About Intrauterine Device (IUD)

An intrauterine contraceptive device (IUCD) or intrauterine device (IUD) is a highly effective and long-term method of contraception. It involves the insertion of a small T-shaped plastic or copper device into the uterus to prevent pregnancy. This form of birth control option is generally used as a long-term protective measure and can last 5 to 10 years, based on the type of IUD.

Types of IUDs: Choosing the Right One

There are two main types of IUDs: hormonal IUDs and copper IUDs. Both types are effective, but they function differently in the body.

• Hormonal or Levonorgestrel (LNG) IUD: This type of IUD releases a small amount of progestin, a synthetic form of the hormone progesterone, into the uterus. Progestin thickens the cervical mucus, making it more difficult for sperm to reach the egg; it also thins the uterus lining, making it less receptive to a fertilised egg.
• Copper IUD: Copper IUDs are available for those who want hormonal-free contraceptives as a personal choice or due to medical conditions. This type of IUD makes the egg impossible to fertilise. Copper ions released from the IUD alter the composition of the cervical mucus and uterine lining, thus disrupting the sperm's attempts to reach the egg.

Eligibility for IUD Usage

IUDs can be safely used by most healthy women with a uterus. However, IUDs are not suitable for women who are pregnant, have abnormal vaginal bleeding and untreated STI or pelvic infection.

A pre-insertion test, which includes a pap smear, pregnancy test, STD screening and breast and pelvic exam, will help determine if you are a suitable candidate for an IUD procedure.

Effectiveness of IUDs

Current research indicates IUDs to be one of the most effective methods of contraception, with a failure rate of less than 1%. Less than 1% of women get pregnant after an IUD insertion. Signs of pregnancy while having an IUD in place are similar to that of a normal pregnancy such as a missed period, fatigue, nausea, and frequent urination. Consult a doctor if you suspect you are pregnant.

Benefits vs Disadvantages of IUDs

1. Benefits of IUDs

   • Both types of IUDs give the benefit of long-term protection against pregnancy. The FDA states that a progestin-releasing IUD - the levonorgestrel-intrauterine system (LNG-IUS), offers users up to 5 years of protection. Copper IUDs can offer protection for up to 10 years.
   • They can be removed when required. Both hormonal and copper IUDs are reversible and do not affect fertility. Therefore, pregnancy is possible after removal.
   • They are low maintenance and cost-effective. Depending on the type and brand of IUD inserted, a replacement may not be needed for up to 10 years. We recommend following up with your doctor by scheduling annual check-ups.
   • Hormonal IUDs also help to alleviate acne and period cramps due to progestin secretion and in treating menstrual periods for women with abnormally heavy and prolonged periods.

2. Disadvantages of IUDs

   • Hormonal or copper IUDs do not protect against sexually transmitted infections (STIs) or HIV. Sexually active women should still use condoms especially if they have a new sexual partner.
   • The initial cost of obtaining and inserting an IUD can be relatively high.
   • Initial IUD insertion does come with a slight risk of infection, which can be avoided with necessary safety precautions.
   • Some individuals may experience increased cramping, especially during the first few weeks or months after IUD insertion. 
   • Copper IUDs do carry a risk of inducing heavier and more painful periods.

Potential Risks of IUDs

It is normal for your body to adjust to a foreign object like an IUD when inserted into the uterus. Side effects may occur during the initial weeks following the insertion as your body gets used to the device. Although rare, long-term risks can also occur. Some of these include:

• Pelvic inflammatory disease (PID) - infection of one or more of the upper reproductive organs, including the uterus, ovaries, and fallopian tubes, can occur following the first 20 days of an IUD installation.
• Thrush - limited research indicates that IUDs can make you susceptible to recurring thrush (also known as yeast infections).
• IUD getting expelled by the womb or moved - your IUD may be expelled fully or even partially from your body due to your body reacting negatively to a foreign device.
• Ectopic pregnancy - an embryo that implants itself outside the uterus, usually in the fallopian tube.
• Damage to the womb - this is very rare, with the chances being one in 1000 insertions.

Signs that Indicate a Visit to the OBGYN After an IUCD Insertion Procedure

See your OBGYN if you notice any of the following symptoms:

• Feeling pain in the insertion area.
• Feeling the IUD.
• The IUD strings are shorter or longer than usual.
• Abnormal bleeding.

Potential Consequences if an IUD Is Not Removed After Its Expiry Date

Once an intrauterine device (IUD) has surpassed its expiration date, there is no assurance that it will effectively prevent pregnancy. Additionally, there is an increased risk of infection if the IUD remains in place for an extended period beyond its expiration date.

Post-IUD Insertion Care Tips

1. Sexual intercourse

   Wait at least 24 hours after insertion before having vaginal sex. It is recommended to consult your doctor about the waiting time, as it can vary based on the individual case and the time of insertion during your menstrual cycle.

2. IUD string

   You may be able to feel the strings of your IUD hanging through your cervix into the upper part of the vagina. This string is there to aid your doctor in removing your IUD and ensuring it is in place. Be careful not to pull or move the strings around, as this can change the position of your device.

3. Changes in menstrual patterns

   While intrauterine devices (IUDs) do not typically stop periods altogether, they can lead to changes in menstrual patterns. You might experience heavier, longer, or more painful periods with a copper IUD, although these symptoms often improve over a few months.

   Some individuals using hormonal IUDs experience lighter periods, and in some cases, periods may stop altogether. It is important to note that individual responses to IUDs can vary.

4. Tampon usage

   Using a tampon is generally safe when you have an intrauterine device (IUD). The IUD is positioned in the uterus, beyond the cervix, and it does not interfere with the use of tampons. Tampons are inserted into the vagina, and they do not interact with the IUD or affect its position.

5. Menstrual cup usage

   The use of a menstrual cup with an IUD may pose a potential risk of IUD expulsion. It is recommended to consult with your doctor on whether you can begin or continue using your menstrual cup after an IUD insertion. 

Make an Appointment at Gleneagles Hospitals

Speak with your doctor to know more about IUDs and if they are the right choice for you. Get in touch with us to book an appointment with our team of gynaecologists today, or find out more about our Obstetrics and Gynaecology Services at your nearest Gleneagles Hospital.