10.2.2 Intrauterine contraceptive devices (IUCDs)
A copper-bearing IUCD can be used within five days of unprotected sexual intercourse as an emergency contraceptive. If you remember from Study Session 4 on Natural Family Planning (NFP) methods, in a woman’s normal menstrual cycle ovulation occurs on the 14th day before the next menstrual bleeding. So an IUCD can be inserted within five days of unprotected sexual intercourse, provided it is after the earliest calculated day of ovulation (e.g. up to day 19 in the case of a 28-day cycle). Implantation may occur 6–12 days after ovulation. Therefore, inserting an IUCD would be effective in making implantation difficult, but would not cause the abortion of an existing implanted fetus.
Box 10.3 Mechanism of action of copper-bearing IUCD for emergency contraception
Based on evidence from a number of studies, copper-bearing IUCDs prevent pregnancy by:
- interfering with fertilisation, by stopping the sperm from fertilising the egg.
- decreasing the number of sperm reaching the uterine tube and interfering with their motility.
- preventing the fertilised egg from implanting in the uterus.
When to use an IUCD
When would you advise using an IUCD as an emergency contraception?
You can use an IUCD as an emergency contraception:
- five days after unprotected sexual intercourse but not more than five days after ovulation
- if the client also wants to use an IUCD for continuous long-term contraception.
For this reason, emergency contraceptive pills may be a better choice for nulliparous women. However, if the client does not wish to become pregnant in the next few years, the copper-bearing IUCD might be an option for her.
Bear in mind that insertion of an IUCD in women who have never given birth can be very painful and difficult.
The insertion of a copper-bearing IUCD as an emergency contraceptive requires a trained professional, and follows the same eligibility criteria as covered in Study Session 7 on IUCDs. Generally, while advising on both emergency contraceptive pills and copper-bearing IUCDs, you should also encourage clients to use barrier methods (male or female condoms) in order to prevent STIs. Remember, emergency contraceptives cannot protect against STIs, including HIV.
10.2.1 Emergency contraceptive pills