MARRIAGE AND FAMILY PLANNING: SIDE-EFFECTS OF THE I.U.D.

There are various known side-effects of the I.U.D. also. It is not 100 per cent effective. In some, infections are possible, and these may continue. Some cases of sterility have been reported in women who have subsequently desired to become pregnant.

There have been several cases in which the I.U.D. has bored its way through the wall of the uterus, to become lodged in some other part of the pelvis or abdomen. In this way of course, the protective function lapses, and it could cause damage to intra-abdominal structures.

There is also an increase in the chance of an "ectopic pregnancy" occurring. This means fertilization and early development of the embryo occurs in the Fallopian tube. This must cause problems, for the development must occur in the uterus. A surgical emergency may ultimately occur as the tube bursts with the increase in size of the foetus.

The I.U.D. has a checking device which will let the woman know that it is still in the right place. This is the "tail," which hangs from the outer cervix and may be felt with the examining finger - a precaution advised by the doctors as a regular issue. If it is missing, it means the I.U.D. may have gone astray and a medical check may be advisable. If you do not know what to look for, discuss this with the doctor and a little instruction will soon show you how to check. Most doctors instruct the patient at the time of insertion what to seek and how to go about this. In the older, larger models, before the copper versions became available, side-effects were common. These were chiefly cramps, backache, local pelvic pain, heavy bleeding and dis­charges. With the advent of the mini-models these are far less common. Infections can occur, and discharges are often the sign of this. In any case, if there is any abnormality, it is wise to check with the doctor, and a pelvic examination will indicate if it is serious or not. In some cases it may be necessary to remove the I.U.D. Incidentally, copper models must be replaced at least two-yearly for continuing protection, as the copper becomes exhausted after this period of time.

Variants of the copper device are currently being assessed. One released a gestogen hormone regularly and is claimed to be highly protective. No doubt other types will flood the market in due course, just as the Pill variations exploded in the earlier years. After all, it is such an attractive market that many major commercial companies just cannot resist the temptation.

However, many doctors currently do not favor any sort of I.U.D. Low-grade infections may occur, and it seems these may impair later fertility. Although they are popular, their track record is not good, and some gynaecologists simply refuse to fit them. If they do, they are often inserted under a general anaesthetic in hospital.

One device called the Dalkon Shield was popular for a while, but it seemed to be associated with many infections, several occur­ring during pregnancy, causing "septic mid-trimester abortions." This has since been removed from the market.

Many women ask what should be done if pregnancy occurs during the use of the I.U.D. The recommendation is to see your gynaecologist at once. Advice currently varies, but at time of writing, the British journals were recommending legal termination of pregnancy,

There have been a few reported cases of congenital malformations in babies born with I.U.D.s in situ, and this has probably influenced this opinion. But, go and see your doctor at once if pregnancy is suspected - in short, if you miss a period. If periods are very heavy, or light, or if any unusual symptoms take place, of any nature, the same principle holds. Visit the doctor for a complete examination.

Some women still use the diaphragm. This is a round spring, covered with a thin sheet of rubber. When inserted high into the vaginal tract, it is hoped to seal off the cervix mechanically and so prevent the penetration of sperms. Often this is used in conjunction with a spermicidal cream or jelly, or aerosol foam. Alternatively, the spermicidals may be used on their own. The protection that these offer is not as effective as the methods already discussed, but some older women still use them success­fully.

A high degree of motivation must be present, and in the pre-Pill, prе-I.U.D. era, they were about all that was available. However, they are now nowhere near as popular as in a bygone era.

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GENERAL HEALTH