INTRAUTERINE CONTRACEPTION

A   30-year-old woman   with    Crohn's disease who periodically    requires

steroid therapy seeks   advice  regarding   long-term   contraception.  She has had

3   pregnancies.    A   subserosal, fundal  fibroid was noted   at  the time    of  her

previous    cesarean    section delivery.   She states  that    she is  in  a   mutually

monogamous  relationship.   She was treated for a   chlamydia   infection   2

months  ago but does    not like    the idea    of  hormonal    contraception   and is

asking  about   the risks   associated  with    an  IUS.

Intrauterine system (IUS) contraception is a long-acting reversible contraceptive
method that involves placement of a small T-shaped object inside the uterus.
Failure rate is <1%. Continuation rates at 1 year are almost 80%.

Mechanisms of action include the following:

Absolute contraindications include a confirmed or suspected pregnancy, known
or suspected pelvic malignancy, undiagnosed vaginal bleeding, and known or
suspected salpingitis. Relative contraindications include abnormal uterine size
or shape, medical condition (e.g., corticosteroid therapy, valvular heart disease,

Decreased   sperm   transport

Increased   tubal   motility    (causing    failure of  implantation    of  immature    zygote) 

Decreased   implantation    secondary   to  endometrial inflammation

Phagocytic  destruction of  sperm   and blastocyst

Alteration  of  cervical    mucus   (only   progesterone    IUSs)