A Guide to Intrauterine Device (IUD)

Birth control options for women have gone through a lot of changes over time. An IUD device is an effective birth control method that is available to women today.

What is an IUD?

IUD or Intrauterine Device is a birth control method for women. There is a T-shaped device inserted in the womb of the woman to prevent pregnancy. It is an appropriate choice for those who cannot use other forms of contraception like birth control pills. Prior to using this method, you should have a discussion with your doctor to check if IUD is the correct type of contraceptive for you and evaluate all the risks and benefits. You may carry on with your daily life as normal (have sex, exercise, and use tampons).

What are the Types of Intrauterine Devices?

There are 2 types of IUDs:

1. Copper IUDs (ParaGard)

These are the most commonly used IUDs. A copper wire is tied around the stem of the T shaped device. This can stay for up to 10 years and is a highly effective method of birth control.

2. Hormonal or Levonorgestrel IUDs (Mirena, Kyleena, Liletta, Skyla)

It is supposed to be slightly more effective in preventing pregnancy than the copper IUD. This IUD can prevent pregnancy for up to 5 years depending upon the type used.

Who Can Use an IUD?

IUD can be used by most women – young women and women who have never had children too. However, the chances of the device being expelled are higher in women who haven’t given birth because the size of the uterus will be smaller than a woman who has had a prior delivery. IUDs are also highly suitable for women having heavy periods.

You may use the IUD in all the following scenarios:

• If you have children or never had children
• If you are unmarried
• IUD can be used at any age (adolescents and women over 40 years)
• Have just had an abortion or miscarriage but there are no infections
• If you are breastfeeding
• If you are into hardcore physical work/activity

Who Shouldn’t Use an IUD?

• You should not use an IUD if you have abnormal vaginal bleeding
• IUD should not be used if you have cervical or uterus cancer
• Pregnant women should not use IUD. You can use it after child birth. In fact, the best time to get an IUD is right after delivery

You may also not be able to use IUDs if you recently had pelvic inflammatory disease (PID) or are allergic to copper. Your doctor will assess your suitability for this method of birth control.

How Does an IUD Work?

The intrauterine device is a contraceptive device made of flexible plastic which is inserted into the uterus. It is a highly effective long-term contraception and can be reversed conveniently.

Copper IUDs – Copper acts as a spermicide preventing the sperm from travelling to the cervix and changes the internal lining of the womb, which makes it difficult to conceive.

Hormonal IUD – This IUD releases a hormonal progestin, which thickens mucus in the cervix. This prevents the ovary from releasing an egg and thus prevents pregnancy.

How Effective is an Intrauterine Device (IUD)?

IUDs are considered to be one of the best methods of birth control and are 99% effective. You do not need to remember to take it (like the pill) or use it incorrectly (like a condom).

Procedure of IUD Insertion

At the time of insertion, your doctor will first clean the vagina with an antiseptic solution. Then a speculum is placed inside the vagina which slowly draws the uterus closer to the vagina. Then the IUD is inserted with the help of an applicator. You may feel a brief pain or cramp which is temporary. The procedure takes about 5 minutes.

The applicator is then removed, and the arms of the IUD spring open into the T formation. Once the IUD is inserted, you will not feel anything. The strings attached to the end of the IUD will hang through the cervix and protrude slightly into the vagina. You should not fiddle or tug with the strings else the IUD may be displaced.

IUDs remain in the uterus where it has been inserted. In some cases, they might come out due to incorrect insertion. This is a rare occurrence.

How Soon Does an IUD Begin Functioning

If the IUD is inserted within 7 days after the start of your period, it is effective immediately. If inserted at any other time during the menstrual cycle, then you should use some other form of contraception if you plan to have vaginal sex within the 1^st week of insertion. Pregnancy protection starts after 7 days.

What Can You Expect After Treatment?

 After the procedure, you may feel a little cramping till a few days. Your doctor might tell you to take some medication (pain killers) to prevent the cramps.

You many need to come back for a check-up after the next period. They will check if the IUD is still inside and check for infections.

There may be some spotting after getting IUD which goes away within 6 months. Hormonal IUDs cause your periods to become scanty, and you may stop getting periods also. The Copper IUDs cause periods to become heavier. If you feel any discomfort due to the IUD, then you should immediately consult your doctor.

Although there is very little chance of the IUD slipping out, it may happen during the first 3 months. They are most likely to come out during your period, so you should check your pad or tampon to see if it fell out. After the IUD has been inserted, it is recommended that you use sanitary pads. If you are using a tampon, then it must be changed frequently, and care should be taken while pulling it out so that the strings of the IUD are not tugged or pulled at.

Once the insertion of IUD had been completed, most women feel well enough to resume their normal life. Medication is prescribed to ease out any pain.

In case the IUD falls out, you will not be protected from pregnancy. Hence, you need to visit your doctor or use some other form of contraception in the meanwhile.

How Long Can IUD Last

The Copper IUD can last up to a period of 12 years, and the Hormonal IUD can last anywhere between 3 to 6 years.

However, there is no minimum time frame for the IUD to stay in. You can have it removed any time you wish to.

You will need to keep track of when IUD has to be replaced. IUD placement may seem to have a higher upfront cost. However, it turns out to be cost effective in the long run because the IUD’s protection can last between 5 to 10 years. They are an inexpensive and reversible form of birth control.

Can an Intrauterine Device Be Inserted Anytime?

It is safe to insert the Intrauterine Device during the menstrual cycle. During this time, it is unlikely that the woman is pregnant and the cervix also dilates during the flow. Dilation helps make insertion easier.

What are the Complications and Risks of IUD?

IUD is one of the most popular forms of birth control across the world. Once inserted, it does not require maintenance and is extremely effective.

Risks of using intrauterine device:

• Copper IUD causes increased menstrual bleeding and cramps accompanied by spotting. Hormonal IUD causes reduction of menstrual bleeding and cramps.
• In a few cases, the IUD may get stuck or perforate into the uterus. Perforation is rare; however, it always occurs during insertion of the IUD. The IUD needs to be removed if the uterus has been perforated.
• Sometimes, the IUDs are expelled out of the uterus into the vagina in the first year. This can happen during the first few months. There is a high chance of expulsion if the IUD is inserted right after child birth or in a woman who has never been pregnant.
• Hormonal IUD may cause benign cysts which go away on their own.
• The hormonal IUD can also cause hormonal side effects like tenderness of breasts, mood swings, headache and acne. These are similar to side effects caused by oral birth control methods. However, they go away after the first few months.
• Only a health professional or doctor can remove the IUD. You should never attempt to remove the IUD yourself.
• The IUD can cause a genital infection in the uterus leading to pelvic inflammatory disease in the first months after insertion.
• You might experience a foul-smelling vaginal discharge at times.
• Sometimes, you may have an unexplained fever.

What are the Advantages of IUD

• IUDs are highly effective methods of birth control
• They are a very cost-effective method of birth control
• Extremely easy to use
• IUDs do not interrupt foreplay or intercourse
• They do not require cooperation of your sexual partner or spouse
• IUDs are safe to use while you are breast-feeding
• Can be removed whenever you face any problems or want to stop using it. Fertility returns with the first ovulation cycle following removal of the IUD
• Hormonal IUD can relieve you of heavy menstrual bleeding
• Copper IUD can be used as an emergency contraception within 5 days of unprotected intercourse
• IUDs can be inserted after a normal vaginal delivery, C section, or first-trimester abortion

How to Ensure IUD is Still in Place

There are no serious problems that are caused by IUDs. However, sometimes, the strings of the IUD cannot be seen because they are drawn back into the cervical canal. In very rare instances, the missing IUD may be due to pregnancy or uterine perforation or expulsion. Therefore, it is important to know how to check if the UTI is still in place.

• If you have an IUD, then you should keep checking the strings on your own once every month. In case you can feel the strings, the IUD is intact. The cervix moves naturally during the periods, so when it moves down, you will be able to feel the device closer to the outside of the vagina.
• In case if you are not able to feel it, then the doctor should be consulted.

How is IUD Removal Done

If you want to get the IUD removed, you need to visit your doctor. Please do not try to do it yourself. The doctor will remove the IUD when it has reached its expiration date or if you are facing some medical problem.

• IUD removal takes only a few minutes. Women usually find it less painful or uncomfortable than having the IUD inserted. You may want to consult the doctor if you need to take medication in case of cramping later on. In case your IUD has been removed due to an infection in the uterus, and you have been prescribed medicine then ensure that you complete the full course.
• The doctor will insert a speculum into your vagina and search for the strings. If they aren’t there, your doctor can insert a thin tool through your cervix to get the strings. He will slowly pull the IUD strings. This will pull the IUD through the cervix and out of the vagina.

Then your doctor will remove the speculum.

Can IUD Affect the Ability to Get Pregnant?

Once you remove the IUD, your fertility levels return to normal at once. IUD does not cause infertility, and once the IUD is removed, you can definitely become pregnant. There are no risks of infertility due to IUD.

 

• If your IUD was non-hormonal, then your fertility was never affected at all. It is similar to using condoms as a method of birth control. Since there are no hormones released in your body, you can get pregnant once you remove the IUD.
• In case you were using the hormonal IUD, you can become pregnant during the first cycle without the IUD.

If you are unable to unable to conceive even after the removal of the IUD then you should consult your doctor.

In What Way Will IUD Affect My Periods?

The Hormonal IUD and Copper IUD affect the periods in different ways.

Hormonal IUDs may make the periods lighter. You may even skip your first period after IUD has been inserted. Periods may even stop altogether. In some cases, hormonal IUDs may cause irregular bleeding for the initial three to six months. The pattern of your periods differs when you are using birth control pills or when you shift to IUD. In rare cases, hormonal IUDs can cause the periods to worsen in the long term.

Copper IUDs cause your periods to become heavier, longer, and accompanied with cramps. In this IUD, the uterine lining takes time to adjust to the foreign body so there may be little bit of inflammation or tissue damage.

What Symptoms May Indicate a Problem?

You have to be observant of any unusual symptoms related to the IUD. These include:

• If you experience prolonged abdominal pain after IUD has been inserted
• Delayed period or if you experience bleeding in between periods
• Abdominal pain along with a delayed period
• Vaginal discharge, which can be caused by an infection
• The length of the IUD string feels shorter or longer than usual
• You can feel the hard plastic bottom of the IUD coming out through the cervix
• Breathing problem

What Happens if a Woman Gets Pregnant While Having an Inserted IUD?

You will still ovulate with the IUD inserted in the uterus, unlike some other methods of birth control.

The IUD can sometimes slip partly or completely out of the uterus. This happens women during the first year after the device is inserted, and occurs mostly within the first few months.

Sometimes, the IUD may get embedded into the uterus. In some rare cases, the device may pierce the uterus. If this happens, then the device will not work, and it needs to be removed and replaced.

Another thing to remember is that while the Copper IUD starts working right after it is inserted., the Hormonal IUD starts working immediately only if inserted during the first 7 days of your period. If the Hormonal IUD is inserted at any other time during the menstrual cycle, then it will take 7 days to be effective. Hence, it is advisable that you use some other form of birth control in the meanwhile. Not doing so can lead to pregnancy.

• The women who become pregnant while IUD is inserted face a greater risk of ectopic pregnancy. In this case, the embryo implants outside the uterus.
• If a pregnancy occurs and the IUD remains inserted into the uterus, then you may have a high risk of severe infection, miscarriage or premature delivery. So, doctors remove the IUD when a woman becomes pregnant.

When Should I Call a Doctor?

The doctor follows the correct process to insert the IUD. However, sometimes, it may be pushed out or displaced due to contractions in the uterus. In case you have excessive bleeding or discomfort, then you should consult the doctor immediately and start using an alternate method of birth control.

These symptoms may signal there is a problem –

• • Severe pain in the abdominal pain
  • Experience pain while having sex
  • When you miss a period or if you sense any sign of pregnancy
  • Unusual discharge from the vagina with a foul smell
  • A change in the length or position of the IUD string

FAQs

1. Can I use IUD while breastfeeding a baby?

Hormonal IUD (Mirena) can cause problems in breastfeeding. Mirena IUD releases progesterone into the body, and this causes a reduction in the milk supply for a breastfeeding mother.

2. Will I need backup form of contraception after insertion?

IUDs have a success rate of 99%. However, depending upon the type of IUD, it may not start working immediately and may require you to use alternate contraception. As discussed earlier, if you have used Copper IUD it starts working immediately. Copper IUD may even be used as a form emergency contraception. In case you are using a Hormonal IUD, and it has been inserted within the first seven days of your periods, then it starts to work right away. Else, you will need to use a backup birth control in the meantime.

3. Will my partner feel the IUD?

No, the IUD cannot be felt while having sexual intercourse. In case you feel the device, then you should consult the doctor. You may feel some pain though during sex in the initial days after the IUD insertion has been done.

IUDs are a convenient and economical form of birth control, though IUDs cannot prevent sexually transmitted diseases. Side effects from IUDs occur in less than 1% of women. Discuss with your doctor if you want to start using this form of birth control.