Implantable contraceptives: IUD spiral and sticks

HORMAL IUD SPIRAL (Mirena)

• It is a small device of various shapes (generally similar to a T), which is implanted in a woman's uterus by a gynecologist
• Typically, the IUD spiral is inserted into the uterus during menstruation, and left there for a few years.
• The hormones (progestins) are contained in a sort of semipermeable membrane, and released gradually inside the uterine cavity to prevent the fertilization of the egg

• The contraceptive action of the implantable contraceptive is guaranteed for 3/5 years, after which the spiral is removed and eventually replaced with a new one.
• Significantly reduces menstrual flow, avoiding heavy menstruation, menorrhagia, dysmenorrhea
• The gradual release of the progestin reduces the risk of endometrial / uterine polyps
• Reduces the risk of local hyperplasia

• It does not protect against sexually transmitted diseases
• During the menstrual cycle, the spiral could shift
• Breast swelling, acne, migraine
• Recommended for women who have given birth to at least one child (to be sure of their fertility)
• the bacteria could nest more easily near the spiral and generate rather unpleasant disturbances
• Vaginal dryness and hot flashes
• Not recommended in the case of vulvodynia and other inflammations
• Need to undergo yearly gynecological checks

• High: 98-99.9%
• The contraceptive efficacy of the hormonal spiral could be compromised by the concomitant use of some drugs (eg anticonvulsants, antibiotics)

Copper IUD spiral

• Small plastic T-shaped device surrounded by a thin copper spiral wire.
• The contraceptive method is implanted in the woman's uterus by a gynecologist during menstruation and released there for 3-5 years
• The copper spiral protects from unwanted pregnancies by exerting an excellent spermicidal action, preventing the fertilization of the egg and hindering sperm motility and survival.

• The application of the spiral within the following 5 days from a potentially risky relationship (emergency contraception), guarantees 99% of the contraceptive effect
• It interferes with sperm motility
• Reversibility of the contraceptive method: after the removal of the IUD spiral from the uterus, total restoration of fertility is guaranteed
• The implantable contraceptive can be removed at any time
• Reduced risk of ectopic pregnancies (after IUD removal)

• It does not protect against sexually transmitted diseases
• During the menstrual cycle, the spiral could shift
• The menstrual flow of the users of this implantable method remains unchanged (it does not decrease, unlike the hormonal IUDs). Sometimes, the menstrual cycle may be more abundant than normal.
• The copper spiral can create spotting in the first few months of use
• It should not be implanted in the uterus in case of salpingitis, metritis, cervicitis, PID and endometritis
• Possible increase in menstrual pain
• Need to undergo one or two gynecological checks every year
• It is not indicated for women who have just given birth: in this case, the contraceptive method is more likely to be expelled
• Not indicated for nulliparas
• Can create allergic reactions to copper. Contraindicated for women who are also allergic to nickel
• Do not take in case of severe anemia

• High: 98-99.9%
• The inclusion of the IUD within 5 days of a risk report is able to avoid the onset of 99% of pregnancies

Implantable sticks (subcutaneous)

• It is a contraceptive method still little known in Italy. It consists of the implantation of a stick (Implanon), 4 cm long and 0.2 cm wide, capable of releasing progestogen hormones (etonogestrel). The device is inserted under the skin, in the upper internal part of the non-dominant arm, at a height of 6-8 cm from the elbow.
• The stick should be implanted in the period between the first and fifth day of a woman's natural menstrual cycle
• The progestogen, by changing the thickness of the cervical mucus, denies the spermatozoa the possibility of reaching and fertilizing the egg. By doing so, it is possible to prevent pregnancy.
• This implantable contraceptive method exerts its therapeutic action mainly by inhibiting ovulation.

• The implantation of an under-contraceptive stick is indicated to prevent pregnancy
• Method reversibility: fertility is guaranteed as soon as the stick is taken from the skin
• Does not require regularity of intake (limit of the contraceptive pill)
• The implantable contraceptive method guarantees excellent coverage against unwanted pregnancies for 3-5 years
• Suitable for women between 18 and 40 years old
• Minor menstrual pain compared to women who do not use any contraceptive method
• The implantable contraceptive stick can be removed at any time. The removal of the device must be performed by an experienced gynecologist.

• It does not provide any protection against sexually transmitted diseases
• Possible formation of hematoma immediately after implantation of the contraceptive stick in the arm
• Implantation of a hormonal stick can cause abnormal uterine bleeding (ie spotting / hypermenorrhea) or amenorrhea.
• May cause chloasma, acne, mood alteration, dizziness and decreased libido
• Possible weight gain (estimated around 2Kg in 5 years)
• It is not indicated for diabetic women because a contraceptive formulated exclusively with progestins can influence peripheral insulin resistance and glucose tolerance
• Not indicated in case of venous thromboembolic disorders, liver diseases or hypersensitivity to one or more stick components
• Possible increase in the risk of ectopic pregnancies
• If the implant is not performed correctly, the contraceptive stick can be expelled

• Excellent protection against unwanted pregnancies (over 99.9%)
• The risk of failure of the implantable contraceptive method may be higher in obese or overweight women