1. What is contraception?
  2. Intrauterine device (IUD), also known as coil, what do we need to know?
  3. Subcutaneous implant, is this the new frontier for contraception?

What is contraception?

Contraception is defined as the method that impedes conception; different options and medical devices can be used for this scope. Such methods can be classified as reversible methods, like hormonal and barrier ones, or as permanent methods. Hormonal methods include oral contraceptive pills, transdermal patches, vaginal rings, intrauterine devices, emergency contraception, injectable contraception and implantable contraception.

Intrauterine device (IUD), also known as coil, what do we need to know?

The majority of women are potential candidates for IUD therapy because this type of contraception has very little contraindications.

Different types of IUD are available on the market:

  • The hormonal coil releases doses of progestin in the uterus making the cervical mucosa difficult to penetrate, creating a hostile environment for semen; the uterus’s coating becomes less thick making the implantation of the fertilised egg difficult. It is made of a polyethylene structure containing levonorgestrel, it releases 20 mg per day and its maximum usage duration is 5 years. Levonorgestrel-releasing IUDs can be used for the treatment of endometrial hyperplasia, dysmenorrhea, menorrhagia and irregular bleeding. In 2013, a new progestin-releasing IUD with a slightly smaller diameter has been approved and its use is guaranteed for a maximum of 3 years.
  • The copper coil acts in a similar way and impedes to the sperm to arrive to the uterus and to fertilise the egg. In addition, the copper filament that envelops the device acts as a spermicidal as the copper ions decrease the semen’s motility and functionality. It is essentially a T-shaped plastic device surrounded by 380 mm of copper. Its use is approved for a maximum of 10 years. The copper IUD has the advantage that it can be used for those patients in which hormonal therapy is not possible (i.e. active breast cancer) and has a failure rate of less than 1%, with the most common side effects of bleeding and irregular pain.

Subcutaneous implant, is this the new frontier for contraception?

Subcutaneous contraceptive implants have become very popular during the years. They are safe and effective in preventing pregnancy and provide a prolonged and slow release of steroid progestin that is translated in an absence of ovulation, in the thinning of the uterine endometrium and in a thickening of cervical mucus creating a barrier that impedes semen penetration. Such implants are inserted under the derma under local anaesthesia, usually in the internal region of the non-dominant arm. They are constituted by a flexible plastic stick that is 4 cm long and 2 mm thick, which is not biodegradable and hypoallergenic. If the patient hasn’t taken any type of oral contraceptive, the implant must be inserted during the first 5 days of the period. If instead the patient was taking the contraceptive pill or any other contraceptive, the implant should be inserted soon after having ended the intake of the previous contraceptive. Its maximum duration is of 3 years. This method is effective in more than 99% of cases for a period of 3 years, thus being even more reliable than oral contraceptives.

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