The intrauterine device is my favorite method of contraception.

Firstly, the most reliable (if a young woman has her tubes tied, then she is more likely to become pregnant over time - the tube can “heal” than if she put a spiral). The effectiveness of the copper spiral - 5 pregnancies per 1000 / year; hormonal - 2 pregnancies per 1000/year

Secondly, one of the safest.

Thirdly, it works for a long time and does not require investments from the patient.

There are two spirals - copper (about 2500r) and hormonal (about 10000). The first works for 10 years, the second - 5. They both work due to the fact that they slow down and destroy spermatozoa. Hormonal also changes the structure of the mucous membrane of the cervix and does not let sperm through.

This is what copper looks like (it is about 2.5 cm long and wide)

Inserting the coil is very easy (in fact, the hardest part of inserting the coil is getting the catheter through the cervix).

This is what a hormonal spiral looks like - it is a little smaller than a copper one, about 2 by 2 (although in the photo - a sample, the real one is completely white).

1. A coiled catheter is passed into the uterus through the cervix (the uterus is really that small when not pregnant)

2. The catheter is brought to the wall of the uterus and begin to push

3. The spiral "straightens its wings" (the main thing is not to fly away)

4. The catheter is removed

5. The threads are cut under the neck - they are usually left about 2 cm long so that a) it can be seen, b) so that the spiral can be removed when needed.

Myths about the spiral (more myths, it seems to me, only about pills and vaccination).

DOES NOT cause infection - no, only if taken when the infection was (therefore it is recommended to take smears for infection before or during the setting of the spiral). The spiral does not increase the risk of infection. But, some doctors/researchers point out that the infection is more severe if the coil is present. Another factor to consider is that if a woman uses a spiral, she will usually not use condoms - the only contraceptive that protects against infections.

DOES NOT cause an abortion - no, only if it was placed after fertilization has occurred

Does NOT cause bleeding - in fact, the hormone coil (Mirena) does not cause, but suppresses menstrual bleeding. Copper spiral - really sometimes increases bleeding during menstruation. In a woman who does not have heavy periods, this happens very rarely, but for one who has been bleeding for more than a week and clots are leaving, I would not put a copper spiral.

DO NOT cause pain - for women who are forced to take painkillers during menstruation, I do not recommend a copper coil, although I can often recommend hormonal

the coil can fall out - this happens very rarely, if this happens, it is most often in the first 1-2 months, so the woman is brought in 6 weeks for an examination to make sure that the coil is in the right place

the spiral is NOT dangerous for nulliparous / the spiral does NOT cause infertility - infection is dangerous for nulliparous, because. it blocks the pipes; the spiral of infection itself does not cause and is not dangerous.

the spiral can perforate the uterus - such a complication as "perforation" is very rare - somewhere in one woman in 1000, if not less often. Usually, perforation occurs during the placement of the helix (the most difficult thing is to pass the catheter through the neck). More often it happens in a woman after several caesarean. If this happens, the coil is usually removed during laparoscopy.

the spiral does NOT grow into the uterus - it's more like from the section about perforation

the coil DOES NOT cause fibroids - sometimes the fibroids even decrease in size when using a hormonal coil

the spiral does NOT cause ovarian cysts - well, it has nothing to do with them.

the spiral DOES NOT cause excess weight - progesterone in large doses does stimulate appetite, but even in the hormonal spiral these doses are not enough. When comparing women with and without a coil, both groups had identical weight gain regardless of the type of coil.

the spiral is placed after menstruation - just to make sure that the woman is not pregnant. can be put on any day of the cycle (technically). If the husband is on a business trip (and there was no sex for a month), you can even put it on the same day (on the day of the appointment)

Personal: I would put a spiral on my relatives, moreover, more hormonal than copper (because I can afford it), but in general I have a very good attitude towards copper.

Candidiasis () is an infectious disease caused by a fungus of the genus Candida. This disease affects the mucous membranes of the genital organs and the oral cavity, and is accompanied by noticeable discomfort and curdled discharge with a sour smell. In thrush, it manifests itself in the form of candida. As for chronic thrush, it is often asymptomatic.

Causes

Candidiasis occurs for the following reasons:

• Unprotected sexual intercourse with a carrier of the infection;
• Weakened immunity due to other diseases;
• Failure to comply with sanitary and hygienic standards;
• Failure of the endocrine system;
• Natural hormonal changes (pregnancy, menopause, etc.).

The chronic form of the disease is less common, and it is not so easy to get rid of it. The fungus penetrates into the deep systems of the body and already has a certain resistance to certain medications. In a sleeping state, the disease may not make itself felt for years, while a person lives an ordinary life, from time to time he is treated for colds and other diseases, taking various medicines. The causative agent of the infection weakens for a while, but does not die, and at the slightest failure in the body it can suddenly manifest itself in an active form.

The causes of relapse, or manifestations of chronic thrush are as follows:

• Hypothermia, colds;
• Any disease that reduces immunity;
• Wearing synthetic underwear;
• Hormonal disbalance.

The chronic form of the disease is most often the result of ignoring the symptoms of candidiasis, or untimely treatment.

Symptoms

Chronic candidiasis is not always actively expressed, but with a careful attitude to your health, you can notice the following signs of the disease:

• Periodic discomfort in the intimate area (itching and burning);
• White coating on the tongue with colds;
• Exfoliating or crumbling nails;
• Sour smell of underwear in the morning;
• Abundant discharge of light tones after sex.

You should not attribute these symptoms to a weakened immune system, even if, in your opinion, they do not cause serious harm to health. A carrier of a fungal infection poses a danger to his sexual partner, and in addition, he can infect his household through household items.

Photo: What does chronic thrush look like?

The first photo clearly shows the discharge on the mucous membranes of the genital organs in chronic thrush, the second image shows damage to the nail plates by the fungus. In the third picture, a characteristic white coating on the tongue is noticeable.

Treatment

Chronic thrush in and is carried out with the help of drugs of general action, namely tablets.

Do not self-medicate!

Before starting treatment, make sure that you are dealing with candidiasis, as its symptoms can easily be confused with signs of some sexually transmitted diseases. Before taking any of the following drugs consult a doctor to find the medicines that are most effective for you. Read the instructions for use. Women before starting treatment should make sure there is no, and in every possible way protect yourself from conception while taking drugs, using contraceptives.

Tablets

Treatment with pills is a convenient and effective way to treat chronic candidiasis, because with its help you will not only get rid of the external symptoms of the disease, but also solve the problem itself from the inside.

Fluconazole

Antifungal tablets.

Instructions for use

Compound: Fluconazole (active ingredient), lactose monohydrate, pregelatinized starch, colloidal anhydrous silica, magnesium stearate, sodium lauryl sulfate.

Indications for use: Candidiasis of the mucous membranes (including the oral cavity, pharynx, esophagus and non-invasive bronchopulmonary infections).

Mode of application: In genital candidiasis, fluconazole is taken once orally at a dose of 150 mg, regardless of food intake. In the chronic form of the disease, the drug is taken longer. The duration of treatment and dosage can only be prescribed by a doctor.

Contraindications: Pregnancy, lactation, hypersensitivity to the drug.

A similar drug is Flucostat.

Diflucan

Antifungal agent in capsules.

Instructions for use

Compound: Fluconazole (active ingredient), lactose, corn starch, colloidal silicon dioxide, magnesium stearate, sodium lauryl sulfate.

Indications for use: Genital candidiasis, cryptococcosis, skin mycoses.

Mode of application: A single dose of 150 mg of the drug (1 capsule may contain 50, 100 or 150 mg of diflucan) 30 minutes before meals. In the chronic form of the disease, the drug is taken longer. The duration of treatment and dosage can only be prescribed by a doctor.

Contraindications: Simultaneous use of drugs containing cisapride, terfenadine, astemizole, hypersensitivity to the composition of the drug, pregnancy.

An analogue of Diflucan are Futsis tablets.

Nystatin

Tablets with antifungal effect.

Instructions for use

Compound: Nystatin (active substance), potato starch, lactose monohydrate, stearic acid, talc, edible gelatin, partially hydrolyzed polyvinyl alcohol, talc, soy lecithin, food coloring, vanillin.

Indications for use: Infections, including genital ones, caused by yeast fungi of the genus Candida, prevention of candidiasis (with prolonged use of antibiotics).

Method of administration: Inside, 1 tablet regardless of food intake 3-4 times a day. The course of treatment is 10-14 days. In the chronic form of the disease, the drug is taken longer. The duration of treatment and dosage can only be prescribed by a doctor.

Contraindications: Hypersensitivity to the components of the drug.

Ointments and creams

In the treatment of chronic thrush, topical preparations have an auxiliary effect, so they must be combined with antifungal tablets, which include the same active substance as in the ointment.

Lomexin

Cream with antifungal effect.

Instructions for use

Compound: Fenticonazole nitrate (active ingredient), water, glyceryl monostearate, disodium edetate, macrogol fatty acid ester, hydrogenated lanolin, almond oil, propylene glycol, cetyl alcohol.

Indications for use: Genital candidiasis, trichomoniasis.

Method of application for women: Cream (5 g) is injected deep into the vagina with a dispenser 1 time per day before bedtime, or, if necessary, 2 times a day (morning and evening). The average course of treatment is 3-6 days. According to the prescription of the attending physician, longer treatment is possible according to an individual scheme.

Method of application for men: The cream is applied to the affected areas of the mucous membranes of the genital organs 2 times a day (morning and evening). The average course of treatment is 3-6 days. According to the prescription of the attending physician, longer treatment is possible according to an individual scheme.

Contraindications: First trimester of pregnancy, individual intolerance to the components of the drug.

Nystatin

Antifungal cream for topical application.

Instructions for use

Compound: Nystatin (active substance), lanolin, white petrolatum.

Indications for use: Inflammatory diseases of the mucous membrane of the genital organs of fungal etiology.

Mode of application: Outwardly, the ointment is applied to the affected surface 1-2 times a day. The course of treatment is 10-14 days. According to the prescription of the attending physician, longer treatment is possible according to an individual scheme.

Contraindications: Individual intolerance to the components of the drug.

Candide

Antifungal cream for external use.

Instructions for use

Compound: Clotrimazole (active ingredient), propylene glycol, white petrolatum, liquid paraffin, cetomacrogol emulsion wax, benzyl alcohol, methyl parahydroxybenzoate, propyl parahydroxybenzoate, butylhydroxytoluene, sodium dihydrogen phosphate dihydrate, sodium hydrogen phosphate, purified water.

Indications for use: Fungal lesions of the skin and mucous membranes of the genital organs.

Method of application for women: The cream is injected 5 g deep into the vagina 1 time per day for 3 days. According to the prescription of the attending physician, longer treatment is possible according to an individual scheme.

Method of application for men: The cream is applied to the penis 2-3 times a day for 1-2 weeks. According to the prescription of the attending physician, longer treatment is possible according to an individual scheme.

Contraindications: Hypersensitivity to the composition of the drug, the first trimester of pregnancy.

Candles

Vaginal suppositories for women, as well as antifungal ointments, are used as an aid in the treatment of chronic thrush with tablets containing a similar active ingredient.

clotrimazole

Vaginal suppositories with antifungal action.

Instructions for use

Compound: Clotrimazole 100 mg (active substance), solid fat.

Indications for use: Genital infections caused by yeast fungus of the genus Candida (candidiasis vulvitis, vulvovaginitis).

Mode of application: A candle is administered once a day, at night, before going to bed. The average course of treatment is 6 days. According to the prescription of the attending physician, longer treatment is possible according to an individual scheme.

Contraindications: Individual intolerance to the components of the drug, the first trimester of pregnancy, the menstrual period (for this dosage form).

Macmirror

Vaginal suppositories with antimicrobial effect. Used to treat gynecological diseases.

Instructions for use

Compound: Nifuratel, nystatin (active substances), dimethicone.

Indications for use: Vaginal candidiasis, bacterial infections in the urogenital area, urogenital trichomoniasis, chlamydial infections.

How to use: Macmirror suppositories are used for 8 days, using 1 suppository at night. According to the prescription of the attending physician, longer treatment is possible according to an individual scheme.

Contraindications: Hypersensitivity to nystatin and nifuratel.

Pimafucin

Vaginal suppositories with antifungal action for local use in gynecology.

Instructions for use

Compound: Natamycin (active substance), cetyl alcohol, solid fat, sorbitan trioleate, polysorbate, sodium bicarbonate, adipic acid.

Indications for use: Vaginitis, vulvitis, vulvovaginitis caused by fungi of the genus Candida.

Method of administration: The suppository is inserted into the vagina in the supine position, as deep as possible, 1 time per day at night. The average course of treatment is 3-6 days. According to the prescription of the attending physician, longer treatment is possible according to an individual scheme.

Contraindications

Nystatin

Vaginal suppositories with antiseptic and antimicrobial effect for the treatment of gynecological diseases.

Instructions for use

Compound: Nystatin (active ingredient), butylocoinizole for medical purposes, butylated hydroxytoluene, citric acid, vaseline oil, semi-synthetic glycerides.

Indications for use: Diseases caused by fungi of the genus Candida.

Mode of application: Deep into the vagina is introduced 1 suppository 1-2 times a day. Duration of admission is 10-14 days. According to the prescription of the attending physician, longer treatment is possible according to an individual scheme.

Contraindications: Hypersensitivity to the drug.

Livarol

Vaginal suppositories with antifungal action.

Instructions for use

Compound: Ketoconazole (active substance), polyethylene oxide 1500, butylhydroxyanisole, polyethylene oxide.

Indications for use: Vaginal candidiasis. It is used to prevent fungal infections while taking antibiotics and other drugs that disrupt the natural microflora of the vagina.

How to use: 1 suppository is inserted into the vagina per day at night, before going to bed. The duration of the course of treatment is 3-5 days. With chronic thrush - 7-10 days. According to the prescription of the attending physician, longer treatment is possible according to an individual scheme.

Contraindications: Individual intolerance to ketoconazole and other components of the drug, the first trimester of pregnancy.

Zalain

Antifungal suppositories of local action.

Instructions for use

Compound: Sertaconazole nitrate (active ingredient), witepsol type H19, suppositories type NAI 50, colloidal anhydrous silicon dioxide.

Indications for use: Infection of the vaginal mucosa caused by fungi of the genus Candida(candidiasis vulvovaginitis).

Mode of application: Intravaginally, once. One vaginal suppository is inserted deep into the vagina, lying on your back, at bedtime. If symptoms persist, it is possible to re-use the drug after 7 days. According to the prescription of the attending physician, longer treatment is possible according to an individual scheme.

Contraindications: Hypersensitivity to the components of the drug.

Folk remedies

Treatments for chronic candidiasis are used as an adjunct to the general course of medications prescribed by a doctor.

soda baths

For the treatment of thrush in men and women, soda baths are used. Cooking method: 1 tbsp. a spoonful of a dry plant is poured with 1 cup of boiling water, covered with a lid, and allowed to brew for 30-40 minutes at room temperature.

Method of application for men: Strain the decoction and moisten a small soft towel made of natural fabric with it. Compresses are done on the penis at night, for 15-20 minutes, 7-10 days in a row.

Method of application for women: Sit in a bowl of warm water for 15-20 minutes twice a day. After the disappearance of the symptoms of the disease, continue the procedure for at least another three days.

Do not increase the number of procedures even if they seem insufficiently effective to you. All of the above plants dry out the skin, and if used improperly, can slow down the healing process.

Treatment of oral candidiasis

If the mucous membranes of the oral cavity are affected, decoctions of the same herbs as for genital candidiasis, a weak solution of Iodinol (1 tablespoon per 1 cup of boiled water), or Furacilin solution (2 tablets per 1 cup) can be used as a rinse.

Home treatment is allowed only with the consent of your doctor. Ignoring the symptoms of the disease or taking inappropriate drugs can lead to serious complications, such as chronic prostatitis, vesiculitis, diseases of the bladder and kidneys, infertility.

My periods completely stopped six months after the installation of the Mirena spiral. This is fine? Will I be able to get pregnant after the coil is removed?

Is there any pain, discharge or uterine bleeding after the installation of the Mirena coil?

Does Mirena affect weight? I really want to buy the Mirena intrauterine device, but I'm afraid to lose shape (there is a tendency to be overweight).

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!

General characteristics

Therapeutic intrauterine system Mirena as an intrauterine contraceptive (IUD)

Therapeutic intrauterine system (hormonal intrauterine system, hormonal intrauterine device, Navy) Mirena refers to intrauterine hormonal contraceptives.

In the 1960s and 1970s, copper-containing IUDs appeared, the efficiency of which was even higher. However, the problem of metrorrhagia (uterine bleeding) was not solved by the second generation of intrauterine contraceptives.

And finally, in the second half of the 70s, the first hormone-containing intrauterine contraceptives appeared - a new, third generation of IUDs. These medical devices combine the positive aspects of the IUD and hormonal oral contraceptives.

Hormone-containing intrauterine contraceptives are more effective than others contraceptives this group. In addition, they do not lead to uterine bleeding. Against the background of the use of hormone-containing intrauterine contraceptives, menstrual bleeding becomes less abundant.

Description of the dosage form

The Mirena intrauterine hormonal system has a T-shaped body that provides a stable location in the uterine cavity. At one end, the body has a loop to which threads are attached to remove the system. On the body there is a hormonal-elastomer core, which is a substance of white or almost white color. The core is covered with a translucent membrane that regulates the flow of the active substance into the uterine cavity.

The active hormonal substance of the system - the progestogen drug levonorgestrel - is presented in an amount of 52 mg. Auxiliary substance - polydimethylsiloxane elastomer.

The Mirena intrauterine hormonal system is located in the cavity of the conductor tube. The conductor and body of the drug do not have impurities.

Each package of Mirena contains one intrauterine hormonal system, placed in a vacuum plastic-paper shell.

The acquired dosage form of Mirena before use should be kept in a place protected from sunlight, at room temperature (15-30 degrees). The shelf life is three years.

Metabolism of the active substance in the body

The hormonal IUD Mirena begins to secrete levonorgestrel immediately after being placed in the uterine cavity. The release rate of the active substance after administration is 20 µg/day, by the end of the fifth year it decreases to 10 µg/day.

The distribution of levonorgestrol characterizes Mirena as a drug of predominantly local action. The highest concentration of the substance is stored in the endometrium (the lining of the uterus). In the myometrium (in the muscular membrane), the concentration of levonorgestrel barely reaches 1% of the concentration in the endometrium. The concentration of levonorgestrel in blood plasma is 1000 times less than in the endometrium.

The active substance enters the bloodstream approximately one hour after the introduction of the system. The maximum concentration of levonorgestrel in the blood serum is reached after two weeks.

Body weight significantly affects the concentration of the active substance in the blood plasma. In women with reduced weight (37-54 kg), the concentration of levonorgestrol in the blood is on average one and a half times higher.

The active substance is almost completely metabolized (broken down) in the liver, and excreted through the kidneys and intestines.

Operating principle

The most important contraceptive effects of the Mirena intrauterine hormonal system are due to a weak local reaction to a foreign body in the uterine cavity, and mainly to the local influence of the progestogen drug levonorgestrol.

There is a suppression of the functional activity of the epithelium of the uterine cavity: the normal growth of the endometrium is inhibited, the activity of its glands decreases, transformations occur in the submucosa - all these changes ultimately prevent the implantation of a fertilized egg.

Another important contraceptive effect is the increase in the viscosity of the mucus secreted by the glands of the cervix, and the thickening of the mucous membrane of the cervical canal, which prevents the penetration of spermatozoa into the uterine cavity.

In addition, the Mirena drug inhibits sperm motility in the uterine cavity and in the fallopian tubes.

In the first months of use, due to the restructuring of the uterine mucosa, irregular spotting is possible. But in the future, inhibition of the proliferation of the endometrial epithelium leads to a pronounced decrease in the volume and duration of menstrual bleeding, up to amenorrhea (cessation of menstruation).

Indications for use

The Mirena intrauterine hormonal system is intended, first of all, to prevent unwanted pregnancy.

In addition, the drug is used for excessively heavy menstrual bleeding of unknown etiology (in cases where the possibility of oncological diseases of the female genital area is excluded).

As a local progestogen drug, the Mirena intrauterine device is used to prevent hyperplasia (growth) of the endometrium during estrogen replacement therapy (this kind of treatment is indicated after surgery to remove both ovaries, as well as with severe menopause).

Contraindications

Mirena is an intrauterine contraceptive, so it is categorically contraindicated in inflammatory diseases of the female genital area, such as:

• acute and chronic inflammatory diseases of the pelvic organs;
• infectious lesions of the lower urinary tract;
• postpartum endometritis;
• septic abortion that took place less than three months before installation.

Since the occurrence of an acute inflammatory disease of the pelvic organs, which is difficult to treat, will be an indication for the removal of the IUD, Mirena is contraindicated in case of an increased tendency to develop acute infectious diseases, including the female genital area (frequent change of sexual partners, a general decrease in body resistance, AIDS in the stage detailed clinical symptoms, etc.).

As an intrauterine contraceptive, Mirena is also contraindicated in cervical dysplasia, malignant neoplasms of the body and cervix, congenital or acquired changes in the configuration of the uterine cavity (including fibromyomas).

Since the active substance of the drug is metabolized in the liver, the Mirena intrauterine hormonal system is contraindicated in oncological pathology of this organ, as well as in acute hepatitis and cirrhosis. If jaundice of unknown origin has previously occurred, the drug should be used with great caution.

Since levonorgestrol is a gestagenic drug, Mirena is contraindicated in all gestagen-dependent oncological diseases (primarily in breast cancer).

The systemic effect of levonorgestrol on a woman's body is weak. Nevertheless, the Mirena intrauterine hormonal system should be used with extreme caution in cases where progestin preparations are contraindicated. This is especially true for severe circulatory disorders (heart attacks, strokes), severe migraine attacks in history (including those that may indicate severe disorders of cerebral circulation), arterial hypertension, severe forms of diabetes mellitus, thrombophlebitis and a tendency to thromboembolic complications.

In such cases, the degree of risk (the severity of the symptoms of the disease, which is a relative contraindication to prescribing the drug) and the benefits of its use should be correlated. The issue of using Mirena is decided in consultation with a professional, and during the application of the spiral, constant medical supervision and laboratory control are necessary.

Mirena is contraindicated in pregnancy (diagnosed or suspected) and in case of hypersensitivity to the components of the drug.

Side effects

Common Side Effects

Common side effects include associated symptoms that appear at least in every hundred, and no more than in every tenth patient using the spiral.

Women using Mirena most often experience unpleasant symptoms from the central nervous system, such as: nervousness, irritability, bad mood, decreased libido, headache.

On the part of the gastrointestinal tract, patients are often concerned about pain in the abdomen, nausea, and vomiting.

Among the adverse effects on appearance, acne and weight gain are most commonly observed.

Often, patients make many complaints about the state of the reproductive system and mammary glands: pain in the pelvic area, spotting, vulvovaginitis, tension and soreness of the mammary glands.

Back pain resembling sciatica is relatively common.

All the symptoms described above are most pronounced in the first months of using the Mirena IUD, then their intensity decreases, and in the vast majority of cases, unpleasant symptoms disappear completely.

Rare side effects

Rare side effects include concomitant signs of drug use that occur no more often than every hundredth patient, and no less than every thousandth.

Rare adverse side effects of Mirena include the following:

• emotional lability (frequent mood swings);
• the appearance of edema;
• alopecia (baldness);
• hirsutism (increased hairiness);
• skin itching;

These unpleasant symptoms are most pronounced in the first months of using Mirena. In cases where their intensity does not decrease, an additional examination is indicated to exclude concomitant diseases.

Very rare side effects

Very rare effects of the drug Mirena (less than one in a thousand) include allergic reactions in the form of a rash and urticaria. When such signs appear, other possible causes of skin allergies should be excluded and, if necessary, the use of the IUD should be discontinued.

Instructions for use

Insertion of the intrauterine device Mirena

Sterile vacuum packaging is opened immediately before the installation of the system. A prematurely opened system must be disposed of as medical waste.

Only a doctor with sufficient experience in carrying out such manipulations can install the Mirena intrauterine system.

Before installing the Mirena coil, it is necessary to consult a gynecologist and get information about all the risks and possible adverse side effects.

Having decided on the installation of the Mirena IUD, a woman must undergo an examination of the mammary glands and mammography, as well as a gynecological examination, including a study of the pelvic organs and colposcopy (or at least a cervical smear analysis).

It is necessary to exclude oncological pathology of the female genital organs, pregnancy and sexually transmitted infections. All inflammatory gynecological diseases should be completely cured by the time of installation.

It is extremely important before installing the Mirena coil to determine the location of the uterus in the small pelvis, as well as the size and configuration of the uterine cavity. The correct placement of the IUD in the uterine cavity guarantees the effectiveness of the Mirena system, and prevents its expulsion (expulsion).

For women of childbearing age, Mirena is placed in the first seven days of the menstrual cycle.

If there are no medical contraindications, the Mirena IUD can be installed immediately after an artificial or spontaneous abortion in the first trimester of pregnancy.

Surgical intervention is extremely rare.

Amenorrhea
Amenorrhea is a common complication of the Mirena IUD. As a rule, it develops gradually during the first six months of using a contraceptive.

With the disappearance of menstrual bleeding, pregnancy should be excluded (conduct a routine test). If the test is negative, you can not repeat it in the future. The normal menstrual cycle will resume after the removal of Mirena.

Spiral Removal

After 5 years of use, the Mirena coil should be removed. In cases where, after removing the IUD, a woman is going to continue contraceptive measures, the Mirena coil should be removed at the beginning of the menstrual cycle. If the IUD is removed in the middle of the cycle, and before that unprotected sexual intercourse took place, then the woman is at real risk of becoming pregnant.

If a woman wishes to continue using the IUD, a new IUD can be inserted immediately after removal. In cases where, after the removal of the IUD, a new intrauterine contraceptive is immediately installed, manipulations can be performed at any period of the cycle.

After removal of the Mirena IUD, the integrity of the spiral should be checked, since if it is difficult to remove the product, the substance sometimes slips into the uterine cavity.

Installation and removal of the Mirena coil may be accompanied by pain and bleeding of varying severity. In some cases, fainting is possible. In women with epilepsy, insertion or removal of a coil may cause a seizure.

Mirena intrauterine device and pregnancy

The drug has a very high efficiency. In cases where an unwanted pregnancy does occur, an ectopic pregnancy should be ruled out first. In uterine pregnancy, the question of its interruption is raised.

If the woman decides to keep the child, then the spiral is carefully removed from the uterine cavity. In cases where it is not possible to remove the intrauterine system, the woman is warned about the possible risks of pregnancy with an IUD in the uterine cavity (spontaneous premature termination of pregnancy).

The possible adverse effect of the drug on the development of the fetus should be taken into account. There are very few cases of bearing a child with the Mirena intrauterine system due to the high contraceptive properties of the drug. However, a woman is advised to report that there are no clinical data on the occurrence of fetal pathology under the influence of this drug.

Application for lactation

The active substance of the Navy Mirena in small concentrations penetrates the blood plasma, and can be excreted during lactation, so that the content of levonorgestrel in breast milk is about 0.1% of the daily dose of the substance secreted by the system.

It is unlikely that such a dose could affect the general condition of the infant. Experts say that the use of Mirena during lactation six weeks after birth is quite safe for a breastfed baby.

Frequently asked Questions

The cost of Mirena is quite high. I have heard that the use of the helix comes with a lot of unpleasant side effects. Is there any positive effect of the drug on the body?

The Mirena intrauterine hormonal system has the following therapeutic (not contraceptive) effects:

• a decrease in the volume and duration of uterine bleeding (idiopathic - that is, not caused by any concomitant pathology);
• increased hemoglobin levels;
• normalization of iron metabolism in the body;
• general strengthening action);
• reduction of pain syndrome during painful menstruation;
• prevention of endometriosis and uterine fibroids;
• prevention of hyperplasia and endometrial cancer.

In addition, Mirena is widely used to normalize the state of the endometrium during estrogen replacement therapy (such treatment is usually carried out with pathological menopause, or after bilateral ovarian removal).

Is it possible to use the Mirena coil for myoma to treat a tumor?

The Mirena therapeutic system inhibits the growth of the fibroid tumor node. However, additional examination and consultation with a doctor is necessary. Much depends on the size of the nodes and their location. For example, submucosal fibroid nodes that change the configuration of the uterine cavity are an absolute contraindication for the use of the Mirena IUD.

Does Mirena help with endometriosis?

The intrauterine system releases a hormone into the uterine cavity that inhibits endometrial proliferation - this is the basis for the ability of the Mirena spiral to prevent the development of endometriosis.

In recent years, works have appeared that testify to the therapeutic effect of the Mirena spiral in endometriosis. Clinical data are rather contradictory. In addition, it should be noted that the treatment of endometriosis with hormonal IUDs is not used in all countries.

From the standpoint of evidence-based medicine, the Mirena spiral for endometriosis, like any other hormonal therapy, can only give a temporary result. The National Guidelines of the Russian Federation on gynecology recommends starting with surgical treatment, as the most radical one.

However, in each case, a thorough examination and consultation of doctors is necessary - a gynecologist, surgeon and endocrinologist.

My periods completely stopped six months after the installation of the Mirena spiral. This is fine? Will I be able to get pregnant after the coil is removed?

Amenorrhea (cessation of menstruation) is a normal reaction of the body to the action of the Mirena hormonal system, which occurs in every fifth woman using the spiral. As a rule, this condition develops gradually.

At the first disappearance of menstrual bleeding, pregnancy should be excluded. The effectiveness of the drug is very high, but experts still recommend taking the test. If the test result is negative, then you don't have to worry. After the removal of the Mirena spiral, menstruation will be restored, and a normal pregnancy can be expected.

Is there any pain, discharge or uterine bleeding after the installation of the Mirena coil?

Immediately after the installation of Mirena, a slight pain syndrome and spotting are possible. Severe pain and bleeding may indicate that the IUD has not been inserted correctly. In this case, the Mirena coil must be removed.

Pain, discharge or uterine bleeding a considerable time after the installation of the Mirena coil may indicate the onset of expulsion (expulsion of the drug from the uterine cavity) or an ectopic pregnancy. Therefore, if such symptoms appear, you should immediately consult a doctor.

Does Mirena affect weight? I really want to buy the Mirena intrauterine device, but I'm afraid to lose shape (there is a tendency to be overweight).

Weight gain is a fairly common unpleasant side effect of the Mirena spiral. However, it should be noted that not everyone is getting fat. According to clinical data, at least nine out of ten women do not even notice a slight increase in weight after the insertion of an IUD.

In addition, weight gain is one of the side effects of Mirena, most pronounced in the first months after installation. As a rule, in the future, the tendency to be overweight, caused by a hormonal drug, disappears.

According to the existing tendency to be overweight, it is impossible to judge the possibility of weight gain after installing the Mirena spiral, since the appearance of this side effect and the degree of its severity depends on the individual response to the hormonal drug.

I was protected by hormonal preparations. There are no side effects, but I often forget to take pills. What is the best way for me to switch from pills to Mirena?

If you took the pills irregularly, then there is a risk of pregnancy, which should be excluded when prescribing the Mirena spiral.

In addition, it is necessary to undergo a complete gynecological examination (examination of the pelvic organs, colposcopy) and check the condition of the mammary glands.

If there are no contraindications to the use of the IUD, it is best to insert the spiral on the fourth or sixth day of the menstrual cycle. On the day of installation of the Mirena spiral, contraceptive pills are canceled.

When does pregnancy occur after Mirena removal?

Clinical data indicate that 80% of women who want to have a baby become pregnant in the first year after the removal of the Mirena coil. This is even slightly above the usual level of fertility (fertility).

Of course, it takes some time to restore the normal state of the reproductive system, which is individual for each woman.

For patients for whom pregnancy is undesirable, doctors advise immediately after removing the Mirena spiral to take measures to prevent conception, since in many women the likelihood of pregnancy appears immediately after the system is terminated.

Where to buy a Mirena coil?

The Mirena intrauterine device can be bought at a pharmacy. The drug is dispensed by prescription.

Mirena coil price

The cost of the Mirena spiral depends mainly on the manufacturer, and ranges from 8700 to 12700 rubles.

Reviews of doctors and women

Reviews of women about the Mirena spiral are unusually contradictory, and contain a wide range of emotions, from admiration and immense gratitude to the inventor of this good, to horror, disgust and curses on the head of the attending physician, who advised "to go through this nightmare."

Appreciative feedback is based on the following positive points:

• the complete absence of side effects (in some cases it is mentioned that "I had to endure several terrible months");
• amenorrhea (mentioned with special admiration by women who suffered from heavy and / and painful periods);
• comfort (no need to count the hours before taking the pill, there is no connection with sexual intercourse, etc.);
• despite the high price of the drug, the duration of action (5 years) gives the right to call the Mirena spiral a fairly cheap type of contraception.

In addition, there are reviews indicating a decrease in the severity of the symptoms of endometriosis and the restraining effect of Mirena on the growth of fibroids.

Negative reviews contain a large number of complaints. In terms of frequency, two groups attract attention:
1. Complaints about disturbances in the emotional sphere (decreased mood, up to "did not want to live"), a sharp decrease in libido, irritability, up to hysteria);
2. Complaints about an ugly appearance (pimples on the face and back, hair loss, rapid weight gain, hair growth in inappropriate places).

It is easy to guess that these two groups of side effects mutually reinforce each other: a reduced emotional background turned even minor external side effects into ugliness in the patients' imagination, and unfavorable external symptoms increased disturbances in the emotional sphere.

An analysis of the reviews showed that some women refused to use Mirena in the first months, some continued to use it and later wrote that at first it was very bad, but then the condition completely returned to normal. However, some reviews indicate that side effects such as decreased libido, irritability and a tendency to gain weight in some patients persisted in the second year of using Mirena.

Many women complain of prolonged spotting and soreness in the lower abdomen for several weeks after Mirena is installed.

There are isolated complaints about Mirena expulsion and the occurrence of inflammatory diseases.

Noteworthy is the review of a woman who spoke about the occurrence of breast cancer against the background of the use of the Mirena spiral. Judging by the volume of the operation (total mastectomy with removal of the axillary lymph nodes), the tumor occurred even before the installation of the Mirena coil (cancer was diagnosed at the beginning of the second year of use). In this particular case, Mirena really could stimulate the growth of a malignant neoplasm (breast cancer is an absolute contraindication to the use of a hormonal coil). The reason for this complication is insufficient or careless examination of the patient.

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!

Every woman has a moment when she thinks about becoming a mother. But for many girls, sexual life begins before they are ready for motherhood, and for family life in general. Especially in modern women, the planning of a child is postponed until the full realization of oneself in other areas of life.

Well, if a woman has already become a mother, and maybe more than once, then there are few who want to repeat this feat a dozen more times and give birth every year. That is why, since ancient times, people have adapted to not getting pregnant without desire. In order to deceive nature, unpretentious methods of contraception were invented (from the Latin word contraceptio - exception). They started with various essential oils, fruit juices, tampons, lotions, broken contact, cloth pouches (precursor to the condom) and so on.

As you can see, the spiral affects all the processes necessary for conception:

• vitality and speed of movement of spermatozoa;
• egg maturation and ovulation;
• attachment of the fetal egg to the endometrium.

Pros and cons of using intrauterine devices

Advantages of the IUD	Disadvantages of the Navy
Convenient to use, the spiral is set for a period of 3 to 10 years or more. It does not require daily procedures, special hygiene care and drinking pills by the hour. In a word, for a long time you can not think about contraception at all and not be afraid of an unwanted pregnancy, but enjoy your sexual relationships.	Not suitable for all women, as it has a number of contraindications. For some women, the spiral does not take root.
High Efficiency Method: pregnancy occurs in only 2 out of 100 cases. Inert spirals give lower efficiency, and when using hormonal intrauterine systems, the risk of getting pregnant is reduced to zero.	Yet there is a risk of unplanned pregnancy with a spiral. In addition, the spiral may fall out and the woman may not notice it. But only the removal of appendages or ligation of the fallopian tubes and a complete renunciation of sexual activity gives a 100% result.
Preservation of childbearing function immediately after removal of the IUD.	From the use of non-hormonal spirals, it is recommended to refrain from young and nulliparous women., since as a side effect, inflammatory changes in the endometrium of the uterus and appendages may develop, reducing the chances of becoming pregnant in the future.
Does not affect the quality of sexual life, that is, sexual attraction, sexual intercourse for both partners and orgasm.	An IUD can cause painful and heavy periods. While hormonal spirals, on the contrary, solve the problems of painful periods. But gestogen spirals can lead to the absence of menstruation, which also negatively affects women's health.
Low cost. At first glance, it may seem that some types of spirals are an expensive pleasure. But given the long period of use, this method will be much more economical than those that require application during each sexual intercourse, daily and monthly.	Possible side effects from the use of spirals, unfortunately, their development is not uncommon.
IUDs can be used after childbirth during lactation when oral hormonal agents are contraindicated.	Increases the risk of developing inflammatory processes genitals, also the spiral does not protect against sexually transmitted diseases.
Additionally for hormonal intrauterine systems: can be used for women of any age; are used not only for contraception, but also in the treatment of certain gynecological diseases (fibroids, endometriosis, painful menstruation, uterine bleeding, etc.).	Increases the risk of developing an ectopic pregnancy. The use of hormonal coils significantly reduces the risk of pathological pregnancy.
	The procedure for inserting an IUD requires a trip to the gynecologist's appointment, brings discomfort and pain, in nulliparous women, the pain syndrome is especially pronounced, sometimes local anesthesia is required.

Indications for the installation of an intrauterine device

1. Temporary or permanent prevention of unwanted pregnancies, especially if the family already has children. Intrauterine devices are ideal for women who have given birth and have a single sexual partner, that is, for those who have a very low risk of contracting sexually transmitted diseases.
2. Frequent unwanted pregnancies, ineffectiveness or inattention of a woman in the use of other contraceptives.
3. Prevention of pregnancy after childbirth, especially cesarean section, after medical abortions or spontaneous miscarriages, when the onset of the next pregnancy is temporarily not desirable.
4. A woman has temporary or permanent contraindications to pregnancy.
5. The presence in the family history of genetic pathologies that a woman does not want to inherit (hemophilia, cystic fibrosis, Down syndrome and many others),
6. For hormonal intrauterine devices - some gynecological pathologies:

• uterine fibroids, especially if it is accompanied by profuse spotting and uterine bleeding;
• profuse painful periods;
• estrogen replacement therapy at the onset of menopause or after removal of the appendages, in order to prevent the growth of the endometrium.

Contraindications

Absolute contraindications to the use of all intrauterine devices

• The presence of pregnancy at any time, suspicion of a possible pregnancy;
• oncological pathologies of the genital organs, as well as breast cancer;
• acute and chronic inflammatory diseases of the female genital organs: adnexitis, colpitis, endometritis, including postpartum, salpingitis and so on, including the presence of sexually transmitted diseases;
• a history of ectopic pregnancies;
• allergic reactions to the materials from which the spiral is made;
• tuberculosis of the reproductive system;

Relative contraindications to the use of non-hormonal coils

• if the woman has no children yet;
• a woman is sexually promiscuous and belongs to the risk group for contracting sexually transmitted diseases;
• childhood and adolescence*;
• the woman's age is over 65;
• uterine bleeding and heavy painful periods;
• anomalies in the development of the uterus (for example, a bicornuate uterus);
• hematological diseases (anemia, leukemia, thrombocytopenia and others);
• growths of the endometrium, endometriosis;
• urethritis, cystitis, pyelonephritis - acute or exacerbation of a chronic course;
• benign tumors of the uterus and appendages (submucosal fibroids and uterine fibroids);
• prolapse of the intrauterine device or the development of side effects after the previous use of the device.

* Age restrictions are conditional, gynecologists usually do not offer young nulliparous women the use of intrauterine contraceptives, fearing harm. But, in principle, the spiral can be successfully installed at any childbearing age, followed by a successful pregnancy.

Relative contraindications to the use of hormonal intrauterine devices (systems):

• cervical dysplasia;
• anomalies in the development of the uterus;
• urethritis, cystitis, pyelonephritis - acute or exacerbation of a chronic course;
• fibromyoma of the uterus;
• liver disease, liver failure;
• severe cardiovascular pathologies: malignant arterial hypertension, condition after a stroke or heart attack, severe heart defects;
• migraine;
• decompensated (uncontrolled) diabetes mellitus;
• thrombophlebitis of the lower extremities;
• the woman's age is over 65 years.

When can I put a spiral after childbirth, caesarean section, abortion?

The intrauterine device can be placed already on the 3rd day after uncomplicated physiological childbirth. But usually gynecologists recommend waiting until the end of the discharge of lochia (on average 1-2 months). So it will be safer. After childbirth, the uterus recovers, so early insertion of the coil increases the risk of side effects and early rejection of the device. To start using the hormonal intrauterine system, you need to withstand 2 months after the birth of the baby, this is necessary not only for the complete restoration of the uterus, but also for the normalization of the hormonal background.

After a caesarean section, the spiral can be installed in the uterine cavity only after 3-6 months. It takes time for the postoperative scar to form.

After a medical termination of pregnancy (up to 12 weeks), it is better to install the IUD within seven days after the start of the next period after the abortion. But the gynecologist may offer to install the spiral immediately after the abortion, without getting up from the gynecological chair. This is possible, but in this case, the risk of developing side effects of the intrauterine device associated with the complications of the abortion itself increases significantly. After a miscarriage, the decision on the appropriateness and safety of installing a spiral is made only by a doctor, he individually assesses the situation, analyzes the cause of spontaneous abortion, weighs all the pros and cons. If it is necessary to use a spiral after a miscarriage, it is installed in the uterine cavity during the next menstruation.

Is an intrauterine device installed after the age of 40?

An intrauterine device can be used for any woman who is ovulating, has her menstrual cycle, and is likely to become pregnant. Hormonal intrauterine systems are also installed in the period after the onset of menopause to obtain a therapeutic effect. Therefore, 40 years is not a limitation for the use of the IUD. According to the instructions, the IUD is not recommended for women over 65 years of age, but this restriction appeared only due to insufficient research on the use of intrauterine devices at an older age.

How is an intrauterine device installed?

The intrauterine device is installed only by a gynecologist in a gynecological office. Before the introduction of the IUD, the doctor assesses the possibility and risk of side effects of using this contraceptive, explains to the woman about the possible reactions of the body to the introduction of one or another type of spiral. Before intrauterine contraceptives are installed, a woman needs to be examined to completely exclude a possible pregnancy and contraindications.

Desirable examination before installing an intrauterine device:

• gynecological examination and palpation (palpation) of the mammary glands;
• smear from the vagina, if necessary, sowing on the microflora;
• cytological examination of smears from the cervix;
• Ultrasound of the pelvic organs;
• in some cases, a pregnancy test or blood test to determine the level of hCG;
• Ultrasound of the mammary glands (for women under the age of 40) or mammography (after 40 years).

Preparing for installation

Usually, special preparation for the introduction of the spiral is not required. If inflammatory diseases are detected, you will first need to undergo a course of appropriate therapy.

Immediately before the procedure, it is necessary to empty the bladder.

On what day of menstruation is it better to install an intrauterine device?

Intrauterine contraceptives are usually installed during menstruation or towards its end, that is, within 7 days from the onset of menstruation. The optimal time is 3-4 days. This is necessary in order not to miss the onset of pregnancy.

An intrauterine device can be installed as emergency contraception, that is, if a woman has had unprotected intercourse and suggests an unwanted pregnancy. In this case, the device is introduced in the period after ovulation, this can prevent the attachment of the fetal egg in 75% of cases.

Intrauterine device insertion technique

Any spiral packed in a vacuum package is sterile. You need to check the expiration date. The spiral must be opened immediately before installation, otherwise it loses its sterility and can no longer be used. The IUD is a one-time use device, its reuse is strictly prohibited.

In most cases, local anesthesia is not required. Cervical anesthetics can be used in nulliparous women and when placing hormonal intrauterine systems, as they are wider.

The insertion technique for different types of spirals may differ. The installation features of each spiral are described in detail in the device instructions.
1. A speculum is inserted into the vagina to fix the cervix.
2. The cervix is ​​treated with disinfectants.
3. With the help of special forceps, the cervical canal (the canal in the cervix that connects the vagina with the uterus) is straightened, the cervix is ​​​​opened.
4. A special probe is inserted through the cervical canal into the uterine cavity to accurately measure the length of the uterus.
5. If necessary, the cervix is ​​anesthetized (for example, with lidocaine or novocaine). The introduction of the spiral itself begins after 4-5 minutes, when the anesthetic takes effect.
6. The spiral is introduced using a special conductor with a piston. A ring is set on it on a scale according to the size of the uterus, this is necessary in order not to damage its walls. Then a conductor with a spiral is inserted into the uterus. Having reached the corresponding mark, the doctor pulls the piston a little towards himself in order to open the shoulders of the spiral. After that, the spiral is moved directly to the wall of the fundus of the uterus. When the gynecologist is satisfied that the device is installed correctly, the guidewire is slowly and gently pulled out. When installing some spirals (for example, annular ones), the opening of the shoulders is not required, so the spiral is inserted to the wall of the uterine fundus, and then the conductor is simply pulled out.
7. The threads of the spiral are cut into the vagina at a distance of 2-3 cm from the cervix.
8. The procedure is over, it usually takes 5-10 minutes.

Does installing an intrauterine device hurt?

The procedure itself, of course, is unpleasant, brings some discomfort. But the pain felt is tolerable, it all depends on the woman's pain threshold. These sensations can be compared to painful menstruation. Abortion and childbirth are more painful.

After insertion of the intrauterine device

Ultrasound photo: Intrauterine device in the uterine cavity.

• The uterus completely gets used to the IUD within a few months, so during this period there may be some changes in women's health, you need to listen to your body.
• In some cases, a course of antibiotic therapy will be required after the introduction of the spiral, for example, if chlamydia is suspected, if there is another chronic infection of the genitourinary system.
• Bloody spotting and pulling pains in the lower abdomen or in the back can be disturbing for 1 week after the introduction of the spiral. To relieve spasms, you can take No-shpu.
• The hygienic regimen is normal, it is necessary to wash with intimate hygiene products twice a day.
• You can have sex only 8-10 days after the installation of the intrauterine device.
• For several months, you can not lift weights, engage in intense physical activity, overheat (sauna, bath, hot baths).
• It is necessary to periodically probe the threads of the spiral, control their length, it should not change.
• After 2 weeks, it is better to visit a gynecologist so that he can see if everything is fine.
• Menstruation in the first months after the installation of the spiral can be painful and plentiful. Over time, menstruation normalizes.
• When using hormonal intrauterine systems, after six months or several years, the disappearance of menstruation (amenorrhea) is possible. After the first loss of the cycle, pregnancy must be excluded. The menstrual cycle will be restored immediately after the removal of the spiral.
• If you have any complaints, you should consult a doctor.
• In the future, an examination by a gynecologist is necessary every 6-12 months, as for any healthy woman.

Can an intrauterine device fall out?

If the intrauterine device is not inserted correctly or if it does not take root, the intrauterine device may fall out. This must be followed. The most common prolapse of the IUD occurs during menstruation or after heavy physical exertion. Therefore, it is important to control whether the spiral threads are in place, inspect sanitary pads.

How long is the use of an intrauterine device?

The term for which intrauterine contraception is installed differs depending on the type of spiral.

• Inert IUDs - usually installed for 2-3 years.
• Copper spirals - up to 5 years.
• Copper spirals with silver and gold - 7-10 years or more.
• Hormonal intrauterine systems - up to 5 years.

The issue of premature removal of the spiral is decided by the gynecologist.

It is not recommended to use the IUD after the expiration date due to the risk of the spiral growing into the uterine tissue. Hormonal spirals lose their properties due to the depletion of the hormonal drug. This reduces the effectiveness of the intrauterine device, which can lead to an unplanned pregnancy.

Intrauterine devices (copper, hormonal): installation, principle of operation, efficiency (Pearl index), expiration date. How to check if the spiral is in place - video

Removal and replacement of the intrauterine device

Indication for IUD removal:

• the period of use has expired, while the replacement of the intrauterine device is possible;
• a woman is planning a pregnancy;
• there were side effects from the use of an intrauterine device.

The removal procedure, as well as the introduction of an intrauterine device, can only be performed by a gynecologist in the condition of a gynecological office. The ideal time to remove the spiral is the first days of menstruation, during this period the cervix is ​​\u200b\u200bsoft, which facilitates manipulation. In principle, the IUD can be removed at any time during the menstrual cycle.

Coil removal often does not require anesthesia, local anesthesia will be required when removing or replacing hormonal coils. The doctor fixes the cervix with a gynecological speculum, and then, using a special tool (forceps), grabs the spiral threads and carefully pulls out the device, while gently stretching the cervix.

Usually this procedure goes without difficulty, the woman experiences less pain than with the introduction of a spiral. But there are situations when the spiral is not so easy to pull out, then the doctor expands the cervical canal and facilitates the removal of the IUD. You can also face the problem of thread breakage, then the doctor inserts a special hook through the cervix, with which he removes the foreign body from the uterine cavity.

But there are situations when the doctor simply does not detect the thread of the spiral. The question arises, is there a spiral in the uterus at all? If yes, where is she? For this, a woman is offered to do an ultrasound of the pelvic organs, if necessary, x-rays. Sometimes there are cases that the spiral is outside the uterine cavity (with perforation of its wall), then a laparoscopic operation is urgently needed to remove the foreign body.

Coil replacement intrauterine contraception can be carried out immediately after the removal of the old spiral, the risk of developing any complications does not increase.

Special instructions before removing and replacing the intrauterine device:

• timely replacement of the IUD facilitates the procedure and guarantees continuous contraceptive action;
• the procedure is best done during menstruation;
• removing the coil during or before ovulation increases the risk of pregnancy;
• before replacing the coil, other methods of contraception (condom, oral contraceptives or spermatocidal preparations) must be used 7 days in advance to prevent an unwanted pregnancy.

Possible side effects

The intrauterine device is a modern, convenient and effective method of contraception. But it is also a foreign body, to which our body can react with undesirable reactions. In most cases, intrauterine contraception is well tolerated, but some women may be intolerant to this method and develop side effects, some of which can have a very negative impact on health and lead to severe pathologies. To reduce the risk of developing these side effects will help the choice of the type of spiral suitable for this woman, a detailed assessment of contraindications to its introduction, its timely removal and, of course, sufficient professionalism of the gynecologist who will install this device in the uterine cavity.

Possible side effects and complications when using an intrauterine device

• "Nulliparous cervix";
• irritation of the autonomic nervous system;
• increased emotionality of a woman;
• the size of the intrauterine device does not match the size of the uterus.

Side effect	Reasons for development	How often does it occur?	Treatment of adverse reactions
Pain in the lower abdomen immediately after the insertion of the IUD	Often.	Anesthesia with local anesthetics of the cervix; the correct selection of the dimensions of the spiral.
Prolapse of the spiral from the uterine cavity or expulsion	Violation of the IUD installation technique; incorrect selection of the size of the spiral; features of a woman - the immunity of a foreign body.	Often.	Adhere to all the rules of the technique of insertion and selection of the size of the IUD; after expulsion, it is possible to replace the helix with another.
Painful and heavy periods	the first months after the introduction of the IUD with copper - a normal reaction; non-infectious inflammation, as a reaction to a foreign body; allergic reaction to copper; inflammation of the ovaries - adnexitis.	Up to 15%.	Removal of the spiral and replacement of the IUD with another type of contraception; replacement of a copper spiral with a hormonal intrauterine system, in which heavy menstruation does not occur; the appointment of antispasmodics (for example, No-shpy) and non-steroidal anti-inflammatory drugs (ibuprofen, indomethacin, nimesulide, and so on) or antibiotics.
Inflammation of the genital organs (colpitis, endometritis, salpingitis, adnexitis): unusual allocation from the vagina, often with an unpleasant odor; itching and burning in the vaginal area; possible bloody issues in the middle of the menstrual cycle; drawing pains in the lower abdomen and in the lumbar region; violation of the menstrual cycle; fever and general malaise.	The spiral was installed in chronic inflammatory diseases of the genitourinary system; the spiral does not protect against sexually transmitted diseases, but increases the risk of the spread of sexually transmitted diseases from the vagina to the uterus and appendages; non-infectious inflammation that develops as a reaction to a foreign body increases the risk of infectious inflammation caused by bacteria and fungi, which are normally found in the bacterial microflora of the vagina.	Up to 1% of cases	Removing the spiral; appointment of anti-inflammatory and antibacterial therapy, according to the results of laboratory diagnostics.
Severe uterine bleeding	Damage (perforation) of the walls of the uterus with a spiral during its installation or operation; the presence of uterine fibroids.	Very rarely	Removal of the spiral as a matter of urgency; emergency medical care.
Anemia: pallor of the skin; changes in the blood test; weakness.	Uterine bleeding; long and heavy periods for more than 6 cycles.	Very rarely.	Individually, it is possible to remove the spiral or replace it with a hormonal IUD; iron preparations (Aktiferrin, Totem and others), vitamins and nutritional correction.
Fibroids development	Damage to the endometrium during the introduction or operation of the spiral;	Rarely.	Removal of the coil or replacement with a hormonal IUD; taking hormonal contraceptives.
Risk of ectopic pregnancy	The inflammatory process, which the IUD can contribute to, in some cases leads to obstruction of the fallopian tubes; one of the effects of the spiral is the contraction and spasm of the smooth muscles of the fallopian tubes, which can cause abnormal pregnancy.	1:1000	Surgical treatment, removal of the fallopian tube.
Soreness during intercourse, difficulty in achieving orgasm.	Inflammatory process in the genitourinary system; incorrect position and / or size of the spiral in the uterus; allergic reaction to the components of the spiral; damage to the walls of the uterus; ovarian cysts.	Up to 2%.	Removal of the coil or replacement with a hormonal IUD.
The onset of pregnancy	The IUD is not 100% effective.	From 2 to 15%.	Individual approach.
Perforation (puncture) of the walls of the uterus: sharp pains in the lower abdomen; uterine bleeding; deterioration of the general condition, up to loss of consciousness.	Damage to the walls of the uterus during the introduction, operation and removal of the spiral. Increase the risk of uterine perforation: early postpartum period; scar on the uterus after caesarean section; anomalies in the development of the uterus;	Very rarely.	Surgical treatment and emergency medical care.
Ingrown spiral into the wall of the uterus	inflammatory process in the endometrium; use of the spiral beyond the recommended period.	Up to 1%.	Removal of the spiral through the cervix using special tools. Sometimes laparoscopic surgery may be required.
Copper intolerance or Wilson's disease	individual intolerance or allergy to copper.	Rarely.	Replacement with another type of contraception or hormonal intrauterine device.

Additional side effects from the use of a hormonal intrauterine system (associated with the hormone progestogen):

• absence of menstruation (amenorrhea), after the removal of the spiral, the menstrual cycle is restored;

Also, an allergic reaction may develop on the introduction of a progestogen, requiring urgent removal of the spiral from the uterus.

Intrauterine device (IUD): composition, action, indications, possible negative consequences from the use - video

Intrauterine device (IUD): mechanism of action, dangerous complications (therapist's opinion) - video

How can a pregnancy proceed with an intrauterine device?



As it has already become clear, intrauterine contraceptives do not protect 100% from pregnancy. Most of these "lucky women" have a normal pregnancy, the child can independently push the spiral out in the second trimester and even be born with it in their hands, for some children it is such a toy. But not everything is always so smooth, and if a woman decides to keep such a pregnancy, she should be ready for various problems.

Basic principles of pregnancy management with a spiral:

1. Difficulties arise with the diagnosis of pregnancy, the woman is confident in her contraception. And menstrual irregularities with IUDs are not uncommon, which leads to the fact that pregnancy can be diagnosed late, when abortion is already difficult. Therefore, it is very important to listen to your body and, with the slightest deviations, changes and hints of pregnancy, consult a doctor.
2. At the request of the woman, a medical abortion can be performed.
3. The spiral is not an indication for medical termination of pregnancy. The choice is up to the woman, because in most cases, pregnancy with a spiral proceeds normally and without complications. But still, the doctor must evaluate the possible risks of pregnancy and may recommend terminating it.
4. The IUD may be removed during pregnancy. The copper coil is often not removed as it does not affect fetal development. The hormonal spiral throughout pregnancy will release hormones that can lead to abnormalities in the development of the fetus. The gynecologist can remove the coil if its threads are preserved and it is removed from the uterus easily and without hindrance.
5. Such a pregnancy requires constant monitoring by doctors, regular monitoring of the ultrasound of the fetus is necessary.

Possible risks of pregnancy with an intrauterine device:

• High risk of ectopic pregnancy, ultrasound monitoring is necessary.
• Such a pregnancy can end in an early miscarriage, which is associated with the effect of the spiral on the endometrium, to which the fetal egg is attached.
• The IUD can cause intrauterine infection of the fetus, as well as intrauterine growth retardation and pregnancy fading.
• High risk of fetal malformations during pregnancy with a hormonal spiral.
Be that as it may, if a woman nevertheless became pregnant with such a powerful contraceptive as a spiral, then, probably, the child really needs to be born. Every woman can listen to herself and decide whether to give this baby a chance to live or not.

How to choose a good intrauterine device? Which spiral is best?

Your gynecologist should deal with the selection of the type of spiral, its size and manufacturer. Only he can determine the indications and contraindications for the use of a particular intrauterine contraceptive, the individual characteristics of your body. But if the woman is absolutely healthy, then the doctor can provide an IUD to choose from. Then many questions arise.

"Which spiral to choose, copper or hormonal?" Here, a woman needs to choose between effectiveness and possible side effects. The hormonal coil has more possible side effects associated with the progestogen, but they are temporary and stop after a few months. And the contraceptive effect of using such a spiral is much higher. If a woman has fibroids, then the hormonal spiral is a method not only of contraception, but also of treatment. A copper coil with silver and, especially, gold has a higher efficiency than a conventional copper device, and the risk of side effects is lower, this is such a middle ground between a hormonal and a copper coil.

"And how much does an intrauterine device cost?" For many women, the issue of economy is of great importance and determines the choice of a spiral. Copper coils are much cheaper than hormonal systems. Also, spirals with silver and gold have a high cost.

"Which spiral is used longer?" The longest you can use spirals with silver and gold, up to 7-10 years or more. Hormonal spirals are usually used for no more than 5 years.

"Which spiral will not affect the next pregnancy?" Any spiral can lead to problems with future pregnancies, this is an ectopic pregnancy, and infertility due to the inflammatory process. The risk of developing an ectopic pregnancy during the use of the IUD is higher with hormonal coils due to the action of the progestogen. Copper spirals give a greater risk of complications in the form of inflammation of the uterus and appendages. When removing the IUD, ectopic pregnancy often occurs after the use of copper coils.

"Which spiral is painless?" During the installation and removal of the spiral, the woman experiences some pain. But this should not fundamentally affect the choice of the IUD. With the introduction of the hormonal system, these painful sensations are more pronounced, which is why local anesthesia is used. Local anesthesia can be carried out with the introduction of a copper spiral in women who are especially impressionable and emotional.

Overview of various modern intrauterine devices: Juno, Mirena, Goldlily, Multiload, Vector extra, spirals with gold and silver

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In recent decades, there has been a pronounced trend towards an increase in the incidence of opportunistic infections - diseases that do not cause pathological effects in a healthy person, but with a decrease in resistance, they manifest themselves in full. Among such infections, vulvovaginal candidiasis is distinguished - an infectious disease of the external genital organs, initiated by fungi of the genus Candida. Fungi are conditionally pathogenic flora in a woman's body, which means the manifestation of pathogenic action only under certain conditions - with a decrease in immunity activity.

A particular problem in gynecology is chronic recurrent vulvovaginal candidiasis, the treatment of which is a problem for women and specialists. The modern pharmaceutical industry and the time of antibiotics make it possible to choose a remedy for the treatment of chronic thrush and treat it effectively. One of the most popular and effective antifungal drugs is fluconazole.

Fluconazole found its way as part of the treatment of all forms of candidiasis and its prevention. The action of fluconazole is fungicidal, and the time of influence on fungi is long, which allows it to be used as a single application or once a week.

Different types of fluconazole are used to treat different types of thrush and its effect will depend on the dosage. The following forms of the course of thrush in a woman are distinguished:

• acute thrush;
• chronic form;
• persistent (constant);
• carriage.

In addition, fluconazole is used prophylactically during antibiotic treatment, before surgical interventions and menstruation.

The cause of the formation of the chronic form of candidiasis is diabetes mellitus, thyroid disease, hormone therapy, including oral contraceptives, concomitant infectious diseases. Often, the process becomes chronic during therapy with immunosuppressants, with uncontrolled treatment with antibiotics, the action of which leads to the death of beneficial flora and the reproduction of fungi. It is advisable to use fluconazole while taking antibacterial agents for the purpose of prophylactic action in the aspect of thrush.

The resistance of yeast-like fungi is another problem in the treatment of the disease. During the fight against the signs of vulvovaginitis, drug regimens that are defective in action are often used, which leads to the gradual formation of resistance. In addition, there is also a species diversity of candida, which cause a chronic process. In the recurrent form, it is often not Candida albicans that is determined, but other types of fungi; not always the action of one or another antifungal agent can suppress the growth of such fungi.

Features of the use of fluconazole

Depending on the form of the course of the disease and the purpose of the application, the age of the patient, fluconazole is used in various regimens and doses.

Therapy of acute thrush and its prevention

During the use of antibiotics, it is advisable to drink fluconazole tablets 150 mg once for prophylactic purposes, and with prolonged antibiotic therapy, repeat the same dosage a week later to enhance the antifungal effect.

The prophylactic effect of fluconazole is also used in the following situations:

• before gynecological operations;
• on the eve of the installation of the intrauterine device;
• before diagnostic tests (hysteroscopy);
• if necessary, cauterization of the cervix and other interventions associated with diseases of the cervical region.

During diagnostic or gynecological surgery conditions are created for the violation of the composition of the vaginal microflora, and the antifungal effect of fluconazole prevents this.

In primary acute thrush, a single application of the drug is used in conjunction with local treatment with suppositories. To provide an antifungal effect, a dose of 150 mg is used. If a child needs to be treated, the dosage is calculated based on 3-12 mg / kg of body weight.

Treatment of the recurrent form

Exacerbation therapy involves taking fluconazole three times, 150 mg every 72 hours. Gynecologists note that after the main course of treatment with fluconazole, an extension of the time of action of the drug is required due to the repeated intake of 150 mg once a week for six months. This time of use of fluconazole provides the necessary duration of action in chronic candidiasis. The recurrence rate is reduced by 90%. According to ongoing studies, it has been established that such a long time of taking fluconazole does not lead to the development of Candida resistance. In addition, there is no marked frequency of side effects from the drug.

For example, the CDC recommends a different treatment regimen for recurrent thrush. The time of admission according to the recommendations is two days, 150 mg daily. To prolong the action, a scheme is used for 6 months with a weekly intake of 150 mg of fluconazole.

In addition to these schemes, in a chronic process, women are recommended to use fluconazole tablets during the first day of menstruation for 6 months to enhance the antifungal effect of the agent and prolong the effect.

The issue of the effectiveness of the original fluconazole (Diflucan) in comparison with generics is still being discussed by experts. But the vast majority of studies confirm the same effectiveness during the use of cheaper generics, and original tablets.

Before starting the treatment of thrush in all its varieties, time is devoted to a thorough diagnosis:

• a bacterioscopy of a smear from the vagina is performed with an assessment of the degree of leukocyte infiltration, the nature of the vaginal epithelium (superficial, intermediate and parabasal);
• sowing of the genital tract discharge for flora and sensitivity to antibiotics, antifungal agents, during the study, the general microbial contamination, the degree of growth of bacteria and candida (weak, moderate, strong growth), the composition of the isolated microflora, the quantitative ratio of species are determined;
• a cytology smear from the cervical canal to exclude dysplasia and carcinoma;
• PCR for viral and bacterial infections.

Detection during the study of single rounded yeast cells, the absence of pronounced leukocytosis and superficial squamous epithelium, indicate carriage and this condition does not require therapeutic actions. The presence of mycelium, an increase in the number of leukocytes, the detection of intermediate and parabasal epithelium in large numbers indicate a recurrence of chronic thrush and require therapeutic actions according to the scheme, lasting 6 months. Leukocytosis and yeast in smears, the presence of a clinic in the form of curdled discharge, itching, hyperemia and burning indicate acute candidiasis. Fluconazole in this case is taken once. Its action time is long - it is several days, so the combination of such a scheme with local treatment in the form of suppositories eliminates the infection quickly.

The fight against persistent or recurrent infection involves monitoring the effects of drugs during therapy. The assessment of the action of fluconazole is carried out on the basis of the suppression of the symptoms of the disease, as well as during laboratory diagnosis.

The effect of fluconazole is considered positive when the leukocyte reaction in smears is reduced and yeast mycelium is absent, relapses are stopped for 12 months.

During treatment with fluconazole, laboratory diagnostics are not carried out to exclude distortion of the result. to evaluate the effect of the drug, smears are performed 2 weeks after taking the last pill. Further, the diagnosis is carried out after 1 month, 4, 9 and 12 months after therapy.

The action of fluconazole

The action of fluconazole does not depend on food intake, so the tablets can be taken before, during and after meals. The drug is well absorbed in the stomach. After an hour and a half, the maximum concentration of the drug is recorded in the blood, which means that the initial relief of itching, burning begins 2-4 hours after taking the pill. the maximum concentration in the blood is observed on the 4-5th day, and when using a double dose - on the second day.

Time of action of fluconazole rather long, the drug tends to accumulate in the tissues and continue to have an antifungal effect after the drug is discontinued.

So, in the treatment of chronic thrush, which implies a six-month intake of the drug, after stopping the use of fluconazole, it acts for several more months. This property allows you to use the medication once a day, and in the treatment of acute uncomplicated candidiasis - use it once. In addition, the drug has a water-soluble property, which explains its accumulation in all tissues of the body.

In the presence of kidney disease, care should be taken during therapy, due to the long action and half-life of fluconazole, it can damage the renal tissue.

With the ineffectiveness of the remedy and the resumption of symptoms, it is necessary to undergo a detailed diagnosis. As a rule, sowing of the discharged genital tract on nutrient media is performed with the determination of the type of candida and sensitivity to antibiotics. The microbiocenosis of the vagina and the detection of sexual infections (chlamydia, urea and mycoplasmosis, genital herpes, HPV) are also examined. Sexual partner therapy is mandatory. Important in the effectiveness of the fight against thrush is the full restoration of the lactic flora with the help of suppositories (Acilact, Vaginorm, Laktonorm, Ecofemin). During the treatment of candidiasis, the intestinal flora is also normalized with the help of probiotics (Biogaya, Enterogermina, Linex). With intestinal dysbacteriosis, the chances of chronic infection increase. In addition, the wearing of synthetic underwear, the use of tampons, self-medication in the form of douching is excluded.

Side effects and contraindications

During therapy, the medication can show its side effect with prolonged use. as a rule, the treatment of acute thrush is not accompanied by adverse events.

Common side effects include:

• headache;
• dizziness;
• perversion of taste;
• pain in the epigastrium;
• nausea and diarrhea;
• allergic rash;
• decrease in the level of leukocytes;
• lipid metabolism disorder;

In some cases, hepatitis and jaundice may occur.

Among the contraindications are:

• pregnancy;
• breast-feeding;
• age up to a year;
• individual intolerance.

In kidney disease, the drug is prescribed at a lower dosage.

Release form

Fluconazole is produced in the form of capsules, tablets for oral administration, as well as in the form of a solution for injection. As a rule, encapsulated or tablet forms of release are used. in severe fungal infections, intravenous injections are used: in HIV-infected people, with lesions of internal organs, skin and mucous membranes in a generalized form.

The dosage of capsules and tablets is 50, 100, 150 mg, and the number of pieces in the package is different, allowing you to use the product both once and for a long time.

The cost of funds depends on the manufacturer and country. Generics, for example, Diflazon, Medoflucon, Mikomax, Mikoflucan will cost much less than Diflucan. Fluconazole is produced in many countries.

Since the antifungal drug is active against not only candida, but also inhibits the growth of microsporium, cryptococci, trichophyton, it is used for fungal meningitis, pneumonia, skin fungus: lesions of the feet, inguinal region, nails, and pityriasis versicolor. During the treatment of malignant tumors, the drug is used to treat and prevent fungal infections of the mucous membranes.