WOMEN GYNACOLOGY-PART-X-INTRA UTERINE DEVICES

OTHER METHODS OF BIRTH CONTROL

INTRA UTERINE DEVICE or IUD is a fashioned historical method to prevent pregnancy by inserting a device into the vigina and make to to stay there to produce longer effects of contraception.

Historically it was rumored that some Arab pagans inorder to prevent the births of several calfs as a burden to their female camels they inserted small stones into their uteruses through their vagina to prevent conception.

This historical basics has been used to develop devices with higher technology.

There are two types of IUDs,the hormonal and non hormonal.The hormonal IUDs contains usually a progestin such as a slow release levonorgestrel.The other nonhormal IUDs contains a copper spring.Both the IUDs are yielding a reversible contraception.The effects of copper IUDs are longer than the hormonal IUDs.The hormonal IUDs like Mirena is found to be effective upto 5 years while as the copper IUDs can give the effects upto 7 years.

The insertion should be done by an experienced physician.

 As seen in the above figure the IUD should be correctly positioned by the help of a speculum a medical device used for inserting a device through any small opening or orifice like vagina.

Before insertion the pelvic portion should be thoroughly examined for any inflammation,injury or infection like chlamydia and gonorrhea.The position and shape of the uterus should be confirmed through the pelvic exam.

During the insertion the vagina is held open by a speculum.The cervix should be grasped by a grasping instrument.The leangth of the uterus must be measured for proper insertion.Now the IUD must be carefully inserted through the cervix by using a narrow tube into the uterus.A short narrow monofilament plastic/nylon string attached to the device should be come and hang out through the vagina for the convenience of the patient to check the IUD position later on at times.

 The above video gives an explanation of the inserting methods.

Mechanisms of Actions

1.Make uterus hostile to the fertilized ovum

2.The endometrium becomes thin and not hospitable to the ovum

3.The cervix become thick and sperm cannot penetrate it.

4.Unimportantly sometimes ovulation is retarded

Advantages:-

1.Longer effects

2.No need to take any systamic medications like pills and injections

3.Most of the released hormone from the hormonal IUDs are absorbed and stay within the uterus by leaving a negligible minute quantity into the system.

4.Reversible contraception

5.Inexpensive as they are made out of plastics.

6.The copper IUDs are totally harmless during breast feeding.But there are no known guarentee for hormonal IUDs.

7.No prior care or preparations needed before sex,but the patient has to check the string at times to ensure the device is staying in proper place.

Disadvantages:-

1.Risks of ectopic pregnancy,the pregnancy happened outside the uterus usually at the tube.

2.Irregular heavier periods and spotting

3.Menstrual cramping and back pain. 

4.Painful intercourse experienced by some women.

5.Rare but serious perforation of uterus.

6.Pelvic pain and inflammation leads to serious infections.

Conraindications:-

1.Patients who take blood hinners like aspirin,warfarin and clopidrogel

2.Those who use copper IUD must avoid exposure to microwaves or any short waves such as ultra violet radiations.

3. Teen agers and women who gave several births are commonly experiencing displacement or expulsion of the device and hence should be careful in their movements.

4.Pelvic infections

WOMEN GYNECOLOGY-PART IX-ANTI PROGESTINS

ANTIPROGESTINS-DRUGS FOR ABORTION

As we have already seen that progestins such as progesterone are the agents aiding and maintaining pregnancy.Any drug which opposes or block the actions of progesterone will result in the termination of pregnancy or abortion.

Although anti estrogens have been available since the late 1950s the first report of an antiprogestin appear only after 1981.In that year a drug which is a glucocorticoid antagonist was reported by the name RU-38486 or simply RU-486 was having some anti gestagenic properties also.Later the drug was named as mifepristone.

Although mifepristone's main use is as a terminator of early pregnancy these anti progestins also are tried for the uses as contraceptives,anti cancer drugs,and agents to induce labour.

Chemistry Structurally mifepristone is related to progesterone as a seroidal compound.It is a derivative of norethindrone (a progestin with a methyl group at the 19 th position of its steroidal structure) with a dimethyl-aminophenyl substituent at the 11-b position.

Mechanism The mechanism of action of mifepristone is that because of its similarity in chemical structure to progesterone it competitively inhibit its receptors and block the pregnancy protecting effect of progesterone  at the sensitive tissues like uterus, and thereby causes early contraction of the uterus and terminate the pregnancy.

But mifepristone when present alone in the absence of progesterone it will act as a weak progestin by acting as a partial agonist.

Mifepristone also act on the progesterone sensitive tissues of ovary.If given for a short period in the later follicular phase of the menstrual cycle,it delays ovulation by depressing LH surge.If it has been given frequently or continuously it can prevent ovulation but not in all cases.

If administered for several days in mid or late luteal phase mifepristone disturb the development of the secretory endometrium and causes menses.

Mifepristone is also having effects oncervix,myometrium,ectopic endometrial tissue,breast cancers,and meningiomas

 

WOMEN GYNACOLOGY-PART-VIII-CONTRACEPTIVE PILLS-HEALTH BENEFITS

BIRTH CONTROL PILLS-OTHER BENEFITS

The birth control pills have proved that they have some beneficial effects on the body other than their contraceptive effects.The modern studies have given some useful positive data.

The combination oral contraceptives have been well accepted over a decade for their substantial health benefits unrelated to their birth control uses.These include their beneficial effects on ovarian and endometrial cancers,a number of menstrual disorders,and many other diseases.

Oral contraceptives reduces the risks of ovarian and endometrial cancers within six months of use.The incidences of these diseases have been reduced by 50% after two years of use.More interestingly it is found that these beneficial protective effects of the oral contraceptives are persisting for 15 years after their use is stopped.These agents also beneficial by decreasing the incidences of ovarian cysts and benign fibrocystic breast disease.

Oral contraceptives also give beneficial effects on regulating menstruation,reducing blood losses,reducing the incidences of iron deficiency anemia,dysmenorrhea,and premenstrual tensions.

Also these combination pills reduces pelvic inflammation,ectopic pregnancies(pregnancy outside the uterus),and ameliorating or reducing endometriosis.

Conclusively it is beleived that combination oral contraceptives prevent thousands of deaths,episodes of various diseases and cases of hospitalizations.Hence fertility regulation by oral contraceptives is safer than pregnancy for most women.