BNF for Children 2011-2012

BNFC 2011–2012 7.3.4 Contraceptive devices 407should provide full counselling, backed, where available,by the patient information leaflet. Devices shouldnot be fitted during the heavy days of the period; theyare best fitted after the end of menstruation and beforethe calculated time of implantation. The main excessrisk of infection occurs in the first 20 days after insertionand is believed to be related to existing carriage of asexually transmitted infection. Women under 25 yearsare at a higher risk of sexually transmitted infections,and pre-insertion screening (for chlamydia, and dependingon sexual history and local prevalence of disease,Neisseria gonorrhoeae) should be performed. If resultsare unavailable at the time of fitting an intra-uterinedevice for emergency contraception, appropriate prophylacticantibacterial cover should be given. Thewoman should be advised to attend as an emergencyif she experiences sustained pain during the next 20days.An intra-uterine device should not be removed in midcycleunless an additional contraceptive was used forthe previous 7 days. If removal is essential post-coitalcontraception should be considered.If an intra-uterine device fails and the woman wishes tocontinue to full-term the device should be removed inthe first trimester if possible.INTRA-UTERINE CONTRACEPTIVEDEVICESCautions see notes above; also anaemia, menorrhagia(progestogen intra-uterine system might be preferable,section 7.3.2.3), endometriosis, severe primarydysmenorrhoea, history of pelvic inflammatory disease,diabetes, fertility problems, nulliparity andyoung age, severely scarred uterus (including afterendometrial resection) or severe cervical stenosis;drug- or disease-induced immunosuppression (risk ofinfection—avoid if marked immunosuppression); epilepsy(risk of seizure at time of insertion); increasedrisk of expulsion if inserted before uterine involution;gynaecological examination before insertion, 6–8weeks after then annually but counsel women to seedoctor promptly in case of significant symptoms,especially pain; anticoagulant therapy (avoid if possible)Contra-indications severe anaemia, recent sexuallytransmitted infection (if not fully investigated andtreated), unexplained uterine bleeding, distorted orsmall uterine cavity, genital malignancy, active trophoblasticdisease (until return to normal of urineandplasma-gonadotrophin concentration), pelvicinflammatory disease, established or marked immunosuppression;copper devices: copper allergy,Wilson’s disease, medical diathermyPregnancy remove device; if pregnancy occurs,increased likelihood that it may be ectopicBreast-feeding not known to be harmfulSide-effects uterine or cervical perforation, displacement,expulsion; pelvic infection may be exacerbated,menorrhagia, dysmenorrhoea, allergy; on insertion:pain (alleviated by NSAID such as ibuprofen 30 minutesbefore insertion) and bleeding, occasionally epilepticseizure and vasovagal attackIndication and doseSee notes aboveCu-Safe c T300 (Williams) DIntra-uterine device, copper wire, wound on vertical stem ofT-shaped plastic carrier, surface area approx. 300 mm 2 ,impregnated with barium sulphate for radio-opacity, monofilamentthread attached to base of vertical stem; preloadedin inserter, net price = £9.11For uterine length over 5 cm; replacement every 5 years (see alsonotes above)Flexi-T 300 c (Durbin)Intra-uterine device, copper wire, wound on vertical stem ofT-shaped plastic carrier, surface area approx. 300 mm 2 ,impregnated with barium sulphate for radio-opacity, monofilamentthread attached to base of vertical stem; preloadedin inserter, net price = £9.47For uterine length over 5 cm; replacement every 5 years (see alsonotes above)Flexi-T c + 380 (Durbin)Intra-uterine device, copper wire, wound on vertical stem ofT-shaped plastic carrier with copper sleeve on each arm,total surface area approx. 380 mm 2 , impregnated with bariumsulphate for radio-opacity, monofilament threadattached to base of vertical stem; preloaded in inserter, netprice = £10.06For uterine length over 6 cm; replacement every 5 years (see alsonotes above)GyneFix c (Williams)Intra-uterine device, 6 copper sleeves with surface area of330 mm 2 on polypropylene thread, net price = £26.64Suitable for all uterine sizes; replacement every 5 yearsLoad c 375 (Durbin)Intra-uterine device, copper wire, wound on vertical stem ofU-shaped plastic carrier, surface area approx. 375 mm 2 ,impregnated with barium sulphate for radio-opacity, monofilamentthread attached to base of vertical stem; preloadedin inserter, net price = £8.52For uterine length over 7 cm; replacement every 5 years (see alsonotes above)Mini TT 380 c Slimline (Durbin)Intra-uterine device, copper wire, wound on vertical stem ofT-shaped plastic carrier with copper sleeves fitted flush on todistal portion of each horizontal arm, total surface areaapprox. 380 mm 2 , impregnated with barium sulphate forradio-opacity, thread attached to base of vertical stem; easyloadingsystem, no capsule, net price = £12.46For minimum uterine length 5 cm; replacement every 5 years (seealso notes above)Multiload c Cu375 (Organon)Intra-uterine device, as Load c 375, with copper surfacearea approx. 375 mm 2 and vertical stem length 3.5 cm, netprice = £9.24For uterine length 6–9 cm; replacement every 5 years (see alsonotes above)Multi-Safe c 375 (Williams)Intra-uterine device, copper wire, wound on vertical stem ofU-shaped plastic carrier, surface area approx. 375 mm 2 ,impregnated with barium sulphate for radio-opacity, monofilamentthread attached to base of vertical stem; preloadedin inserter, net price = £8.80For uterine length 6–9cm; replacement every 5 years (see alsonotes above)MultiSafe c 375 Short Stem (Williams) DIntra-uterine device, copper wire, wound on vertical stem ofU-shaped plastic carrier, surface area approx. 375 mm 2 ,impregnated with barium sulphate for radio-opacity, monofilamentthread attached to base of vertical stem; preloadedin inserter, net price = £8.80For uterine length 5–7cm; replacement every 5 years (see alsonotes above)7 Obstetrics, gynaecology, and urinary-tract disorders