Copper T is an IUD (intrauterine device) which is said to be an effective form of contraception for women. This option is usually given to women who have delivered a baby in the past. Insertion of Copper T is a surgical procedure that needs to be conducted by an experienced doctor. The device is placed into the uterus of the woman with a plastic string tied to the end of the intrauterine device hanging from the cervix to the vagina.
Description of the device
The widely used medicated device is copper T. it carries 215 sq mm surface area of fine copper wire wounded around the vertical stem of the device. Stem of the T shaped device is made of a polyethylene frame. It has a polyethylene monofilament tied at the end of the vertical stem. These two threads are used for detection and removal. In spite of the copper being radio-opaque, additional barium sulphate is incorporated in the device. The device contains 124 mg of copper. The copper is lost at the rate of about 50 ug per 24 hours during a period of one year. It is supplied inside a sterilized sealed packet. The device is to be removed after 4 years.
Advantages of Copper T
- Known as 99% effective method of pregnancy prevention
- This method is known as much cost effective among birth control methods over time
- Easy to use
- Safe to use while breastfeeding
Mode of action
Mechanism of antifertility effect of all the IUDs is not yet clear. They act predominantly in the uterine cavity and do not inhibit ovulation. Probable factors are:
- Biochemical and histological changes in the endometrium.
- There may be increased tubal motility.
- Endometrial inflammatory response.
- Copper devices: Ionized copper has got an additional local antifertility effect by preventing blastocyst implantation through enzymatic interference. copper initiates the release of cytokines which are cytotoxic. Serum copper level is not increased. It seems that the progressive calcium deposition in the device prevents copper diffusion if kept for a longer
Time of insertion
- Interval: It is preferable to insert in the interconceptional period beyond 6 weeks following childbirth or abortion. Or 2-3 days after the period is over.
- Postabortal: Immediately following after termination of pregnancy by suction evacuation or D and E, or following spontaneous abortion, the device may be inserted.
- Postpartum: Insertion of the device can be done before the patients are discharged from the hospital. Because of the high rate of expulsion, it is preferable to withhold insertion for 6 weeks when the uterus will be involuted to near normal size.
- Post placental delivery: Insertion immediately following delivery of the placenta could be done. But the expulsion rate is high.
Methods of insertion
- History taking and general and pelvic examination to exclude any contraindication of insertion.
- Patient is informed about the various problems, the device is shown to her and consent is obtained.
- The insertion is done in the outpatient department, taking aseptic precautions without sedation or anesthesia. To reduce cramping pain ibuprofen (NSAIDS) may be given (200-400mg) 30 minutes before insertion.
- Placement of the device inside the inserter: the device is taken out from the sealed packet. The thread, the vertical stem and then the horizontal stem folded to the vertical stem are introduced through the distal end of the inserter. The device is now ready for the introduction. “no touch” insertion method is preferred.
- The patient empties her bladder and is placed in lithotomy position.uterine size and position are ascertained by pelvic examination.
- Posterior vaginal speculum is introduced and the vagina and cervix are cleansed by antiseptic lotion.
- The Anterior lip of the cervix is grasped by Allis forceps. A sound is passed through the cervical canal to note the position of the uterus and the length of the uterine cavity. The appropriate length of the inserter is adjusted depending on the length of the uterine cavity.
- The inserter with the device place inside is then introduced through the cervical canal right up to the fundus and after positioning it by the guard, The inserter is withdrawn keeping the plunger in position.
- Thus, the device is not pushed out of the tube but held in place by the plunger while the inserter is withdrawn.
- The excess of the nylon thread beyond 2-3 cm from the external os is cut. Then the Allis forceps and the posterior vaginal speculum are taken off.
“NO TOUCH” insertion technique
- Loading the IUD in the inserter without opening the sterile package. The loaded inserter is now taken out of package without touching the distal end.
- Not to touch the vaginal wall and the speculum while introducing the loaded copper T inserter through the cervical canal.
- Presence of pelvic infection current or within 3 months
- Undiagnosed genital tract bleeding
- Suspected pregnancy
- Distortion of the shape of the uterine cavity eg, fibroid uterus
- Severe dysmenorrhoea
- Past history of ectopic pregnancy
- Trophoblastic disease
- STIs- current or within 3 months
- Severe arterial disease
- Current breast cancer
- Significant immunosuppression
- Within 6 weeks following cesarean section
- Hepatic tumor
- Copper allergy
- Wilson disease
Instructions to the patient
The possible symptoms of pain and slight vaginal bleeding should be explained. The patient should be advised to feel the thread periodically by the finger. The patient is checked after 1 month and then annually.
- Cramplike pain
- Syncopal attack
- Partial or complete perforation
- Abnormal menstrual bleeding
- Pelvic infection
- Spontaneous expulsion
- Perforation of the uterus
Indications for removal
- Irregular uterine bleeding
- IUD has come out of place
- Woman desire of a baby
- Flaring up of salpingitis
- Perforation of the uterus
- Missing thread
- One year after menopause
Removal of copper T
It is simple and can be removed at any time. It is done by pulling the strings gently and slowly with a forceps.
If for some reason an experienced doctor is not available around you, then you can contact us here.