Iud purpose: Intrauterine Device (IUD) – familydoctor.org
Intrauterine Device (IUD) – familydoctor.org
An intrauterine device (IUD) is a form of birth control. It prevents pregnancy either by damaging or killing a man’s sperm or blocking it from entering a woman’s uterus. An IUD is a small, T-shaped device with a string attached to the end. The purpose of the string is to make sure the IUD stays in place. It also is how a doctor removes the device.
There are 2 types of IUDs available in the United States: hormonal and non-hormonal. ParaGard is the non-hormonal option. It has copper rings, or coils, that alter the chemicals in your uterine fluid to kill sperm. You should not use ParaGard if you are allergic to copper. Hormonal options include Mirena, Kyleena, Liletta, and Skyla. These release progestin hormones to thicken your cervical mucus and stop ovulation.
Path to improved health
Your primary care or women’s doctor can insert an IUD. They can insert ParaGard at any time during your menstrual cycle. Hormonal IUDs should be inserted in the first 7 days of your cycle. The procedure is quick and done in the doctor’s office. The doctor puts a small plastic tube with the IUD into your vagina. You may have pain or cramping during this process. Discomfort can last several hours or days. Most doctors suggest that you have someone else drive you home from the appointment.
IUDs start working immediately. You can have sex, exercise, and use tampons. An IUD is effective for 3 to 12 years, depending on the type. Your doctor can remove it at any time.
Call your doctor right away if you have the following symptoms or problems. They will check your IUD and may remove or replace it.
- You can’t find the string.
- You can feel the IUD.
- Your IUD comes loose or falls out.
- You have a fever or chills.
- You have abnormal blood, fluid, or odor coming from your vagina.
Things to consider
You should not use an IUD if you have abnormal vaginal bleeding. Cancer of the cervix or uterus or AIDS infection prevent IUD use, as well. You shouldn’t use an IUD if you are pregnant or want to become pregnant. You can, however, get an IUD immediately after giving birth. The best time for the doctor to insert it is after delivery of the baby and placenta.
IUDs do not protect you from sexually transmitted diseases or infections (STDs or STIs). To reduce your risk of getting an STD, use a condom when you have sex. IUDs can affect your menstrual cycle. At first, you may have pain, cramping, or spotting (light bleeding) between periods. This can last for 3 to 6 months. Hormonal IUDs can cause your periods to be irregular. They may also cause you to miss periods. Copper IUDs can cause worse cramps and bleeding during your period.
The benefits of IUDs include:
- Prevention success rate of 99% when used properly.
- Use of 3 to 12 years, depending on the type.
- Can be removed by your doctor at any time.
- Safe for women who just gave birth and/or are breastfeeding.
- Cannot be felt during sex.
- Low risk of side effects.
Risks are uncommon, but include:
- Injury to the uterus when the IUD is being inserted.
- Increased risk of pelvic inflammatory disease if you have an STD.
- Chance of getting pregnant, in which case your doctor should remove the IUD. If you become pregnant, the risk of miscarriage and health problems for you and the baby increase.
- Chance of an ectopic pregnancy. This occurs when an egg fertilizes outside of your uterus. It is rare but can be harmful for a woman.
Questions to ask your doctor
- How do I know which IUD is right for me, or if I should use another form of birth control?
- Are there any other health conditions that prevent me from using an IUD?
- Does my age play a factor in which type and brand of IUD I get?
- Does my insurance cover an IUD?
- How often do I need to check my IUD, either by a doctor or myself?
- What happens after an IUD expires?
American Academy of Family Physicians: Birth Control Options
National Institutes of Health, MedlinePlus: Intrauterine Devices (IUD)
Copyright © American Academy of Family Physicians
This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.
The IUD (for Teens) – Nemours KidsHealth
What Is an IUD?
An intrauterine device (IUD) is a piece of T-shaped plastic, about the size of a quarter, that is placed inside the uterus to prevent pregnancy. Two types of IUDs are available: one is covered with copper, the other releases the hormone progestin.
How Does an IUD Work?
The copper-coated IUD prevents pregnancy by not allowing the sperm to fertilize the egg. It may also make it harder for a fertilized egg to implant in the uterus.
An IUD coated with progestin works in a similar way, but also thickens the cervical mucus and thins the uterine lining. In some cases, it stops
ovulation(the release of an egg during the monthly cycle). This prevents sperm from fertilizing the egg and implanting.
A progestin IUD also can be used to help reduce blood flow for girls who have heavy, painful periods (dysmenorrhea).
How Well Does an IUD Work?
Both types of IUDs are very effective at preventing pregnancy. Over the course of a year, fewer than 1 out of 100 typical couples using an IUD will have an accidental pregnancy.
The IUD is effective as soon as it is put in and it lasts a long time. A copper IUD can work for 10 years. Progestin IUDs can work for 3 to 5 years, depending on the brand. This makes the IUD a good option for women who are not ready to start a family. Even though an IUD can stay in place for a long time, the doctor or nurse practitioner can remove it at any time.
Does an IUD Help Prevent STDs?
No. The IUD does not protect against sexually transmitted diseases (STDs). Couples who are having sex must always use condoms along with the IUD to protect against STDs.
A doctor or nurse practitioner will check to be sure a woman doesn’t have any STDs before putting in an IUD. Getting an IUD put in while she has an STD could lead to pelvic inflammatory disease (PID).
Abstinence (not having sex) is the only method that always prevents pregnancy and STDs.
Are There Any Problems With IUDs?
The most common side effects of the IUD include:
- irregular bleeding for the first few months
- with the copper IUD, heavier periods with more cramps
- lighter and shorter periods (or no periods) with some kinds of progestin IUDs
- PMS-like symptoms such as moodiness, headaches, acne, nausea, and breast tenderness with the hormonal IUD
Rare problems include:
Expulsion. An IUD can come out of the uterus by accident (called “expulsion”). Sometimes a woman doesn’t know this has happened. If an IUD comes even part of the way out, it does not protect against pregnancy. A woman can check that an IUD is still in place by feeling for the string (a doctor or nurse practitioner can explain how to do this). After someone has an IUD inserted, she’ll need to go back for a follow-up visit to check that the IUD is properly in place.
Perforation of the uterus. There’s an extremely small risk that an IUD might push through the wall of the uterus while it is being put in.
Pelvic inflammatory disease (PID). There’s a very low risk of infection from bacteria getting into the uterus during IUD insertion. Most such infections happen in the first 20 days after placement of the IUD.
Who Is an IUD Right for?
IUDs are a good birth control option for many girls and women. However, IUDs aren’t recommended for someone:
- with PID or an active STD infection
- who is already pregnant or may be pregnant
- who has problems with her uterus, like a disease or malformation, or has abnormal bleeding
Experts recommend IUDs as a good birth control option for younger women and teens because they last for many years, need no daily care, and are very effective at preventing pregnancy.
Where Are IUDs Available?
An IUD must be inserted by a doctor or
nurse practitioner. This can be done at the doctor’s office, or at a health clinic, like Planned Parenthood. It can be inserted anytime during a menstrual cycle as long as she is not pregnant.
How Is an IUD Put In?
The doctor or nurse practitioner puts the IUD in through the vagina, past the cervix, and into the uterus. This only takes a few minutes from start to finish. People usually feel some cramping during the placement, but it gets better within a few minutes.
Taking it easy for the rest of the day, using a heating pad, and taking over-the-counter pain medicine can help with any discomfort after the IUD is placed.
How Much Does an IUD Cost?
An IUD can cost anywhere from $0 to $1,300. The cost can vary depending on your health insurance and the type of IUD. Many health insurance plans cover the costs, and family planning clinics (such as Planned Parenthood) may charge less.
Because an IUD lasts for many years, the cost works out to about the same as monthly birth control methods, such as the Pill or ring.
When Should I Call the Doctor?
If you have an IUD, call the doctor if you:
- might be pregnant
- notice a chance in the length of the IUD string
- have a change in the smell or color of vaginal discharge
- have lasting cramping or pain
- have unexplained fever or chills
- have belly or pelvic pain
- have pain during sex
- have heavy or long-lasting vaginal bleeding
IUD (Intrauterine Device) Birth Control: Effectiveness & Side-Effects
If you’re looking into your options for birth control, one method you may want to think about is the IUD. They’re not for everyone, but today’s IUDs are considered both effective and safe for most women. And they’re also long-lasting.
What Is an IUD?
“IUD” stands for “intrauterine device.” Shaped like a “T” and a bit bigger than a quarter, an IUD fits inside your uterus. It prevents pregnancy by stopping sperm from reaching and fertilizing eggs.
Five types are available in the United States.
Four — Liletta, Kyleena, Mirena, and Skyla — release small amounts of the hormone progestin (levonorgestrel) into your body. It’s the same hormone used in many birth control pills. These types of IUDs tend to make your period lighter and may be a good option if you have heavy periods.
The fifth is ParaGard, also called the copper T IUD. It’s hormone-free. The copper triggers your immune system to prevent pregnancy. It can cause your periods to be heavier, especially at first. But ParaGard lasts longer than hormonal IUDs. Watch a video on the basics of an IUD.
How effective are IUDs?
If you use an IUD correctly, your chance of getting pregnant is less than 1%.
What are the benefits of IUDs?
- They last a long time.
- They’re mostly hassle-free. Once you have one inserted, you don’t have to think about it, and neither does your partner.
- It’s one cost, upfront.
- They’re safe to use if you’re breastfeeding.
Read more about other benefits of birth control beyond pregnancy prevention.
Who can use them?
Most healthy women can use an IUD. They’re especially suited to women with one partner and at low risk of contracting an STD. IUDs don’t protect against STDs. You shouldn’t use one if:
- You have an STD or had a recent pelvic infection.
- You’re pregnant.
- You have cancer of the cervix or uterus.
- You have unexplained vaginal bleeding.
You can’t use the copper IUD if you have an allergy to copper or have Wilson’s disease, which causes your body hold too much copper.
Hormonal IUDs are considered safe unless you have liver disease, breast cancer, or are at a high risk for breast cancer.
In rare cases, the size or shape of your uterus may make it tough to place an IUD. Watch a video on the truth about IUDs and their safety.
How is an IUD inserted?
Your doctor will insert the IUD during an office visit. They may suggest you take over-the-counter pain medication such as ibuprofen a few hours before the procedure to offset cramping.
The procedure starts out similar to getting a Pap smear. You’ll put your feet in stirrups. The doctor will then place a speculum in the vagina to hold the vagina open. The doctor will put the IUD in a small tube that they’ll insert into your vagina. They’ll move the tube up through the cervix and into the uterus. Then they’ll push the IUD out of the tube and pull the tube out. Strings attached to the IUD will hang 1-2 inches into the vagina.
The procedure is uncomfortable, and you may have cramps and bleeding, but they tend to go away in a few days. Some women may also feel lightheaded from the pain.
You can have most IUDs placed at any time in your cycle. But it may be more comfortable to have one inserted while you’re having your period. This is when your cervix is most open. Find out more on what to expect with IUD insertion.
How soon do IUDs start working?
The non-hormonal ParaGard is effective as soon as it’s inserted.
If it’s put in during your period, hormonal IUDs start working right away. Otherwise, this type may take up to 7 days to be effective.
How long does one last?
This depends on what kind of IUD you get.
- 3 years for Skyla
- 5 years for Kyleena
- 6 years for Liletta and Mirena
- 10 years for ParaGard
Learn more about the types of IUDs and which one is right for you.
Will my periods change?
With hormonal IUDs, many women have fewer cramps. For the first few months, some women have irregular spotting. Eventually, most women have light periods or no period at all. Pregnancies rarely happen with IUDs, but if not having a period will make you constantly worry that you’re pregnant, you may want to consider the copper IUD instead.
The copper ParaGard may make periods heavier and cramping worse. This may go away after a few months. Read more on how to use birth control to stop your period.
Can my partner feel it?
Your partner shouldn’t be able to feel anything, but if they do, it will only be minor contact with the strings of the IUD. This shouldn’t cause any discomfort. The strings soften the longer you have the IUD and can be trimmed shorter.
Are there side effects?
IUDs are safe. Some women do have side effects, but most are mild. Serious problems with them are rare.
Some women feel lightheaded right after their doctor inserts the IUD, but the feeling should pass after a few minutes. In the first few days after insertion, you can expect to have period-like cramps.
You’re very unlikely to get pregnant while you have an IUD. But if it happens, it raises your risk for miscarriage, infection, and early labor and delivery. It also puts you at risk for an ectopic pregnancy, when a fertilized egg implants outside of your uterus. Let your doctor know if you think you might be pregnant or if you have belly pain or vaginal bleeding.
About 1 in 10 women will get ovarian cysts in the first year after they get an IUD. They’re usually harmless and go away on their own within 3 months. But some can cause bloating, swelling, or pain in the lower belly. If a cyst ruptures, it will cause severe pain. See your doctor if you have these symptoms.
An IUD slightly raises your odds for pelvic inflammatory disease (PID), which is an infection of the uterus, fallopian tubes, or ovaries. Signs include belly pain, pain during sex, smelly vaginal discharge, heavy bleeding, chills, and fever. Let your doctor know about these symptoms right away. It’s important to treat PID quickly to prevent more serious problems.
It’s rare, but an IUD can poke through the wall of your uterus as your doctor puts it in. It’s called perforation. If it happens, your doctor will have to remove the device. Know more about the side effects of an IUD.
Can my IUD fall out?
Your doctor will check your device during your regular office visits. Your cervix should hold the IUD in place, but in rare cases, it can fall all the way or part of the way out.
This is more likely if:
- You don’t have children.
- You’re under 20 years old.
- You had the IUD put in right after having a baby or after having a second-trimester abortion.
- You have fibroids in your uterus.
- Your uterus is an unusual size or shape.
IUDs are more likely to come out during your period. You may see the device on a pad or tampon. Check periodically to make sure you can feel the strings. If they feel shorter or longer or if you can feel the IUD itself pushing against your cervix, it may have moved. If this happens, contact your doctor.
What if I want to have kids in the future?
Using an IUD shouldn’t affect your ability to have children later on. If you want to get pregnant, ask your doctor to take out your IUD. Your cycle should return to normal as soon as the IUD is removed. Get more information on pregnancy and IUDs.
How is an IUD removed?
Your doctor will take out the IUD in their office. It should only take a few minutes. You’ll put your feet in stirrups and the doctor will use forceps to slowly pull the IUD out. You may have some cramping and bleeding, but this should go away in 1-2 days. Learn more about what to expect with IUD removal.
Mirena IUD | Uses, Pros and Cons, Interactions & Cost
What Is Mirena?
Mirena birth control is a T-shaped intrauterine device (IUD). Bayer manufactures Mirena. The IUD contains levonorgestrel, a type of hormone that prevents pregnancy.
Mirena lasts for up to five years, according to 2017 Mirena prescribing information.
The U.S. Food and Drug Administration approved Mirena birth control for the U.S. market in December 2000. In 2009, the FDA approved Mirena to treat heavy periods (menorrhagia).
Did You Know?
Women with heavy periods had 62 percent to 94 percent less blood loss after three months on Mirena.
Bayer markets two other IUDs that are part of the Mirena birth control family: Kyleena and Skyla. Of the three IUDs, Mirena releases the largest amount of hormones. It also has a greater chance of stopping periods in the first year.
Potential complications of Mirena include ectopic pregnancies and perforation of the uterine wall or cervix. Mirena may also cause severe infections, including pelvic inflammatory disease (PID) and sepsis.
Women who say the IUD injured them filed thousands of Mirena lawsuits. As of July 16, 2018, nearly 600 Mirena lawsuits remain pending in federal court, according to the U.S. Judicial Panel on Multidistrict Litigation.
How Does Mirena Work?
Mirena birth control works by releasing levonorgestrel. This hormone thins the lining of the uterus. It also thickens the mucus in the cervix.
As a result, sperm has a hard time moving and surviving in the uterus. This prevents pregnancy.
The thinning of the uterine lining can also reduce or stop menstrual bleeding.
Mirena is more than 99 percent effective at preventing pregnancy, according to Bayer. The FDA approved using it for up to five years.
Mirena Insertion and Removal
Doctors place the Mirena IUD in the uterus.
Women can have Mirena birth control inserted during a regular doctor’s visit. Mirena insertion takes about five minutes.
Doctors use a few tools to help insert the device but the insertion is not considered surgery.
Women should wait at least seven days after the start of their period to insert Mirena. Women who have just given birth, had a miscarriage or an abortion should wait at least six weeks.
A doctor or other trained health provider can remove Mirena at any time.
Eight out of 10 women who have had their Mirena IUD removed can get pregnant within a year, according to Bayer’s Mirena Handbook.
Health care providers must remove Mirena if it moves out of place. If a patient is not pregnant, she can get a new IUD inserted.
Not all women experience Mirena side effects in the same way. Some women may have pain during insertion and for several days after. Others experience only minor discomfort or cramping. There’s also the potential for more serious complications such as perforation or Mirena migration.
Side effects and complications of Mirena include:
Unexpected pregnancy, including ectopic pregnancy
Spontaneous abortion or loss of pregnancy and preterm labor
Pelvic inflammatory disease (PID) or other severe pelvic infections, including sepsis
Intracranial hypertension or pseudotumor cerebri (unexplained pressure inside the head that can lead to vision loss)
Some websites refer to Mirena removal side effects as the “Mirena Crash” But there have been no official studies done on the crash.
After doctors remove Mirena, the sudden change in hormone levels can cause a number of symptoms. These include mood swings, breast tenderness, nausea, sadness or depression and flu-like symptoms.
Who Should Not Use Mirena?
Women who are pregnant or suspect they may be pregnant, should not use Mirena.
Patients with the following health conditions should not use Mirena
- Uterine abnormalities (including fibroids)
- History of pelvic inflammatory disease
- Postpartum endometriosis or recent infected abortion
- Abnormal Pap smear
- Genital bleeding
- Vaginal, cervical or genital infections
- Liver disease or tumors
- Breast cancer
- Known hypersensitivities to the IUD or any of its’ components
In some cases, there may be other birth control options available.
Patients should discuss all medications with their doctor before using Mirena.
Drugs and herbal supplements can make Mirena less effective. Examples of these substances include some blood thinners, anti-anxiety drugs and anti-seizure medications. Anti-retroviral drugs, antibiotics and St. John’s Wort may also interact with Mirena.
Some interaction can be dangerous to women’s health.
Mirena can cost anywhere from $0 to $1,300. Under the Affordable Care Act (also known as Obamacare), plans in the Health Insurance Marketplace must cover some type of contraception.
If women work for a religious employer, such as a church, they may have to pay for Mirena out-of-pocket. Programs such as Planned Parenthood may offer the IUD at a reduced cost.
Mirena Pros and Cons
There are good things and bad things about Mirena and other hormonal IUDs, according to Birthcontrol.com. Women should weigh all the risks and benefits before using Mirena.
“I will say there are times when Mirena is needed, and it is often a better choice than surgery or full-dose hormonal birth control.”
- Mirena is more than 99 percent effective.
- Women don’t have to worry about remembering to take a pill.
- It lasts up to five years, according to the FDA.
- Most insurance plans cover Mirena.
- It is long-term and reversible birth control.
- Women can still breastfeed.
- It uses a lower dose of hormones than some other birth control methods.
- It reduces or stops menstrual flow in women who don’t want a period or suffer from excessive bleeding.
- It may cause ovarian cysts.
- Pregnancy with Mirena can be life-threatening.
- IUDs can become infected during insertion.
- Device insertion can cause perforation.
- It doesn’t protect against STDs.
- Devise expulsion can occur, leaving the woman at risk of pregnancy.
Mirena Research and Studies
Since the FDA approved Mirena, it has been the subject of several studies. Some findings were positive. Others were negative.
For example, a 2017 study released in Obstetrics & Gynecology found invasive cervical cancer may be less frequent in women who use IUDs.
In 2018, the University of California released information that suggests the Mirena IUD may work longer than five years. Out of 500 women who kept their Mirena implant for seven years, only two women got pregnant.
A new Bayer clinical trial will test how effective and safe Mirena is after five years. The company should finish the study in 2021.
But a 2015 study in Therapeutic Advances in Drug Safety found a higher number of intracranial hypertension reports than expected in the FDA’s FAERS database. Intracranial hypertension is a condition where the pressure increases in the skull. Symptoms may mimic a brain tumor.
A 2016 study in Open Access Journal of Contraception found that most cases of IUD perforation happened during insertion. But, perforation could also occur if the IUD gradually eroded the uterine wall.
Please seek the advice of a medical professional before making health care decisions.
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Everything You Should Know About the IUD
What is an IUD?
IUD stands for “intrauterine device.” Shaped like a “T” and slightly larger than a quarter, an IUD fits inside your uterus, and is one of the safest, most effective methods for preventing pregnancy. While the IUD is a good choice for women or teens who do not want to get pregnant for at least one year, some women use IUDs for reasons other than birth control. For example, one type of IUD can be used to treat heavy, painful periods, or anemia from heavy periods. They can also be useful for emergency contraception, given that they are effective immediately after placement and do not require time for hormones to take effect.
How does an IUD work?
IUDs prevent pregnancy by preventing sperm from reaching and fertilizing eggs, although some aspects of the precise mechanism of action are unknown. IUDs are not abortifacients; in other words, they do not interrupt an implanted pregnancy. Pregnancy is prevented by a combination of the “foreign body effect” of the plastic frame and the specific action of the medication (copper or Levonorgestrel) that’s released, which impairs sperm function and implantation, and prevents fertilization.
How does IUD insertion and removal work?
An IUD can be inserted in your gynecologist’s office setting. The best time to have an IUD inserted is during your period, as this is when your cervix is most open. Overall, the entire procedure takes less than five minutes. You may experience some mild cramping from insertion, so some women often choose to take over-the-counter pain medication, such as ibuprofen or acetaminophen, before coming to the office.
Once inserted, an IUD can be removed on request, or at the time of expiration, approximately three to 10 years later. Removal takes about two to three minutes by your gynecologist in the office. You may experience some normal cramping and bleeding as a result, but this should go away quickly.
What are the different types of IUDs?
Five different IUDs are available in the United States, and they fall under one of two categories:
1. Copper-containing IUD (non- hormonal)
- There is only one copper-containing IUD. It is called Paragard and can stay in your uterus for up to 10 years to prevent pregnancy. Some women who use it notice heavier or longer periods than they had before getting the IUD, especially at first. However, Paragard lasts longer than hormonal IUDs.
2. Progestin-releasing IUDs
- There are four progestin-releasing IUDs: Mirena, Kyleena, Skyla, and Liletta.
- Mirena, Liletta, and Kyleena can stay in your uterus for up to five years to prevent pregnancy, and Skyla can stay in place for up to three years. Many women who use progestin-releasing IUDs have lighter, less painful periods than they had before getting the IUD. Some women stop getting a period completely. This is not harmful and does not need to be treated. Regular periods return when the device is taken out.
The benefits of using an IUD
There are several benefits patients experience when using an IUD. For example:
- IUDs are very effective. Fewer than 1 in 100 women who use these devices get pregnant during the first year of using them.
- They’re mostly hassle-free. You do not have to remember to do anything or take any birth control medicines on a regular basis.
- IUDs have few side effects.
- IUDs do not contain estrogen, a hormone that some women can’t take.
- If you decide you want to get pregnant, you can have the IUD taken out.
- If you use an IUD for several years, it costs less overall than many other types of birth control. That’s because there are no costs after you have it inserted.
- They’re safe to use if you’re breastfeeding.
Effectiveness & reversibility
Let’s talk more about the effectiveness of the IUD. If you use an IUD correctly, your chance of getting pregnant is less than 1%. Here is a breakdown of birth control methods and their effective rates:
- Nexplanon, IUDs, and bilateral tubal ligation have a failure rate for typical use of less than one in 100 women per year.
- Birth control pills, the patch, the Depo-Provera injection, and the ring have a failure rate for typical use of six to 12 in 100 women per year.
- Natural family planning, the pull out method, and condoms have a failure rate for typical use of 18 or more in 100 women per year.
Using an IUD should not affect your ability to have children later on. If you want to get pregnant, simply ask your doctor to remove your IUD. Your cycle should return to normal very soon after the IUD is removed, and you can then begin trying to conceive.
The disadvantages of using an IUD
While there are many benefits to using an IUD, there are still some downsides that should be considered. For example:
- You may experience changes in your bleeding patterns. With Paragard, some women have heavier or longer periods than they had before getting the IUD, especially at first. On the other hand, with the progestin releasing IUDs, you can have irregular bleeding, lighter periods, or no period at all.
- Unlike condoms, an IUD does not protect you against sexually transmitted infections. However, you and your partner can use a condom to prevent spreading infections.
- There is a small chance the IUD will come out during your period. If this happens, you will need a new IUD. If you see your IUD in your underwear, on your pad, or in the toilet, call your care provider. You will have a follow-up visit after it is placed to ensure correct placement.
- Only a doctor or nurse can insert or remove an IUD.
Who should not use an IUD?
There are some women should, for medical reasons, avoid using an IUD. Some examples are below.
- You can’t use a copper IUD if you have an allergy to copper or have Wilson’s disease, which causes your body hold too much copper.
- Women with liver disease or breast cancer should not use a hormonal IUD.
- Women who have an STD or who have had a recent pelvic infection should not use an IUD.
- Pregnant women should not use an IUD.
- Women who have cancer of the cervix or uterus should not use an IUD.
- If you have unexplained vaginal bleeding, it is best to avoid the IUD.
Don’t be afraid to speak up
As a physician myself, I can tell you firsthand that your care provider is happy to answer any questions you may have about your birth control methods or the IUD. It’s what we’re here for!
If you already have an IUD placed, you should know there are several reasons for which you may need to let your care provider know you have a problem. In particular, you should see your doctor or nurse right away if:
- You have bad pain in your lower belly
- You have a positive pregnancy test
- You cannot feel the string of the IUD or if the string seems shorter than usual
- You think your IUD might have moved or fallen out
- You had sex with someone who has or might have an STD, or you think you have an STD
Your gynecological health is important, and the IUD is just one excellent method for birth control today. Speak with your physician to determine the best course for you.
Author: Melanie Schatz, MD, a board-certified OB/GYN with Main Line OB/GYN Associates.
To schedule an appointment with Dr. Schatz, call (610) 688-3744.
Mechanisms of action of intrauterine devices
The major effect of all intrauterine devices (IUD) is to induce a local inflammatory reaction in the endometrium whose cellular and humoral components are released into the uterine cavity. This inflammatory reaction has a variable effect on the reproductive strategy of the species studied. For example, this foreign body reaction can be localized within the uterus of rodents; and in farm animals it can have striking extrauterine effects. Thus, the action of IUDs in humans cannot be discerned from animals. In humans, copper ions released from Cu-IUDs enhance the inflammatory response and reach concentrations in the luminal fluids of the genital tract that are toxic for spermatozoa and embryos. In women using the IUD, the entire genital tract seems affected, at least in part, because of luminal transmission of the fluids that accumulates in the uterine lumen. This affects the function or viability of gametes, decreasing the rate of fertilization and lowering the chances of survival of any embryo that may be formed, even before it reaches the uterus. Studies on the recovery of eggs from women using IUDs and from women not using contraception show that embryos are formed in the tubes of IUD users at a much lower rate compared with nonusers. This is believed to be the major action of IUDs. Therefore, the common belief that the major mechanism of action of IUDs in women is through destruction of embryos in the uterus (i.e., abortion) is not supported by the available evidence. In Cu-IUD users, it is likely that few spermatozoa reach the distal segment of the fallopian tube, those that encounter an egg may be in poor condition. Thus, the few eggs that are fertilized have little chance for development and their possibility for survival in the altered tubal milieu become worse as they approach the uterine cavity.
All IUDs induce a local inflammatory reaction that disturbs the functioning of the endometrium and myometrium and changes the microenvironment of the uterine cavity. Moreover, these effects alter signaling between uterus and ovary. The entire genital tract seems affected, at least in part because of luminal transmission of fluids accumulating in the uterine lumen. Copper or progesterone-releasing IUDs may attenuate or accentuate the inflammatory response, disturb the physiology of the gametes in the female genital tract, or destroy the viability of the embryos or endometrial receptivity to implantation. Studies on the recovery of eggs reveal that embryos are formed in the tubes of IUD users at a significantly lower rate compared to non-users. This, rather than the destruction of embryos in the uterus, appears to be the IUD’s major mechanism of action.
Hormonal IUDs Are a Viable and Underutilized Method for Emergency Contraception
Jan 27, 2021 3:00 PM
A new University of Utah Health study determined that hormonal IUDs (left) were comparable to copper IUDs (right) for use as emergency contraceptives. Photo credit: Getty Images
Researchers and clinicians have long known that copper intrauterine devices (IUDs) work extremely well for emergency contraception. But few bothered to examine the possibility of using hormonal IUDs for the same purpose.
Now, in a first-of-its-kind study, University of Utah Health scientists found that hormonal IUDs were comparable to copper IUDs for use as emergency contraceptives. The researchers say the finding supports adding hormonal IUDs to current emergency contraception options. They conclude that using hormonal IUDs could have dramatic effects on emergency contraception, including reducing menstrual bleeding and cramping associated with copper IUDs.
The study appears in the Jan. 28 issue of the New England Journal of Medicine.
“These findings support using hormonal IUDs as a safe and viable alternative for women seeking to prevent pregnancies up to five days after intercourse,” says David Turok, M.D., M.P.H., lead author of the study and an associate professor in the Department of Obstetrics and Gynecology at U of U Health. “As an emergency contraceptive, it appears to be no worse than a copper IUD and is way better than the morning-after pill. ”
He adds, “And, unlike emergency contraception pills, hormonal IUDs can continue to provide highly effective contraception for up to seven years.”
The risk of pregnancy after using morning-after pills is about 2%, Turok says. In comparison, the 0.1% risk of pregnancy with copper IUDs is far less. In this study, the risk with hormonal IUDs was 0.3% and statistically was not less effective than the copper.
“I was surprised to see that the hormonal IUD worked just as well as the copper IUD.”
All hormonal IUDs approved in the U.S. contain a synthetic version of the hormone progesterone called levonorgestrel (LNG). This study used the Liletta IUD; Mirena, another type of hormonal IUD, uses the same amount of LNG as Liletta.
When people are offered both hormonal and copper IUDs, they more frequently choose the LNG IUD. However, unlike copper IUDs, little or no research had been conducted on the LNG IUD use as an emergency contraceptive device. As a result, few, if any, medical providers have used LNG IUDs for this purpose.
To address this concern, the U of U Health researchers decided to test the effectiveness of LNG IUDs versus copper IUDs. Over a three-year period beginning in August 2016, they recruited more than 700 people, ages 18 to 35, who were seeking emergency contraception at six Utah Planned Parenthood health clinics.
David Turok, M.D., M.P.H., and Lori Gawon, M.D., M.P.H. and colleagues at University of Utah Health found that hormonal IUDs are a safe and effective form of emergency contraception for women seeking to prevent pregnancies up to five days after intercourse. Photo credit: Charlie Ehler
All of the participants had unprotected intercourse at least once in the previous five days. In addition, they had regular menstrual cycles, knew the date of their last menstrual period, had a negative urine pregnancy test, wanted to prevent pregnancy for at least a year, and were interested in using an IUD. The participants were randomly assigned to receive either an LNG or copper IUD. One month later, none of the 321 participants who received a copper IUD were pregnant. Pregnancy occurred in only one of the 317 participants who received LNG IUDs.
“While I assumed the hormonal IUD would work for emergency contraception, I was surprised to see it worked just as well as the copper IUD,” says Lori Gawron, M.D., M.P.H., a study co-author and an assistant professor in the Department of Obstetrics and Gynecology at U of U Health. “This finding is exciting because it will give people more options for both emergency and ongoing contraception and decrease barriers to same-day IUD placement when patients want one.”
Turok adds that this research supports providing IUDs to those who want one at any point in the menstrual cycle, regardless of recent unprotected intercourse, giving women more opportunity for intervention than current medical recommendations.
The researchers obtained urine pregnancy tests from about 93% of the participants. They ruled out pregnancy in the remaining 7% based on survey information and clinical reports. Among other study limitations was that although participants were unaware which device they received in the first month of use, the nurse practitioners who placed them knew which device was implanted in each patient. That’s because of distinct differences in the appearance of these IUDs.
The last new method of emergency contraception was approved for use by the Food & Drug Administration nearly 15 years ago. According to the researchers, LNG IUDs may become an attractive choice because they are used widely and are already FDA-approved for use as birth control.
“This is all about increasing access and options for people,” Turok says. “It’s about supporting their opportunity to live the life they want and have meaningful sexual relationships in ways that are not tied to pregnancy.”
In addition to Dr. Turok and Dr. Gawron, Alexandra Gero, Rebecca Simmons, Jennifer Kaiser, Gregory Stoddard, Corrine Sexsmith, and Jessica Sanders of University of Utah Health contributed to this study.
The study, “The Levonorgestrel vs. Copper Intrauterine Device for Emergency Contraception,” appears in the New England Journal of Medicine. The study was supported by the Eunice Kennedy Shriver National Institute of Institute of Child Health and Development.
90,000 History of Judas. How was it really? – Orthodox journal “Thomas”
Estimated reading time: 12 minutes.
Since the time of the Gospel events, mankind does not know a name more shameful and lower than the name of Judas Iscariot. The story of how one of Christ’s closest disciples for thirty pieces of silver betrayed his Divine Teacher to be crucified is known today even by people who have never read the Bible in their lives. But those who have read the Gospel story of the betrayal of Judas inevitably have a number of questions.Judas’s actions are striking with some amazing internal inconsistency. Indeed, even in betrayal there must be a certain logic. And what Judas did is so contradictory and meaningless that it does not even fit into the logic of betrayal. However, up to a certain point, his actions are clear. Thinking of betraying Christ, Judas goes to the high priests and says: What will you give me if I betray Him to you? They offered him thirty pieces of silver; and from that time on he sought an opportunity to betray Christ.The chance turned up the very next night. Judas leads an armed detachment of soldiers and servants of the high priests to the Garden of Gethsemane, where Christ and the apostles usually spent the night. “But the one who betrayed Him gave them a sign, saying: Whom I kiss, he is, take him. And immediately going up to Jesus, he said: Hail, Rabbi! And he kissed Him. But Jesus said to him: Friend, why have you come? ”
And here the question arises: why, in order to point to Christ, Judas chose such a defiantly arrogant way? After all, usually a traitor is ashamed to even look his victim in the eyes.And here he openly greets Christ, not at all hiding his intentions to give Him into the hands of the servants of the high priests. This behavior could be explained by the complete indifference of Judas to the fate of the Christ betrayed by him. But there is a circumstance that does not allow one to interpret Judas’s kiss so simplistically. Because upon learning about the condemnation of Christ to death, Judas hanged himself. This is how the Evangelist Matthew describes it.
Judas. Nikolay Ge
“Then Judas, who betrayed Him, seeing that He was condemned, and repented, returned the thirty pieces of silver to the chief priests and elders, saying: I have sinned by giving up innocent blood.But they said to him: what do we care about? Take a look yourself. And, throwing the pieces of silver in the temple, he went out, went and hanged himself. “(Mt 27 : 3-5).
It turns out a paradox. If Judas hated Jesus or was simply petrified in heart and was indifferent to Him, then why did he commit suicide? After all, only the death of the one without whom life loses all meaning can push a person to commit suicide. So Judas loved Christ? But then why did he so easily put Jesus into the hands of those who sentenced Him to death?
The story of the payment for betrayal only adds to the bewilderment.The Gospel text unequivocally testifies that Judas betrayed his Teacher for thirty pieces of silver. But if they were the purpose and cause of Judas’ betrayal, then why, after the fulfillment of his plan, does he so easily return these pieces of silver back? And if they were not valuable to Judas, then why did he go for the betrayal that cost him his own life?
All these questions arise because betrayal is the secret of a sick soul. A traitor nurtures his criminal plans in his heart and carefully hides them from others.Judas did not reveal his intentions to anyone until his inglorious death. And the evangelists, of course, could not know exactly what was going on in his soul. The Gospel tells about betrayal very sparingly and this is quite natural, because the Gospel is the story of our salvation, and not the story of Judas’ betrayal. Evangelists are interested in Judas only in connection with the Sacrifice of the Savior on the Cross, but not in itself. Therefore, the story of the fall of Judas will forever remain a mystery. However, this mystery has always worried people.Even the apostles at the Last Supper, when the Lord warned that one of them would betray Him, began to excitedly ask each one to himself: “Is it not me?” And every Christian, reading the Gospel, asks this question: “Have I never betrayed Christ with my sins?” The ancient Christian interpreters also turned to the topic of betrayal, but especially often it began to sound in the works of modern theologians and philosophers. This is not surprising, because the time is now “very wrong”, traitors are honored, and loyalty is not in vogue.
However, since very little is said about Judas in the Gospel, an attempt to comprehend his betrayal always requires reconstruction of the missing facts with varying degrees of probability. Such an interpretation, of course, cannot claim to be definitive or unambiguous, but some information about Judas given in the Bible can shed light on his dark history. And one most important fact, without knowing which it is impossible to understand the inner motives of Judas, is cited in his Gospel by the Apostle John.
The fact is that Judas was a thief.
… And I will buy the collected estates …
This is what the Bible says about the theft of Judas: “Mary, taking a pound of pure precious nard ointment, anointed Jesus’ feet and wiped His feet with her hair; and the house was filled with the fragrance of the world. Then one of His disciples, Judas Simon Iscariot, who wanted to betray him, said: why not sell this ointment for three hundred denarii and give it to the poor? He said this not because he cared about the poor, but because he was a thief.He had a cash drawer with him and carried what was put there ”(Jn 12 : 3-6). In the Greek original of the Gospel, this is said even more categorically, because the use of the Greek language makes it possible to understand the word translated as “worn,” in the sense of stealing.
Judas was the treasurer of the apostolic community. He had quite significant sums at his disposal, since among the admirers of Jesus there were rich women who were healed by Him from evil spirits and incurable diseases. They all served Christ with their property.But since the Lord was absolutely indifferent to wealth, the donated money was mostly distributed to the poor, with the exception of small expenses for the sustenance of Christ himself and his disciples. The monetary affairs of the apostles were handled by Judas. The amounts distributed to the beggars were not accountable, no one could check whether Judas distributed the money, or appropriated part of it to himself. This unaccountability, obviously, in an unkind hour, seduced the money-loving Judas. Of course, he could not openly spend the stolen money. Transferring them from a box to your pocket would be stupid and inconvenient.Apparently he had some secluded place where he kept the stolen wealth. This treasure as the reason for the betrayal of Judas is directly spoken of in the liturgical tradition of the Church. This is what the Church sings on Holy and Maundy Thursday during Holy Week in one of the stichera of the morning Divine Service:
“Judas, slave and flatterer, disciple and lieutenant, friend and devil, appeared from deeds: follow the Teacher, and listen to the tradition against him, verbally: – I will betray Him, and I will acquire the collected property (wealth) …”
It is impossible to find out exactly when he first put his hand into the apostolic treasury.But there is no doubt that Judas stole from there much more than thirty pieces of silver. It is also clear that Judas could use the stolen wealth only on one condition: if the apostolic community ceases to exist. And he got his way. After the arrest of Christ, even the most faithful and devoted disciples to Him fled in fear in all directions. And here a new series of incongruities arises. Instead of taking the collected treasure, adding to it the payment for the betrayal, and finally healing for his own pleasure, Judas suddenly commits suicide.
Judas Iscariot throwing a silver coin. Platon Vasilievich Vasiliev. 1858 g.
This can be explained in different ways. It is only quite obvious that neither the thirty pieces of silver nor the stolen treasure he collected were no longer the main value in life for Judas. But what could devalue in the eyes of a thief the state that he systematically accumulated over the course of three years? The answer suggests itself. More expensive than big money for a thief and a money-lover is only … – a lot of money.
The disciples recognized in Christ – the Messiah.But just like all Jews, they saw in the Messiah an earthly ruler who, having come to power, would make Israel the strongest and richest country on earth. The Messiah-king was supposed, according to their ideas, to subjugate all the peoples of the world. And all the numerous parables and explanations of Christ that His Kingdom is not of this world, could not convince the apostles. Until His Ascension, they were sure that the Lord would finally become the earthly king of Israel. The disciples of Christ saw themselves as the closest assistants and co-rulers of the Messiah and even argued about which of them would be more important in the new government of the Kingdom of Israel.Money-loving Judas, of course, was no exception here.
If Christ becomes king, then he, Judas, will become the king’s treasurer, that is, the most influential person in Israel after the Messiah. In his dreams, he already imagined how he did not manage the apostolic money box, but the treasury of the richest state in the history of mankind.
Becoming a thief, Judas at first made plans to betray Christ in order to acquire the collected money, as the Church sings about it.But the name of Christ became more and more glorious among the people of Israel. After the unprecedented miracle – the resurrection of the dead Lazarus – even those Jews who had previously tried to stone Christ, saw in Him the Messiah. When Jesus entered Jerusalem, the inhabitants of the capital paid him royal honors, covering His path with their robes. After such a reception, it became simply unprofitable for the practical and greedy Judas to betray the future king for the sake of the stolen money. The love of money and theft burned his soul to ashes. Even the Messiah-king, he was going to use as a means to satisfy his passion for wealth.
And suddenly it turned out that Christ was not going to reign. The Israeli treasury, to which there were only a couple of steps, again became unattainable for Judas. It was necessary to urgently take some kind of decision to rectify the situation. And the decision was made.
And the one whom Christ called – “a murderer from the beginning” prompted him to the traitor. True, Judas did not know then that this prompter would eventually drive him into a noose.
Council of Satan
All interpreters of Holy Scripture unanimously affirm that Judas betrayed the Savior through the direct suggestion of the devil.The Gospel text directly testifies to this: “Satan entered Judas, called Iscariot, one of the Twelve, and he went and talked with the chief priests and rulers how to betray Him” (Luke 22: 3-4).
In Orthodox asceticism, the effect of the devil on the soul of a person is described as follows. An evil spirit gains access to a person through his passions (that is, sick inclinations of the soul). Mentally, he whispers how best for a person to satisfy his sick desires, and step by step leads his victim to death.Moreover, first the devil assures the person that sin, they say, is not so great, but God is merciful and will forgive everything. But then, after committing a sin, an evil spirit plunges a person into an abyss of despair, inspiring him that his sin is immeasurable, and God is inexorable. But what did Satan whisper to Judas, with what promise did he tempt him to betray Christ?
Judas’ greatest passion was the love of wealth – the love of money. And the most cherished desire, perhaps, is the post of Minister of Finance in the kingdom of the Messiah, where he could steal such amounts that the most successful thieves in the world never dreamed of.And this cherished goal was already very close.
But Christ was in no hurry to become the religious and political leader of Israel. Arriving in Jerusalem, He did not cast out the high priests and elders in order to rightfully take their place. All plans of Judas collapsed.
At this moment, Satan, obviously, gave him a thought that prompted him to betray. Judas knew that the chief priests and Pharisees, fearing Jesus, gave the order that “if anyone knew where He would be, he would declare in order to take Him.”Judas also knew that Christ avoided direct conflict with the authorities.
And so, incited by Satan, he decides to betray Christ in order to provoke an open clash between the high priests and the Messiah. Jesus’ victory in this conflict does not raise the slightest doubt in him. After all, he saw all the power of the Messiah, saw how the dead were raised at His command, how the storm obeyed Him, how evil spirits obey Him unquestioningly … Who can kill the Messiah? His word alone is enough, and even the indestructible iron legions of Rome will scatter without a trace, like dry leaves!
Blinded by the thirst for wealth and the whispering of Satan, Judas betrays Christ.But at the same time, even a thought does not admit that He can be killed. After all, in Jesus, who defeated the high priests, there was all his hope, all the hope for the future.
Did Judas want Christ to die? No, because it was not profitable for him. Did Judas Love Christ? No, Jesus was just a means for him to become fabulously rich. With such a motive of betrayal, it becomes clear the strange way chosen by the traitor to point the guards at Christ at night in the Garden of Gethsemane. With a kiss, Judas simply showed his respect to the king who is about to defeat his enemies.
“… and has nothing in Me”
Satan instilled in Judas that Christ would certainly accept the challenge, sweep away the high priests, the Roman occupiers, and Himself will reign in Israel.
But he deceived Judas, as he should have deceived the father of lies – an unfortunate man, mired in the swamp of his passions and blinded by the brilliance of the ghostly treasures of a man. The idea that the Savior will abandon the Feat of the Cross, tempted by the earthly kingdom, is indeed satanic. With this thought, the Devil tempted Christ in the wilderness, before He went out to preach the Gospel.The evil spirit tried to instill the same idea in the Apostle Peter when he began to dissuade Christ from the atoning sufferings, and immediately received a harsh reprimand from Him: “… Get away from me, Satan! You are a temptation to me! Because you think not about what is of God, but what is human. ” The Savior knew very well who tried to speak to Him through the most devoted disciple, and he also knew and whom Judas believed. Just before the arrival of the traitor with a detachment of guards, Jesus said to his disciples: “It is already a little for me to speak with you; for the prince of this world is coming and has nothing in Me ”.The prince of this world, Christ called, of course, not Judas, but Satan. Who once again, now through a traitorous disciple, wanted to tempt the Savior with the temptation of earthly dominion. But the Lord walked the Way of the Cross, for the sake of which he came into this world. Satan was left with nothing, and Judas went bankrupt with him.
Christ really threw down the soldiers who had come to take him to the ground. But he did this only in order to let go of the disciples, who could also have suffered. And then he allowed himself to be tied up, obediently proceeded to the place of the trial and by the morning, in violation of almost all the norms of Jewish law, he was sentenced to death.
When Judas learned about the death sentence handed down to Christ, he realized that all his plans had collapsed. He became the culprit in the death of the greatest righteous man, he lost the right to be called a disciple of the Messiah … But the most terrible loss, probably, was that unfulfilled wealth, which Judas already considered his own. In his dreams, he already distributed the financial flows going to the treasury of the Messiah from all over the world. What, in comparison with this wealth, is the miserable treasure that was accumulated by a thief and a traitor during the years of preaching Christ? And, even more so, thirty pieces of silver … He took them only in order not to frighten off the high priests, so that they would believe in the sincerity of his desire to give them the Teacher.
Painting by Geliy Korzhev “Judas”
Everything ended for Judas, everything for which he lived turned out to be a ghost and a lie, a mocking mockery of the devil. And when in the Gospel we read that Judas repented, one should not be deceived by the noble sound of this word.
The traitor mourned not the Messiah, who was innocently given to death by him. He mourned his failed post of treasurer of the Messiah, which, as it seemed to him, he took away from himself, giving Christ to death. He could not survive this loss.But he was incapable of genuine repentance.
I would like to finish the sad story of the betrayal of Judas with the words of St. John Chrysostom:
“Notice this, you money-lovers, and think what happened to the traitor? How did he lose money, and sin, and destroy his soul? Such is the tyranny of avarice! I didn’t use the silver, neither the present life, nor the future life, but … I hanged myself. ”
• Judas – one of twelve
• Great Wednesday
90,000 Recommendations for the Management of Dyslipidemia and the Prevention of Cardiovascular Disease Associated with Atherosclerosis (American Association of Clinical Endocrinologists and American College of Endocrinology, 2017)
The full text of the guidelines is published in Endocr Pract 2017; 23 (4): 479-497 American Association of Clinical Endocrinologists and American College of Endocrinology Guidelines for Management of Dyslipidemia and Prevention of Cardiovascular Disease.
The presented document contains 87 recommendations, each recommendation has a gradation of the degree of evidence, consistency of expert opinions, the influence of subjective factors on decision-making; 45 recommendations belong to class A (51.7%), 18 – class B (20.7%), 15 – class C (17.2%) and 9 (10.3%) – class D. A, B and C have varying degrees of evidence based on clinical trials, while grade D is expert judgment in the absence of evidence. Each recommendation is based on a thorough review of available clinical trials.A total of 695 publications were included in the analysis; 202 (29.1%) have a strong level of evidence (1BEL), 137 (19.7%) – BEL 2 (medium), 119 (17.1%) – BEL 3 (weak) and 237 (34.1%) – BEL 4 (no clinical evidence). The annexes to the main body of the recommendation contain the relevant background information that was used in the preparation of the recommendation.
Selected provisions of the Recommendations are presented below.
It is recommended to use 1 or more of the following instruments to assess the 10-year risk of coronary events (the recommendations provide characteristics, risk levels and clinical examples corresponding to specific risk levels) (class C, BEL 4):
Recommendations for screening for dyslipidemia
Annual screening for dyslipidemia is indicated for all adults with diabetes mellitus (class B, BEL 2).
At ages 20-45 for men and 20-55 for women, screening for dyslipidemia is indicated every 5 years as part of the overall risk assessment (class C, BEL 4)
At the age of 45-65 years for men and 55-65 years for women in the absence of risk factors for CVCAA, screening is indicated at least once every 1-2 years. More frequent lipid testing is recommended when multiple risk factors for CVD are present (class A, BEL 1).
The frequency of lipid assessment should be based on the patient’s individual clinical characteristics and the clinical thinking of the clinician (grade C, BEL 4).
Over the age of 65, annual screening is indicated for both the absence and presence of 1 RF (class A, BEL 1).
Evaluation of the lipid spectrum is indicated for all elderly (over 65 years of age) with several common risk factors for CVCAA (except age) (class C, BEL 4).
Screening is indicated for older women to the same extent as for older men (class A, BEL 1).
If data for FHC are available, screening should be performed at age 3, repeated at age 9 to 11, and then at age 18 (class B, BEL 3).
Screening is indicated for adolescents over 16 years of age every 5 years, or more often if they have HF SSZAA; overweight or obesity, insulin resistance syndrome, FHC (class B, BEL 3). The LDL level ≥130 mg / dL in the recommendations is called as high for children and adolescents, 100-129 – borderline.
For familial hypercholesterolemia (FHH), all persons in the family who have:
- there were cases of early CVCAD (definite MI or sudden death before the age of 55 in the father or another relative of the first degree, or before the age of 65 in the mother or other relative of the first degree on the mother) or
90,475 elevated cholesterol levels (total, non-HDL and / or LDL cholesterol) were reported (grade C, BEL 4).
Recommendations for the determination of target lipid levels in persons with dyslipidemia and risk of CVCAA
Treatment goals for dyslipidemia should be personalized according to risk levels (see table 6 and table 12 in the text) (grade A, BEL 1).
At a low risk level (i.e. no risk factors), the recommended LDL-C target is <130 mg / dL (grade A, BEL 1).
At moderate risk (i.e. 2 or less RF and an estimated 10-year risk of less than 10%), the recommended LDL target is <100 mg / dL (grade A, BEL 1).
At high risk (eg, presence of CVAA or 2 or more RF and 10-year risk of 10-20%) LDL target <100 mg / dL (class A, BEL 1).
At very high risk (i.e. after hospitalization due to ACS, other diseases of the coronary, carotid or peripheral vessels; diabetes mellitus or CKD stage 3-4 with 1 or more RF and 10-year risk above 20%; or heterozygous SHC) LDL target <70 mg / dL (class A, BEL 1).
At extremely high risk (i.e.e. progressive course of CVSD, including unstable angina pectoris, which persists after reaching LDL cholesterol <70 mg / dl, or a combination of clinical manifestations of CVSAA with diabetes mellitus, stage 3 CKD and / or CKD) recommended goal of LDL cholesterol <55 mg / dl ( class A, BEL 1).
A target reduction in LDL cholesterol <100 mg / dl is considered acceptable for children and adolescents, with 100-129 mg / dl considered "borderline" and 130 mg / dl or higher considered "high" (grade D).
Adequate HDL cholesterol is> 40 mg / dL, but a higher level can be recommended, mainly due to lifestyle changes (e.g., weight loss, physical activity, and cessation of smoking) and if RF is present, pharmacotherapy directed at primarily to reduce LDL (class A, BEL 1)
The target non-high-density lipoprotein (total cholesterol – HDL) level for most people is 30 mg / dl higher than the target LDL (class D) level.
For those at increased risk, a target level 25 mg / dL higher than the individual target LDL cholesterol is recommended (class A, BEL 1)
With an increased risk of CVSAA, including in the presence of diabetes mellitus, the optimal target level of apolipoproteins (apoB) is <90 mg / dL, while in the presence of CVSAA or diabetes mellitus in combination with 1 or more additional RFs, the optimal target level of apoB is < 80 mg / dL, and for individuals with an extremely high risk of CVSAA <70 mg / dL (class A, BEL 1).
Target triglyceride level <150 mg / dL (Class A, BEL 1)
Lifestyle correction (class A, BEL 1) and patient education are recommended first, pharmacotherapy is prescribed as needed to achieve individually tailored lipid targets (class A, BEL 1).
Adults are encouraged to eat a reduced calorie diet that includes fruits, vegetables (≥5 servings per day), whole grains, fish, and lean meats (Grade A, BEL 1).Consumption of saturated fat, trans fat, and cholesterol in adults should be limited; the diet should contain plant stanols / sterols (~ 2 g / day) and soluble fiber (10-25 g / day) (Class A, BEL 1). All healthy children are advised to eat dietary food as primary prevention (class A, BEL 1).
Aggressive lipid-lowering drug therapy is recommended in individuals at increased risk of developing CVSAD to achieve appropriate LDL-C target levels (Table 13) (Class A, BEL 1).
Statin therapy is recommended as first line therapy (class A, BEL 1).
If a patient has a moderate increase in blood glucose and / or an increased risk of diabetes mellitus associated with intensive statin therapy, it is recommended to weigh the risk (of developing diabetes) / benefit (reducing the risk of developing CVD) when deciding whether to prescribe statins (class A , BEL 1).
In individuals belonging to high-risk and very high-risk groups, a further decrease in LDL cholesterol after reaching target levels while taking statins leads to an additional reduction in CVAA events (class A, BEL 1).
In the presence of established coronary, carotid and peripheral vascular disease or diabetes mellitus in combination with 1 or more additional RF while on statin administration, the target level of LDL reduction should be <70 mg / dL (class A; BEL 1).
For extremely high risk with statin therapy, the target LDL-C reduction should be <55 mg / dL (Class A, BEL 1)
Fibrates should be used to treat severe hypertriglyceridemia (TG> 500 mg / dL) (class A, BEL 1).
Fibrates as a primary and secondary prophylaxis agent may reduce the risks of CVSAD when the concentration of triglycerides is ≥200 mg / dL and HDL is <40 mg / dL (class A, BEL 1).
Omega-3 should be used in case of severe hypertriglyceridemia (TG> 500 mg / dL) at a dose of 2 to 4 g per day. Dietary supplements are not approved by the FDA for the treatment of hypertriglyceridemia and are not recommended (Grade A, BEL 1).
Niacin (nicotinic acid) is recommended as an additional agent for the reduction of TG (class A, VEL 1).
Niacin therapy should not be used in combination with statins in individuals with well-controlled LDL cholesterol due to lack of additional benefits C (class A, VEL 1)
Bile acid sequestrants may be considered to lower LDL and apo B and moderately increase HDL, but they may increase triglyceride levels (class A, BEL 1).
Ezetimibe can be considered as a monotherapy for lowering LDL and apo B levels, especially in individuals who cannot take statins (class B, BEL 2).Ezetimibe can be used in combination with statins to reduce LDL cholesterol and the risk of CVDs (class A, BEL 1)
Inhibitors of proprotein convertase subtilisin-kexin type 9 (PCSK9) should be considered:
- As a statin combination therapy for lowering LDL cholesterol in individuals with FHC (class A, BEL 1).
- as an adjunct if, in the presence of clinical manifestations of cardiovascular disease due to atherosclerosis, it is not possible to achieve target LDL / non-HDL levels against the background of the maximum daily dose of statins.
PCSK9 inhibitors should not be used as monotherapy except in cases of statin intolerance (Class A, BEL 1).
Combination therapy with lipid-lowering drugs should be prescribed in cases where the level of LDL / non-HDL is significantly increased, and on the background of monotherapy (usually a statin) the target level is not achieved (class A, BEL 1).
Hormone replacement therapy is not recommended for the treatment of dyslipidemia in postmenopausal women (class A, BEL 1).
Pharmacotherapy with lipid-lowering drugs is recommended for children over 10 years old and adolescents who, against the background of lifestyle adjustments, have levels (class D, BEL 4) of LDL cholesterol ≥190 mg / dl or ≥ 160 mg / dl in combination with 2 or more RF , or there is a family history of premature CVSAA (before age 55), or being overweight, obese, or other signs of insulin resistance syndrome.
Dynamic observation and correction of therapy
Reassessment of lipid levels is recommended 6 weeks after initiation of therapy and then again 6 weeks after the goal of treatment is achieved (grade D, BEL 4).
For stable lipid-lowering therapy, it is recommended that lipid levels be assessed at 6-12 month intervals (class D, BEL 4).
The above interval for assessing the level of lipids should be determined taking into account the individual characteristics of the patient – adherence to therapy and the initial lipid profile. If adherence to therapy is questionable or the lipid profile is unstable, the patient is likely to benefit from more frequent assessments (grade C, BEL 4).
More frequent testing of lipid levels is recommended in situations such as worsening diabetes mellitus, prescribing any new drug that is known to have an effect on lipid levels, progression of CVSAA, significant weight gain; unexpected adverse changes in any lipid, compelling new clinical evidence that can be regarded as indications for setting more stringent target lipid levels (class C, BEL 4).
Transaminase levels should be measured before and 3 months after starting treatment with niacin or fibrates, and thereafter semiannually or annually (class C, BEL 4).
In the event that a patient reports significant muscle pain or muscle weakness during statin therapy, creatine kinase levels should be assessed and statins should be temporarily discontinued (class C, BEL 4).
90,000 5 sure ways to miss your goal – Woman Delice
Have you ever wondered what is the ratio of achieved goals and unrealized projects in your life?
Have you thought about what your dreams are “paused” or completely forgotten?
Each of us has dreams, even the most mundane comrades, but someone manages to realize them (even contrary to common sense), and for someone dreams remain plans that are sometimes taken out of oblivion and almost immediately sent back for storage in a dusty box.
dreams and goals
Why is this happening? Why are there always fewer goals achieved than unfulfilled dreams?
After all, any dream is an understandable final goal, why don’t we always come to this goal?
Brazilian psychologist Bel Pesce , who has devoted many years to the study of this topic and has published several books that have sold millions of copies, is sure that the main killers of the dream are ourselves. Not circumstances, not other people – we kill our own dreams on our own, we don’t need anyone for this.
And this is very sad, the psychologist writes, because any dream is worthy of a chance to come true, even the most unrealistic and ambitious, because a dream is an incentive to move forward.
All dreams can be divided into several groups – ideas that remained at the level of ideas, ideas that began to be implemented and were abandoned, and ideas that were successfully implemented (that is, the dream was achieved).
Bel Pesce in his books and lectures talks about the first two types of ideas – what do we do with our own hands so that they never come true?
We believe in the formula “the next morning she woke up famous”
And we expect that our dream should also come true overnight.We read stories of other people’s success – “I made my blog and got rich”, “I launched an application and became a millionaire in two months”, “a housewife wrote a book that became a bestseller” – and we believe that everything should start working out for us right away …
However, if you dig deeper, then behind each case of someone else’s quick success there is a solid base – long years of work or study, difficult life experience, etc. We see the tip of the iceberg, compare it with our own results, become disappointed and abandon what we started halfway through.
It is impossible to fulfill your dream overnight if you live in real life, and not in Andersen’s fairy tale. Making a dream come true is a road, and it can be very long, but this does not mean that you need to give up a dream.
Photo: Collage Vintage
We believe that there are ready-made solutions somewhere that will help us fulfill our dream
There is no place to buy and download the instruction pack “making my dream come true”, writes Bel.Each dream is individual, and on the way to realizing it, you will have to constantly make decisions, and no one but you knows the right answers.
The psychologist says a lot that dreams for us are like guiding stars on the path of our development, moving in their direction we grow up, learn to hear ourselves and use other people’s experience only as a recommendation, and not as a ready-made solution.
When you rush from side to side in search of other people’s answers to your questions, you only get confused even more, the energy that came to make your dream come true is spent on following other people’s recommendations, and at some point you don’t have the strength to move on.
This does not mean that you do not need to learn from other people’s mistakes, it means that you need to learn to transform someone else’s experience and knowledge in relation to your dream and not wait for someone to give you a ready-made solution.
Just believe me, says Bel, no one really knows exactly what is right. No one.
We stop at takeoff
Bel Pesce has worked for many years in Silicon Valley, a place where dreams come true and collapse in huge numbers.In his books, the psychologist writes a lot about the phenomenon of “settle down on your way up” – when a person stops having achieved the first results.
Business starts to bring money, business develops, first results are achieved in sports: this is the most dangerous moment, since the goal seems to have been achieved, but success is still very fragile.
At this moment, writes Bel, you need to work with double strength to make the reality that you have dreamed of for so long.
Photo: Gillian Stevens
We think that if our dream remains a dream, then someone else is to blame for this
Investors are stupid and do not want to give money to your brilliant project.Colleagues are narrow-minded, and do not understand the full depth of your ideas. The market is too complicated and the situation is not in your favor. You would make your dream come true, but … And this “but” is outside your jurisdiction, that is, you shift the responsibility for your dream onto someone else.
Bel says that help and resources are certainly needed, but the dream is yours, and the responsibility for its realization is also yours.
No one is to blame for the fact that your idea is not being implemented, except you: if you are trying to move forward, and no one understands and supports you, then the problem is in you.
We think that if we reach our goal, we will find ourselves in a magical place
In his TED talk, Bel Pesce delivers a simple message:
Achieving a dream is a moment, but life is a journey
It seems to us that the moment our dream comes true, our life will change, and we will find ourselves in some magical place, from which we will not want to leave. In reality, the realization of a dream can even be disappointing, since the moment the goal is realized, the powerful incentive that made us move forward disappears.
Do not become a slave to your dream, use the dream for its intended purpose – as a vector of self-development, without making its realization the culmination of your life, personal or professional. Enjoy the movement, every step on the way to a dream, watch how it becomes more and more real, remembering that after its implementation, life will continue, and there will be new goals and new ideas.
Listen to Bel Pesce’s TED lecture (the video has Russian subtitles), think about your completely abandoned dreams, and give them a second chance.
At least theoretical – according to Bel, it’s worth it.
Children’s Art School No. 2, Stary Oskol
Dear colleagues! Dear Parents! Our beloved students! I sincerely congratulate everyone – teachers, students, parents, everyone for whom the art school is a vocation, life and inspiration, everyone who was united by love for creativity
on the 40th anniversary of the children’s art school №2.
The school anniversary is a special holiday!
This is an unforgettable event that gives wonderful memories, gives an opportunity to take stock and outline plans for the future.
For 40 years, a long way has been passed, filled with bright events and glorious achievements, behind which is the painstaking work of each teacher, students and parents.
I wish the entire teaching staff of the school creative inspiration, successful professional activity, interesting ideas, stability, well-being and health! Let each of the schoolchildren be able to reveal their talent, gain knowledge, exciting leisure time, the joy of communicating with art, and let the parents be calm, happy and proud of the achievements of their children!
Happy Anniversary !!!
Director of MBU DO
“Children’s Art School No. 2” N.V. Tsytsugin
Dear students, dear parents! Summer holidays will end very soon and Children’s Art School 2 will hospitably open its doors for you! To make your visit, study at the school joyful, fruitful, and most importantly safe, the school staff were vaccinated against COVID-19 and received a Green Card with a personal QR code! We care about your Health !!
Dear parents and recipients of our institution’s services! We ask you to complete an independent assessment survey of our institution on the “People’s Expertise” portal in the “Independent Assessment” section.
Access to information systems and information and telecommunication networks
The past and present of our school
Starooskolsk children’s art school No. 2 was opened by the decision of the Council of People’s Deputies in 1981 as a school general aesthetic education.
It was the Belgorod region that became the ancestor of schools-complexes, the purpose of which is the aesthetic education of children and adolescents.In Stary Oskol, the ideological inspirer of the development of a whole network of art schools, music and art schools was the first secretary of the City Committee of the CPSU Valentin Nikolaevich Tsytsugin. He paid great attention to personnel policy; specialists from other regions were invited to work in schools. They were provided with housing. As everything in life starts small, our school originally had 80 students and 5 teachers, it was not easy. The teachers themselves made curricula, learned from other people’s experience, their own mistakes.The school of arts was part of the cultural and sports complex of the north-eastern part of the city, which included cultural institutions, secondary specialized and higher educational institutions, sports, educational institutions, leading enterprises of the city. The Council planned, coordinated the holding of festive events, cultural, educational and sports work. To exchange experience, delegations from the twin cities of Salzgitter, Shved-na-Oder, Mentte came to our school.
Years passed, the teaching staff was replenished with professional personnel, new departments were opened, creative teams were created.
Today 933 children of metallurgists, miners, city employees aged from 5 to 17 study at the school. On the basis of the school, 12 departments are successfully operating: music, choreographic, art, folklore, pop, acting, design basics, solo singing, pop vocals, early aesthetic development of children, modern dance; 12 specializations: piano, button accordion, accordion, cello, balalaika, domra, guitar, violin, wind instruments, pop singing, solo singing, folk singing.Educational activities are carried out by a workable, professional pedagogical team of 53 teachers of additional education, of which 2 are excellent students of culture of the Russian Federation, 2 are Honored Workers of Culture of the Russian Federation. 37 the teacher has a higher professional education. 85% of teaching staff have the first and highest qualification categories. Over the past three years, 100% of teaching staff have been trained in additional professional programs in order to improve their professional competence.
More than 80 graduates leave the school every year. 12% continue their professional education in specialized universities and colleges of culture and art.
The school has created and successfully operates 20 children’s creative teams, the number of their participants – 389, 5 creative teams of teachers. The result of the creative and painstaking work of the teachers is the victories of our pupils in regional, All-Russian and International competitions, festivals, exhibitions: 2017-2018 academic year – 364 prizes; 2018-2019 academic year – 682 prizes, 2020-2021 academic year – 987 prizes.
For 2016-2019 within the framework of methodological events on the basis of MBU DO “Children’s School of Arts No. 2”, more than 68 zonal, interzonal and regional seminars, open lessons, master classes, solo concerts were held, which were positively assessed by the curators. 63% of the institution’s teachers presented materials from their work experience at conferences, festivals, forums of various levels. Children’s school №2, being the center of cultural and educational work, sets as its task not only teaching children various types of art, but also the formation of a cultural environment, general culture, organization of meaningful leisure.The team of teachers and students of the school are constant participants in city events, such as concerts and theatrical processions dedicated to the City Day, concerts dedicated to festive dates: Victory Day, Day of Slavic Literature and Culture, Harvest Day, Builders Day, Metallurgist Day, March 8, Defender’s Day Fatherland, New Year and Maslenitsa festivities, exhibitions of children’s art.
For the highest achievements in the development of the economy and social sphere, the collective of the municipal budgetary institution of additional education “Children’s School of Arts No. 2” was entered on the Board of Honor of the Starooskolsky urban district in 2014.In 2015, the school was included in the register “Leading cultural institutions of Russia”; 2016 – laureate of the competition “100 best organizations of continuing education for children in Russia in the nomination” The best children’s art school – 2016 “.
/ Works / Andreev L.N. / Judas Iscariot / The psychology of betrayal in the story of Leonid Andreev “Judas Iscariot”
Betrayal is a topical issue in our time, in difficult days of swings in human moods, in days of doubt and misunderstanding between people. Therefore, perhaps, the story of L. Andreev, although written at the beginning of the century, is so popular today: the author’s assessment of the motives of betrayal (distinguished by a paradoxical view) is interesting, the purpose of the hero’s act and the prerequisites for it are investigated.
Added by : PanD
/ Works / Andreev L.N. / Judas Iscariot / The psychology of betrayal in the story of Leonid Andreev “Judas Iscariot”
Electronic document management and business process management in Belarus
Organization of business processes and related content (documents, tasks, orders, orders) regularly faces challenges in the field of security, structuring and classification, long-term storage of information.Intelligent systems for managing digital processes and documents can solve these problems by reducing the cost of time-consuming routine operations through the use of solutions based on artificial intelligence.
By the level of implementation of electronic document management , the Republic of Belarus confidently takes the second place in the post-Soviet space after Russia
According to open data of projects on the websites of the largest developers of EDMS, BPM- and ECM-systems
…The EDMS has already been implemented in hundreds of large companies throughout the Republic of Belarus. Leaders in this area are government and medical organizations, enterprises
complex, agro-industrial complex, food industry, chemical industry companies.
According to the analytical center TAdviser, Directum is one of the most popular systems for managing digital processes and documents in the market of electronic document management in Belarus and the CIS.The Directum Bel system was created especially for the Belarusian market. The system covers the entire range of tasks for automating internal and external legally significant document flow, as well as specific business processes in companies of various industries.
Introduction of electronic document management in Belarus
On the territory of the Republic of Belarus, the implementation of the Directum electronic document management system is carried out both by the vendor itself and by a network of partner companies with all the necessary competencies.
When implementing a turnkey EDMS, you can choose from the following options: