Birth control is an issue which at one time or another you share with many women all over the world. Fortunately, there are now a number of reliable and simple methods of preventing pregnancy. One of these is called intrauterine contraception. This method, although not guaranteeing absolute protection against pregnancy, is indeed very reliable. The intrauterine device (IUD) which your doctor has advised you to use is called Multiload.

Before starting to tell you how Multiload works, we would first like to explain a few things.

The womb or uterus (c) is situated in the lower part of the abdomen, just above the pubic bone. The uterus is more or less pear-shaped, has muscular walls and is slightly smaller than your fist. Access to the uterus is by means of the vagina (e). At the top and on both sides of the uterus are the fallopian tubes (a) with ovaries (b) beneath them. The ovaries, fallopian tubes, uterus and vagina together form the female organs of reproduction. They do not function until puberty.

1. fallopian tubes
2. ovaries
3. uterus
4. cervix
5. vagina

From the time when a woman starts menstruating she is sexually mature. Approximately every four weeks a tiny egg cell (which is smaller than this dot.) ripens in one of the ovaries. This egg cell (a) travels to the fallopian tube where it may be fertilised with male seed cells (sperms = b) or not.

Meanwhile, the uterus prepares to receive a fertilised egg. The inside of the uterus is lined with a specialised mucous membrane (c) through which run many tiny blood vessels. About the time when an egg is ripe for fertilisation, this membrane - the endometrium - becomes twice as thick as normal and the blood vessels supply it with an extra quantity of blood.

If the egg in the fallopian tube is not fertilised, a part of the endometrium is shed after fourteen days together with a quantity of blood. In other words, menstruation (d) takes place.

Figure 2

endometrium, generally high up in the uterus. This whole process takes about one week.

When implantation occurs, the endometrium is not shed and no menstruation takes place.

For more than 2000 years it has been known that pregnancy could be prevented by inserting objects such as a stone, a ring or a wire into the uterus. Since the start of this century doctors have carried out extensive research in order to develop a reliable way of contraception based on this age-old knowledge. Why lUDs prevent pregnancy is not exactly known, but studies point towards two possible actions. They may prevent fertilisation by their action on the fallopian tube; alternatively should an egg be fertilised they may prevent implantation in the uterus.

Early devices were made of metals such as gold, silver and stainless steel. In the 1940s and 50s, pliable plastics were used to create devices such as the 'loop' and 'coil'. About 1965, it was discovered that by covering an IUD with a layer of copper its contraceptive reliability was increased.

Copper-carrying lUDs are effective at a smaller overall size than lUDs without copper. This gives copper lUDs the advantage of being easier to insert.

There are various types of lUDs in existence. One of these is Multiload.

It consists of a small plastic rod wound with copper wire and provided with two flexible plastic arms and a nylon thread (Figure 3).

1. flexible plastic arms
2. small plastic rod with copper wire wound round it
3. nylon thread

After examining your uterus to determine its position size and condition, a speculum is inserted into you; vagina (as for a cervical smear) and the cervix and vagina are cleaned with antiseptic lotion.

The uterus is held steady while its depth is sounded.

Your doctor uses a slender flexible transparent plastic tube to insert Multiload into your uterus. After insertion the two strings attached to Multiload extend into the top of the vagina so that the presence of the device may be checked by you or your doctor (Figures 4 and 5).

Figure 4

Figure 5 (A, B and C): These pictures show how Multiload is inserted.

1. The flexibility of Multiload makes it easy to pass the portio.
2. This picture shows that Multiload has been completely inserted into the uterus.
3. In this manner the insertion tube is removed. Multiload stays in the uterus.

Neither you nor your partner will experience the presence of Multiload during intercourse. If otherwise, please consult your doctor.

Menstrual tampons can be freely used. You need only to feel for the strings after each menstruation. Your doctor will instruct you how to do this. If you do not feel the strings, or you do feel the firm part of Multiload, you should contact your doctor.

Multiload is usually well tolerated. Only a few women may experience a slight discomfort during insertion and/or during use. In rare cases a complication might develop later on. You should be aware of the nature and symptoms of such a complication so that you know what should be done in such a case.

Soon after Multiload has been fitted, you may possibly experience abdominal pain or cramps which usually quickly subside. However, in case of serious and persistent abdominal complaints or heavy bleeding you must consult your doctor.

Your first, and sometimes also your second menstruation may come slightly earlier than expected. These periods may also be a little more painful, heavier and last longer than usual. Sometimes there is a little bleeding on and off between periods. This is nothing to worry about but tell your doctor during your next visit. After two or three months everything should be back to normal again.

There have been occasional reports of breakage of the thread or very rarely of the plastic body at removal of the Multiload. This is mostly associated with embedding of the device or part of it in the uterine wall. Embedding or breakage may require surgical intervention (e.g. curettage) to remove the device or retained fragments.

Occasionally, it may happen that Multiload may be pushed out of the uterus into the vagina. This is called expulsion. Your uterus remains slightly open during your menstrual period so that the chance of losing Multiload is somewhat greater during these days. Therefore make sure after each period, that you do feel the strings and do not feel the firm part of Multiload. Your doctor has instructed you how to do this. Always wash your hands carefully before and after this examination. You should also check your sanitary towel or tampon before disposing of it.

Women using copper-carrying lUDs, such as Multiload, should not have microwave, shortwave or diathermy treatment to the lower abdomen or back.

Women fitted with an IUD still have a very slight chance of pregnancy. If in this situation the IUD remains in the uterus, pregnancy could lead to serious complications. Therefore the IUD should be removed as soon as pregnancy is established. This removal may lead to a miscarriage, but this is not always the case.

urgently requiring medical intervention: for symptoms see section "Medical advice".

During the first few months of IUD use there is a slightly increased risk of infection of the uterus and the fallopian tubes which might affect future fertility.

If an infection occurs is should be treated until it is completely healed: for symptoms see section "Medical advice".

To ensure complete healing it may sometimes be necessary that the IUD is removed.

Your doctor will have taken a thorough medical and gynaecological history in order to decide whether or not there are any medical reasons why you can not use an IUD. Therefore you should inform your doctor about your state of health. In any case, you must not use an IUD if you are pregnant. If in doubt about this ask your doctor for advice.

You should be counselled by your doctor on all aspects of Multiload including those concerning your health and future fertility.

Your doctor should arrange regular check-ups for you.

Inform any doctor you consult that you are wearing an IUD.

In view of the complications described in the sections "Pregnancy" and "Genito-urinary infection" it is very important to contact your doctor without delay if any of the following symptoms should occur:

• symptoms indicative of a pregnancy outside the uterus:

• symptoms indicative of a genito-urinary infection:
• flu-like complaints with fever in excess of 38°C (100°F), persistent lower abdominal tenderness or pain, pain during or after sexual intercourse, prolonged or heavy menstrual bleeding, foul-smelling vaginal discharge.

• If your period is two weeks late.
• If you think that you have lost Multiload, either because you cannot feel the strings, or if you can feel the firm part of Multiload. Until you have been examined, use an additional form of contraception such as a sheath.
• If you plan to use analgesics for more than just a few days.
• If any change in your state of health occurs which you think may be due to the use of Multiload.

Ask your doctor when Multiload should be replaced. With Multiload Cu250, Multiload Cu250 Short this is usually done after 3 years; with Multiload Cu375 this is usually done after 5 years. If necessary remind your doctor of the need of replacement. If you wish to become pregnant, ask your doctor to remove Multiload .

Multiload Cu250 PL 0065/0062

Multiload Cu250 Short PL 0065/0075