## Mechanism of Copper IUCDs **Key Point:** Copper IUCDs work primarily through a **local inflammatory response** in the endometrium, not through systemic hormonal effects. ### Primary Mechanism Copper ions released from the device: 1. Trigger an **acute inflammatory reaction** in the endometrium 2. Recruit **polymorphonuclear leukocytes and macrophages** 3. Create a **spermicidal environment** that immobilizes and destroys sperm 4. Prevent fertilization at the level of the fallopian tube and uterus ### Secondary Effects - Altered endometrial morphology - Reduced sperm transport - Possible interference with sperm capacitation **High-Yield:** The inflammatory response is **NON-HORMONAL** and **LOCAL** — copper IUCDs do NOT suppress ovulation and can be used in lactating women without affecting milk supply. ### Efficacy - **Pearl:** Copper IUCDs are >99% effective (failure rate <1 per 100 woman-years) - Effectiveness increases with copper surface area - Multiload and TCu devices have higher copper content than standard T-shaped devices **Clinical Pearl:** Unlike hormonal IUCDs, copper devices do not alter the menstrual cycle hormonally, though they may increase menstrual bleeding and dysmenorrhea in some users.
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