All you need to know about IUD
An intrauterine device (IUD) is a small contraceptive device which is inserted into the uterus.
It is a long-term reversible type of contraception and is considered one of the most effective reversible birth control on the market.
There are two types of IUDs, a copper IUD and hormonal IUD.
- Very good at preventing pregnancy
- Can be used for years at a time
- Can be used directly after giving birth, while breastfeeding, or after having an abortion
- You can immediately get pregnant once the IUD is removed
- Can decrease periods
- Can sometimes slip out of the uterus (expulsion) or puncture the uterus (perforation)
- It doesn’t protect against STDs
- Risk of getting pelvic inflammatory disease (PID) within three weeks of insertion
- Needs to be placed by a doctor
- Hormonal IUD can be expensive
- If you do get pregnant with an IUD, there is a higher risk of miscarriage and complications which would require immediate medical help
Are IUDs safe?
For the first few months, it’s normal to have some side effects.
If you still have side-effects after six months, you should see your healthcare provider to check if everything is normal.
One of the complications that can arise is expulsion. That means that the IUD partially or fully slips out of the womb. If that happens, you can get pregnant. That’s why it’s important to check if you can still feel the strings once a month.
Another very rare complication is that the IUD pushes through the wall of your uterus. It happens during placement and can be immediately corrected. If it’s not, the IUD can damage your internal organs. This is why an IUD should only be placed by a medical professional.
Where do I get an IUD?
You need to see a healthcare provider to get the IUD. The placement of the IUD should also be done by an experienced provider.
How is an IUD inserted?
Make an appointment with a qualified healthcare provider to have a hormonal IUD placed. The procedure can be a bit painful so ask them if you can take a mild painkiller an hour beforehand.
They will do an internal examination to figure out what size you will need and generally test you for STDs before they place it. Your vagina is opened with a speculum, and the IUD is placed inside the uterus using a thin tube.
It shouldn’t take longer than 15 minutes. There may be some spotting and cramping afterwards.
Most providers will want a follow-up appointment 3-6 weeks after the IUD is placed to check that everything is okay and that the IUD has stayed in place.
The hormonal IUD can be inserted at any time of the month, but it’s best during your period when the cervix is more open and you are unlikely to be pregnant.
You can have sex again as soon as everything feels normal after the placement. This may take a few days given cramping and some bleeding.
How can I tell if something is not right with my IUD?
You need to see your health service provider if you have any of the ‘PAINS’-signs:
P: Period pain, or spotting lasting longer than the first few weeks
A: Abdominal pain, pain with intercourse
I: Infection or STD exposure, abnormal vaginal discharge
N: Not feeling well, fever, chills
S: String missing, shorter or longer
What can stop the IUD from working properly?
If the IUD doesn’t sit correctly in the uterus, it can be less effective and cause more side-effects. You can check yourself if it’s still in its proper place by feeling for the strings. The strings hang out of the uterus and make the removal of the IUD easier.
The best way to check if the IUD is in place is by squatting and inserting two fingers deep into the vagina. Feel around and do not pull on anything because you might displace it. You should feel the wires coming out of your cervix.
If you feel a hard piece of plastic and wires then you know for sure that is out of place.
If you do not feel the wires, see your health service provider immediately. It is recommended to check a few times in the first month to make sure it was placed properly, after that it is less of a concern.
The copper-T IUD, which is often sold under the name ‘Multiload’, is a non-hormonal birth control device that sits in your uterus or womb. It’s a T-shaped piece of plastic wrapped with a coil of copper-wire. That’s why some people call it the ‘coil’. Two little strings are attached at the end. This makes it easy for a doctor to remove it or check it’s in the right position. It can be placed for up to 10–12 years.
There are other copper IUDs as well, but the Multiload is the most effective and the most common. However, check with your doctor which copper-T IUD is best for you and ask about its specific characteristics.
The copper-T IUD is a reversible form of contraception. Once you take it out you can aim to get pregnant.
Typical use: 0.8 per cent
Perfect use: 0.6 per cent
The copper in the IUD works as a natural spermicide – it kills the sperm that comes into the vagina. That way, eggs in the fallopian tubes won’t get fertilised and you can’t get pregnant.
What happens to my period if I use a copper-T IUD?
When using the copper-T IUD, many women have heavier periods and more cramps than they did before. This is usually not a problem, unless you were anaemic even before starting to use the copper-T IUD.
For many women, their periods go back to the way they were within three to six months. Other women will always have heavier periods while on an IUD.
Period changes are normal, but if you are worried, talk to your healthcare provider about it.
What are the side effects of a copper-T IUD?
- Spotting, frequent bleeding
- Heavier periods, and resulting from that: anaemia
- Vaginitis (inflammation of the vagina)
- Vaginal discharge
Who shouldn’t use a copper-T IUD?
- Women with severe anaemia
- Pregnant women
- Women at high risk of STDs, unless they also use condoms with all sex partners
- Women at high risk of pelvic inflammatory disease (PID). Women who have had PID in the past can still use the copper-T IUD.
- Women with undiagnosed, abnormal vaginal bleeding
- Women with uterine or cervical cancer
- Women with copper allergies
- Most women with HIV/AIDS and ovarian cancer can use an IUD but need to check with a doctor first.
Does the copper-T IUD work as emergency contraception?
Yes. In fact, the copper-T IUD is the most effective form of emergency contraception. It works even better than emergency pills. Even if it’s inserted five days after intercourse, it’s still 99.9% effective.
The hormonal IUD is a small cylinder about as long as a matchstick that is put inside the uterus or womb. It’s put in place by a doctor and can stay in the body for up to five years. It works by giving off a steady low dose of the hormone progestogen (levonorgestrel). Hormonal IUDs are sold under the brand name Mirena.
The hormonal IUD makes the mucus around your cervix thicker so the sperm can’t get through and it can also stop your ovaries producing an egg.
Also, the hormone makes it harder for sperm to travel up towards the egg. And finally, it thins and suppresses the lining of the uterus, so that in the rare case an egg does get fertilised, it can’t be implanted.
Typical use: 0.2 per cent
Perfect use: 0.1 per cent
What happens to my period with a hormonal IUD?
Any problems you may have with your periods may be relieved if you use a hormonal IUD. It’s normal that after a few months of use you will stop having heavy periods. Or your periods may stop altogether.
The hormonal IUD may also stop cramps and/or pain before your period.
After one year of use, only about half the women with a hormonal IUD still have their periods. And even if you still have your period, there is up to 70 per cent less blood loss in women with a hormonal IUD compared to those who don’t use birth control.
Some women find it difficult to accept that this is normal. In fact, not having their periods is the number one reason for women to stop using the hormonal IUD.
So it is a good idea to think about this before having it placed, and talk to your healthcare provider about any concerns you have regarding your period before having the IUD placed.
What are the side effects?
- Weight gain
- Mood changes
- Ovarian cysts
- Breast tenderness
Who shouldn’t use a hormonal IUD?
- Women with recent pelvic inflammatory disease (unless they have had a pregnancy since their last PID episode)
- Women with an untreated pelvic infection
- Women with breast, cervical, or uterine cancer
- Women with undiagnosed and abnormal vaginal bleeding
- Women with liver tumours
- Women at high risk of STDs, unless they use condoms with all their sex partners
- HIV-positive women should check with their doctor if they can use hormonal IUDs. Because there’s a slight risk of infections with IUDs, other birth control methods might be better.