What is an IUD?
An IUD (Intrauterine Device) is a very effective method of contraception, and is appropriate for use in most women.
It is a small “T” shaped device that is inserted into the uterus. There are thin wire strings on the tail of the “T” that hang into the top of the vagina, making for easy retrieval when indicated. An IUD is a low-maintenance and highly effective way to control your fertility. It does not depend on daily dosing of pills, and user failure rates tend to be lower as a result.
The progesterone IUDs are also prescribed for treating heavy periods and pelvic pain (currently only the 5 year device is approved for these indications).
What are the types of IUDs available?
There are two major types of IUDs: Copper (non-hormonal) and a Progesterone-containing IUD (hormonal). Their differences are summarized in the chart below:
What are the risks of the device?
There are small risks associated with IUDs, including a 1/1000 chance of puncturing through the uterus during insertion, a 5% risk the device will be expelled, requiring device replacement, approximately 5% risk of infection, 0.1-1% risk of device failure, and a <1% risk of ectopic (tubal) pregnancy.
How is the device inserted?
An IUD can be easily inserted in your doctor’s office or at the outpatient unit of the hospital. A speculum is used to locate the cervix, the cervix is prepared with a cleaning solution. Depending on your pregnancy history, your doctor may or may not recommend some freezing to be injected into the cervix. The size of the uterus is measured, the device is inserted, and the strings are trimmed.
Insertion is generally well tolerated; most women experience some mild to moderate cramping when the device is inserted, but this tends to resolve after the procedure.
Depending on your medical history and risk factors, your doctor’s office may give you some specific instructions prior to the insertion. These may include the following:
1) Ensure you are not pregnant. Ensure you use backup contraception prior to the IUD insertion. The doctor’s office may recommend a home pregnancy test prior to the procedure. If there is any doubt about your pregnancy status, you should rebook the appointment for after your next period.
2) Urine testing for sexually transmitted infections. Young women aged 16-25 are at high risk for chlamydia, and should be treated prior to having an IUD inserted. If there are no recent swab results on record, your doctor’s office may recommend you have a urine screen for chlamydia and gonorrhea performed at a lab 5-7 days prior to the scheduled IUD insertion.
3) Pre-procedural medication. Your doctor may recommend you take a medication prior to the procedure called misoprostol. This medication helps to soften the cervix to make the insertion easier, safer, and more comfortable. Side effects are transient and may include cramping, spotting, and some bowel disturbance. Pregnancy must absolutely be ruled out before taking this medication.
What can I expect after the IUD is inserted?
Most women will have some cramping and spotting after the device is inserted. This is normal and tends to resolve in the next few days. If you are able to take ibuprofen, you can take this for the pain. Spotting with the progesterone devices can last several weeks and in rare cases, several months. It tends to get progressively lighter and resolve.
When should I contact the doctor’s office?
Most complications with IUD insertion are experienced within the first 3 weeks of insertion. Contact the doctor who inserted the device if you experience any of the following:
Pain that is getting progressively worse (some cramping is normal)
You are unable to feel the strings of the IUD in the 4 weeks after insertion
Foul-smelling vaginal discharge
You think the device has been expelled
The risk of contaceptive failure is overall very low, but tends to be higher with increasing years after insertion. There is also a 30-50% chance that this pregnancy will be in the fallopian tube. If you think you are pregnant, take a home pregnancy test and contact your family doctor or walk-in clinic urgently.
Removing an IUD
If you would like to get pregnant, your family doctor / primary care provider can often remove the IUD in their office if the strings are visible. If the strings are not visible, you may require a referral to a gynecologist to remove the device.
If your device is due for replacement, the old IUD can be removed and a new one inserted at the same visit.