Long acting reversible contraception

MOA - Coil into vagina - inhibits HPO axis via hormone release and mechanically prevents sperm accessing uterus

• copper coil (IUCD/IUD) - Doesn’t release hormones but is embryotoxic, decreases sperm motility and survival
• IUS - Has HPO effects (releases progesterone)

Efficacy - When taken correctly - over 99% effective

Contraindications - breast cancer, cervical cancer, liver disease, unexplained vaginal bleeding, CHD, stroke, untreated STI

Copper coil (IUD)

Can be inserted at any point in the menstrual cycle

Advantages - Long term, doesn’t limit or interrupt sexual activity (partner unaware), no hormonal side effects

Disadvantages - bleeding, cramping, invasive, risk of expulsion, perforation, infection

Contraindications - less suitable in women with existing heavy menstrual bleeding, wilsons disease, pregnancy, active pelvic infection

IUS

Typically releases levonorgestrel

Advantages - Long term (5 years), doesn’t limit or interrupt sexual activity (partner unaware), amenorrhoea, decreases dysmenorrhoea

Disadvantages - Irregular bleeding, more expensive, invasive, risk of expulsion, perforation and infection,

• progesterone can cause acne, increased apetite, decreased libido