Intrauterine contraception today is one of the most common methods of contraception. Although it was already known in antiquity that the introduction of a foreign body into the uterine cavity impedes conception, modern intrauterine contraception has its history since 1909, when the German gynecologist R Richter first proposed a device for intrauterine contraception, which had a ring shape and was made from a silky intestine worm Such devices were made of different materials (silver, copper wire, steel, plastic) and were of various forms (ring, loop, umbrella, spiral, letter “T”), but until 1965 all these structures were rigid, which necessitated the expansion of the cervical canal for their introduction (this is quite a painful procedure) and caused lower abdominal pain and bleeding in women.
Principles of intrauterine contraceptives
In our time, intrauterine contraceptives (IUDs) are made of plastic with the addition of various metals (copper, gold, silver) and hormones (progesterone derivatives).
In addition, the metals contained in the IUD have a spermatoxic effect, that is, they have a detrimental effect on spermatozoa, and progesterone derivatives alter the local hormonal background, which also prevents the implantation of the embryo.
There are three types of intrauterine contraceptives; copper intrauterine device, intrauterine progesterone-releasing 1system (ORS) and the intrauterine levonorgestrel-releasing system (LSR). Copper spirals (their duration is from 2 to 5 years, depending on the thickness of the copper wire) are most widely used in the world. The mechanism of their action is associated with spermicidal activity of copper and the reaction of the endometrium to a foreign body, which violates the processes of fertilization and implantation. ORS mainly provide their contraceptive effect by changing the properties of cervical (cervical) mucus and the reaction of the endometrium to a foreign body. These systems are more often used not only as contraceptives (their duration is about 12 months) but also as a therapeutic agent for various hormonal disorders in the gynecological field. One of the latest achievements in the field of intrauterine contraception was the creation of LSR, the contraceptive effect of which lasts 5-7 years. LRS
In addition, LSR can cause excessive production of a special substance glycodelin-A in the endometrium, which, getting into the fallopian tubes, has a local contraceptive effect, preventing the sperm from attaching to the egg. LRS leads to a decrease in the number of estrogen and progesterone receptors in the uterus, which again interferes with implantation.
In general, summing up all the above, we can say that the main mechanism of action of the IUD is a violation of the delicate balance of all local factors that ensure the normal development of pregnancy at its earliest stages. It is important to note that all these changes are reversible.
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