget it” type of birth control. It is a highly convenient and reliable intrauterine contraceptive. 

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