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IUDs (Intrauterine Devices)

IUD’s are a highly effective form of contraception although not as effective as the Pill (combined oral contraceptive). The IUD appears to work:

  • by thickening the mucus round the neck of your womb (cervix) making it difficult for sperm to fertilize an egg
  • by interfering with the passage and implantation of an egg into the womb which helps stop conception
  • disrupting the normal structure of the uterine lining with infection fighting white blood cells which gather in the lining of the uterus

Modern IUD’s mostly look like a matchstick with a bar across the top, in a letter ‘T’ shape, whereas the early models were coil or loop shaped. The IUD must be inserted by a doctor trained in family planning and a medical examination is needed before insertion of the IUD (intrauterine device) to check the uterus. The IUD, is a small device, about 11/2 inches/4cm long, made of metal (usually copper) and plastic and placed inside the uterus to prevent pregnancy.

How to use
  • The doctor examines the vagina and then inserts a speculum to hold the vagina open
  • The IUD comes compressed in a thin tube, which is slid through the cervical canal at the top of the vagina into the uterus and then withdrawn, leaving the IUD to spring into shape
  • Thin threads hang from the IUD about 3cm/1 inch into the vagina, and these can be felt with the fingers to make sure that the device is still in place
  • The IUD string should be checked monthly to make sure it is still in in place
  • To remove an IUD the doctor pulls the string of the IUD with a specially designed instrument

Insertion can be slightly painful and unpleasant. The amount of pain you feel generally depends on:

  • if you are relaxed
  • the skill of the doctor
  • the shape of your womb
  • whether you have had children as insertion is usually easy if you have had a baby or abortion
  • size of IUS or IUD as insertion of an IUS and larger IUDs can be more painful than smaller devices

Painkillers can be taken before insertion if recommended by your doctor.

After insertion of IUD:

  • rest for at least half an hour
  • do not drive just in case you feel faint
  • have aspirin or paracetamol on hand for cramps or pain over the next few hours
  • you may lose a little blood during the next few days
  • you will be protected against pregnancy immediately so sex can be resumed as soon as you like

An IUD coil should NOT be inserted in any woman who:

  • has had an ectopic pregnancy (in which the fetus starts to develop in the tubes)
  • has had cancer of the ovary or the womb
  • has unexplained bleeding or pelvic pain
  • has multiple sexual partners because of the danger of infection
  • has a pelvic infection or sexually transmitted disease
  • has major structural problems of the womb
  • has had surgery on the Fallopian Tubes
  • has had serious artery disease (Mirena IUS only)
  • has an artificial heart valve (Mirena IUS only)
  • has a liver condition called Wilson’s disease
  • is allergic to copper (should not have IUDs that contain copper)
  • may be pregnant

Some side effects include:

Pelvic Inflammatory Disease. The risk of pelvic infection is increased with an IUD, especially if you have more than one sexual partner. Symptoms include:

  • discharge occurring soon after insertion
  • fever
  • pelvic pain

IUD’s are usually fitted during the last few days of a period or just after and insertion usually takes only about 10 minutes. An IUD can be fitted immediately after a termination (abortion) but after having a baby an IUD is not usually put in until about six weeks after childbirth. Very occasionally doctors are unable to fit the IUD and have to suggest other methods of contraception.

If you fall pregnant on an IUD (about 2 in 100), the pregnancy carries the risk of being an ectopic pregnancy (fetus starts to develop outside the womb usually in one of the Fallopian Tubes). Severe pain and bleeding may occur. Consult a doctor immediately as this is a very serious condition.

IUD’s have a 96-99 % effectiveness rate. Depending on type, IUDs are usually replaced about every 3 to 10 years:

  • FLEXI-T 300 – 5 years
  • GYNEFIX – 5 years
  • MULTILOAD Cu 375 – 5 years
  • MULTILOAD Cu 250 and Cu 250 Short – 3 years.
  • NOVA-T380 – 5 years
  • MIRENA IUS – 5 years
  • PROGESTASERT – replaced yearly
AdvantagesDisadvantages
in women who have had children or an abortion the uterus is enlarged allowing more room for the IUD to fit bettermay cause pelvic inflammatory disease or worsen existing infection
effective immediately 1.5 times greater risk of getting a pelvic infection than on another method of birth control
sex is not interruptedsterility due to scarring of the fallopian tubes by pelvic infection
easily reversedmore bleeding or cramping with periods
discomfort and bleeding for a few hours or days after the IUD is inserted can occur
one in four women have it removed because of acute pain and heavy bleeding.
sometimes an IUD may fall out and this is more likely to happen during a period
medical risks sometimes include infection or puncture of uterus, increased difficulty in getting pregnant and problems with pregnancy

Call your medical practitioner immediately should the following occur:

  • abdominal or pelvic pain
  • bleeding between periods
  • chills
  • fever
  • IUD felt at cervical opening
  • lost string
  • perforation (occasionally, an IUD may perforate (go through) the womb usually at insertion) is a serious matter because if the IUD gets inside inside your abdomen it could cause you severe pain and an operation might be needed to remove it
  • severe cramping
  • very heavy periods
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