Module 1 – Introduction to intrauterine systems
This session commences with outlining the reasons for using long acting and reversible contraceptive options and which types of intra-uterine contraceptive device (IUCD) are available. The modes of action are details including the advantages and disadvantages of levonorgrestrel-releasing intrauterine systems (LNG-IUS). Guidance criteria that enables and supports clinicians to deliver safe, evidence-based contraceptive care to women are provided. A comparison is made between the different IUCDs. The use of IUDs for non-contraceptive purposes including hormone therapy or menorrhagia is included. The session outlines the correct steps in the process of intrauterine procedures, emphasizing training requirements, examination and investigation, timing and rare and unusual complications during insertion. Reducing insertion related pain and prevention of insertion crisis are the two topics that conclude this session.
Module 2: Copper IUD and IUS practical
This session focusses on possible complications and management of IUDs, starting with intrauterine or extrauterine pregnancy. The session then continues with factors that influence malposition and expulsion, perforation or pelvic infection/pelvic inflammatory disease, bleeding or persistent pain and the management of these incidences. Furthermore, the removal of IUS (in women aged 50+ or of devices inserted in other countries) is described. A brief overview of copper IUDs is given, listing main mode of action, effectiveness and indications and contraindications. A comparison is made between levonorgrestrel-releasing intrauterine systems and coper IUDs as well as the advantages and disadvantages specific to copper IUDs. The session concludes with the use of copper IUDs as an emergency contraception and hormonal IUD effective options.
Module 3: IUS practical and case studies
The session recognises the safety rules to avoid complications in intrauterine procedures, starting with a pre-insertion counselling checklist, including aspects like (contra-)indications/suitability, microbiological screening, timing of insertion and pre-medication. The session details the necessary equipment for intrauterine procedures, including a so-called emergency tray consisting of several drugs like Diazepam, Atropine and mefenamic acid. A description is given of the insertion process in which special attention is being paid to the necessity of patient informed consent. A post-insertion checklist is given including aspects like documentation, re-iteration of possible complications and discussion of follow-up.
The session concludes with an overview of the IUS removal procedure.
Module 4: Case studies
This session examines different case studies. The first case study of this last session commences with the case of a 23-year-old nulliparous woman who wants to use an IUS because of dissatisfaction with the COC she is currently using. The second case study is of a 30-year-old mother of one who is currently breastfeeding. She had an occurrence of pelvic inflammatory disease. The final case study is of a 37-year old woman who has an IUCD sitting within the pelvic cavity. In all studies the questions and concerns of the patients are discussed in small groups and then the larger group. The session concludes with business considerations, including cost of providing IUD service, cost of equipment/consumables and cost comparisons.