ParaGard

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[content_band bg_color=”#EDFFDC” border=”all”] [container] [custom_headline style=”margin: 0;” type=”center” level=”h4″ looks_like=”h3″ accent=”true”]About ParaGard as IUD Birth Control[/custom_headline]ParaGard is classified as an effective and promising IUD that provides successful contraception in more than 99% of cases. It is a copper IUD that is inserted into the uterine cavity by a healthcare professional and is considered very convenient since no maintenance is needed other than monthly doctor’s visits to review the string placement.

The way ParaGard works is simple: it interferes with the motility of sperm and in that way prevents fertilization. Data and clinical studies suggest that it also interferes with normal fertilized egg implantation in the uterine cavity if fertilization does occur. The dual action prevents unwanted pregnancies in more than 99% of cases.

But is it is safe? Are there any adverse effects or complications associated with the use of ParaGard?

According to data reported by WHO, each year more than 4932 women begin ParaGard use for contraception, yet many have it removed within a few years. Only 872 women from that study continue ParaGard use after 5 years and that drops to 325 after 10 years.
[custom_headline style=”margin: 0;” type=”center” level=”h4″ looks_like=”h3″ accent=”true”]What are some common adverse effects caused by ParaGard?[/custom_headline]

  • Pelvic infection
  • Intrauterine pregnancy
  • Septic abortion in the case of pregnancy
  • Ectopic pregnancy
  • Embedment of IUD
  • Perforation of the uterine lining

Additionally, the following adverse effects have also been reported.

  • Anemia
  • Inflammation of the vagina
  • Backache
  • Thick, white or yellow vaginal discharge
  • Partial or complete expulsion
  • Painful sexual intercourse
  • Prolonged menstrual flow
  • Cramping and pain (About 9% of women report serious pain and abdominal discomfort within 9 weeks of ParaGard insertion.)
  • Menstrual spotting
[/container][/content_band] [custom_headline type=”center” level=”h2″ looks_like=”h3″ accent=”true”]What do these complications mean for ParaGard users?[/custom_headline] If you are planning to initiate ParaGard use, here is what you should know:

[accordion] [accordion_item title=”Intrauterine Pregnancy”]While using ParaGard, if you become pregnant, it is highly recommended to remove the IUD as early as possible to decrease the risk of having premature delivery, miscarriage, septic shock, sepsis, and even death. Although the risk of pregnancy is low, if the string is displaced or if the IUD accidentally implants incorrectly, pregnancy can occur.

There is a slight possibility that the removal of the IUD may result in miscarriage. However, if the string is not visible, an ultrasound can be performed to determine whether the IUD is still embedded in the uterine cavity. If it is still embedded, then there are chances of developing septic shock, sepsis, miscarriage, premature labor and delivery, and rarely even death.[/accordion_item] [accordion_item title=”Ectopic Pregnancy”]Women who conceive while using ParaGard are advised to be checked by their doctors for ectopic pregnancy via ultrasound. There is a high risk that pregnancy while using ParaGard will be ectopic.[/accordion_item] [accordion_item title=”Pelvic Infection”]Pelvic inflammatory disease or PID is uncommon in women with IUDs. However, ParaGard is associated with a relatively high risk of pelvic inflammatory disease as compared to other contraceptives. PID is more likely to occur within 20 days of inserting the ParaGard IUD; therefore, proper placement and any infectious process can be easily detected by the first post insertion menstrual period. Women who have a risky lifestyle or who are at high risk of contracting sexually transmitted diseases are at much higher risk of developing pelvic infection.

PID can result in sepsis, hysterectomy, tubal damage, and rarely death. This is why it is important for ParaGard users to be evaluated for any signs and symptoms related to PID.[/accordion_item][/accordion][accordion][accordion_item title=”Impaired Immune System”]Women with a history of AIDS are strictly advised to avoid ParaGard unless they are stable clinically on antiretroviral therapy. According to clinical data, asymptomatic women with HIV can use IUDs. Currently, there is not much information available about using IUDs for women with impaired immune systems.[/accordion_item][accordion_item title=”Embedment”]Embedment or fractional penetration of ParaGard in the middle layer of the uterine wall makes removal complicated. In some cases surgical intervention is needed for removal. This is mainly because an improperly positioned IUD can lead to infection or inflammation.[/accordion_item][accordion_item title=”Perforation”]Rarely, some cases of ParaGard are followed by partial or total damage to the cervix or uterine wall. In case of bleeding or signs of active infection and/or damage, remove ParaGard immediately because the copper component of IUD can lead to the development of fibrous bands of tissue, making removal even more difficult. Leaving an IUD in the peritoneal cavity may trigger intestinal obstruction, intestinal penetration, and/or may damage the adjacent organs. In order to remove the IUD from peritoneal cavity, a surgical procedure is usually needed.[/accordion_item][/accordion][accordion] [accordion_item title=”Expulsion”]Expulsion usually occurs during a woman’s period or in the initial months after insertion. In patients who have never been pregnant, the expulsion risk is high.[/accordion_item][accordion_item title=”Wilson’s Disease”]ParaGard can aggravate Wilson’s disease, a disease which prevents the metabolization of copper.[/accordion_item][/accordion] [content_band bg_color=”#FAFFF4″ border=”all”][container][custom_headline style=”margin: 0;” type=”center” level=”h4″ looks_like=”h3″ accent=”true”]What Precautions are Needed with ParaGard Use?[/custom_headline]Because ParaGard does not protect against sexually transmitted diseases, additional protection is necessary when engaging in sexual intercourse.

  • Information for patients:It is important to discuss the patient package insert with your doctor before placing ParaGard. Persist in getting the answers you need to every question. It is vital to report any symptom of pregnancy and/or infection.
  • Vaginal bleeding: After ParaGard placement, most women experience changes in their menstrual changes. This is a common issue and usually resolves after a year. However, if a woman experiences intense vaginal bleeding, she should be treated and evaluated and ParaGard use should be discontinued.
  • Vasovagal reactions: Some women experience vasovagal reactions such as fainting immediately after placing ParaGard. Those patients should be cautious when getting up from the examination table.
  • Magnetic resonance imaging (MRI): According to some limited data MRI is safe in women using ParaGard. Hypothetically, the copper IUD can cause the surrounding tissues to heat to a level that may be damaging. However, some data indicates injury is preventable.
  • Nursing mothers: Nursing and Breastfeeding mothers can safely use ParaGard. However, according to some limited data there may be chances of expulsion and perforation if a female is lactating.
  • Pediatric use: ParaGard is not advised for use before the first menstrual cycle begins.

It is highly recommended to speak to your healthcare professional in detail before opting for contraceptive options (especially if you are planning for long-term contraception). Knowing the adverse effects and taking precautions can help in early management of possible complications.

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References:

  1. Russo, J. A., Miller, E., & Gold, M. A. (2013). Myths and misconceptions about long-acting reversible contraception (LARC). Journal of Adolescent Health, 52(4), S14-S21.
  2. Hubacher, D., Chen, P. L., & Park, S. (2009). Side effects from the copper IUD: do they decrease over time?. Contraception, 79(5), 356-362.
  3. Hardeman, J., & Weiss, B. D. (2014). Intrauterine devices: an update. American family physician, 89(6).
  4. Asch, E., Levine, D., & Brook, O. R. (2013). Fractured Intrauterine Device Copper Sheath With an Intact Polyethylene Core. Journal of Ultrasound in Medicine, 32(10), 1877-1878.
  5. Lazorwitz, A., & Guiahi, M. (2014). Increasing Use of and Adherence to Long-Acting Reversible Contraceptive Methods in Adolescents and Young Adult Women. Postgraduate Obstetrics & Gynecology, 34(4), 1-7.