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What is Progesterone release rate in Progestasert is: and explain in detail?
Ans: (c) 65mg/dayShaw's Textbook 15th editionINTRAUTERINE CONTRACEPTIVE DEVICESA. Biologically inert devices: Lippe's loop and Saf-T-coil.B. Copper carrying devices: Copper T 200, Copper 7, Multiload Copper 250, Copper T 380, Copper T 220 and nova T.About 50 pg of copper is eluted daily,Nova-T has silver added to the copper wire.C. Hormonal lUCD'sProgestasertLevonova*. 38 mg progesterone*. Release 65mg/day*. Expensive and Effective for 1 year*. 40% reduction of menorrhagia and dysmenorrhea*. 60 mg of levonorgestrel*. Releases the hormone in very low doses (20mg/day)*. Incidence of ectopic pregnancy more*. Safe during lacation*. Longer acting (5 years)MIRENA: Emerging as a better alternative to tubectomy in a young womanMIRENA*. 52 mg Levonorgestrel*. Releases 20mg/day, from 15 mins following insertion*. Less systemic side effects*. Does not suppress ovulation, mainly acts on the endometrium and cervical mucus*. Used in DUB, endometrial hyperplasia, HRT, and with tamoxifen for Ca. Breast, to counteract endometrial hyperplasia*. Lasts for 5 years with fewer incidences for Ectopic gestation. Patient selection for IUCD:*. Low risk of PID/STD*. Multiparous woman*. Monogamous relationship*. Desirous of long-term reversible method of contraception*. Unhappy or unreliable users of oral contraception or barrier contraceptionUses of IUCD:*. As a contraceptive*. Post coital contraception (emergency contraception)*. Following excision of uterine septum, Asherman's syndrome*. Hormonal IUCD in menorrhagia and dysmenorrhea and hormonal replacement therapy in menopausal women*. In a woman on tamoxifen for Ca. Breast, to counteract endometrial hyperplasiaContraindications:*. Suspected pregnancy*. Pelvic inflammatory disease (PID), lower genital tract infection*. Presence of fibroids-because of misfit*. Menorrhagia and dysmenorrhea*. Severe anemia*. Diabetic women who are not will controlled- because of slight increase in pelvic infection*. Previous ectopic pregnancy*. Scarred uterus and uterine anomalies*. In unmarried nulliparous because of the risk of PID and subsequent tubal infertility*. Levonorgestrel IUCD in breast cancerComplications:Immediate:*. Difficulty in insertion*. Vaso vagal attack and Uterine cramps Early:*. Expulsion (2-5%)*. Perforation (1-2%)*. Spotting, menorrhagia (2-10%) and Dysmenorrhea (2-10%)*. Vaginal infection (Actinomycosis) Late:*. PID-2 to 5%, occurs in the 4th week*. Does not prevent transmission of HIV*. Pregnancy -1 to 3 per 100 women years (failure rate)*. Ectopic pregnancy*. Perforation*. Menorrhagia and dysmenorrheaInsertion technique:CuT -withdrawal methodLippe's - push in methodLifespan:Cu380A (Para guard) : 10 yearsCu T 200 : 3-4 yearsMultiload Cu250 : 3 yearsCu375 : 5 yearsNova T 5 yearsCuT380Ag and CuT380S : 3-4 yearsRecent advances:Frameless IUCD and fibroblast releasing 14mg/day for 3 years.Frameless IUCD contains several copper cylinders tied together on a string and it is anchored 1 cm deep in the fundus.