Intrauterine Device (IUD)

Overview

An Intrauterine Device (IUD) is a contraceptive option that a healthcare professional inserts into the uterus. IUDs are the most commonly chosen form of Long-Acting Reversible Contraception (LARC). Once an IUD is in place, you do not need to worry about contraception until it requires replacement, typically every three to 10 years, depending on the brand. LARCs, including IUDs and contraceptive implants, are considered the most effective non-surgical birth control methods available.

If you decide to become pregnant, your healthcare provider can remove the IUD. It’s important to note that unlike some other contraceptive methods like condoms, IUDs do not offer protection against Sexually Transmitted Infections (STIs). To have both pregnancy prevention and STI protection, using an IUD in conjunction with condoms can provide dual protection. This combination helps prevent pregnancy while also reducing the risk of contracting an STI.

Types of IUDs

There are two types of IUDs: copper IUDs and hormonal (levonorgestrel) IUDs. Both variations have plastic frames that unfold into a T-shape once placed inside your uterus. They feature strings attached at the base, extending into your vagina, allowing your doctor to remove the IUD as necessary.

• Copper IUDs: Paragard’s IUD features a slender copper wire coiled around the stem portion of the “T.” The stem concludes with a smooth ball, serving to prevent any risk of puncturing your cervix during the insertion process by your doctor.
• Hormonal (levonorgestrel) IUDs: The upper section of the “T” incorporates the progestin hormone levonorgestrel, which circulates through the stem. Progestins, synthetic versions of the naturally occurring hormone progesterone in your body, are utilized. Mirena and Liletta have a slightly larger diameter compared to Kyleena and Skyla.

Both types incorporate components that make them visible during imaging procedures. Your doctor can assess the positioning of your IUD during routine wellness visits to ensure it is correctly placed.

All IUDs elicit an immune response, as your body identifies the IUD as an intruder and initiates a defense mechanism. This response leads to inflammation. The inflammation in your uterus generates an environment toxic to sperm. Consequently, sperm are unable to reach your fallopian tubes for fertilization.

Moreover, the distinct characteristics of copper and hormonal IUDs also hinder sperm from exiting your uterus.

• Copper IUDs: Amplify the inflammatory response, inducing inflammation in your uterine lining (endometrium). Even in the event of sperm fertilizing an egg, the inflammation in your uterine lining would create challenges for a fertilized egg (embryo) to successfully implant and develop there.
• Hormonal IUDs: Gradually release modest quantities of the progestin hormone levonorgestrel. Levonorgestrel works by thickening your cervical mucus, creating a more challenging environment for sperm to navigate to your fallopian tubes. Additionally, it thins your uterine lining and partially suppresses the release of an egg during your menstrual cycle.

Hormonal IUDs come in different variations concerning the amount of levonorgestrel they contain and their release rates. For example, Mirena and Liletta release a higher dose of progestin compared to Kyleena and Skyla. It’s essential to consult with your healthcare provider to determine which specific brands align best with your individual needs.

Depending on factors such as your age and overall health, your healthcare provider may recommend an extended duration of IUD use while still ensuring the same level of contraceptive effectiveness. Always follow the guidance provided by your healthcare provider in this regard.

It’s important to note that the insertion, adjustment, or removal of an IUD can only be performed by a qualified healthcare professional.

Risks

An IUD has the potential to alter your menstrual cycle:

• Copper IUDs may exacerbate menstrual cramps and intensify menstrual bleeding, particularly in the initial months following the insertion of your IUD.
• Hormonal IUDs can cause irregular periods, particularly in the initial months following insertion, potentially leading to missed periods (amenorrhea).

Initially, the strings of the IUD may feel stiff, and you or your partner might notice this during intercourse. However, over time, the strings should soften. If your IUD is affecting your sex life or causing discomfort during sex, consult your doctor.

Most individuals using IUDs typically continue to ovulate, releasing an egg each month in their menstrual cycle. Ovulation may lead to the development of ovarian cysts, which are generally harmless and often resolve on their own. The occurrence of cysts is common and depends on your menstrual cycle phase.

IUDs are regarded as both safe and effective. Although complications are infrequent, they may include:

• Perforation: The uterine wall may be punctured during the insertion procedure.
• High-risk pregnancy: Pregnancy is unlikely with an IUD, but if it does occur, it may pose a higher risk of complications. Ensuring that you replace your IUD before its expiration date can prevent pregnancy.
• Infection: Bacterial entry during IUD insertion can lead to infection, with the highest risk within the initial 20 days after insertion. To reduce this risk, your doctor will clean your cervix during the IUD insertion procedure.
• Expulsion: Your IUD may dislodge from your uterus. Typically, this occurs during your menstrual period, usually within the initial months after insertion.

Before the procedure

Your doctor will assess your eligibility for an IUD considering your health and lifestyle. Before the procedure, you might be required to undergo a pregnancy test or be tested for STIs.

Discuss pain management options with your provider in advance of the procedure. While many individuals tolerate IUD insertion without issues, some may hesitate due to concerns about the experience. Your provider may suggest taking pain medications beforehand to alleviate any potential discomfort. Additionally, they may numb the area before the procedure.

Open communication with your doctor can alleviate any anxiety you may have regarding getting an IUD.

During the procedure

• Placement of an IUD typically takes fifteen minutes or less. Your doctor can carry out the procedure during a regular office visit.
• You will be positioned on a table similar to a Pap smear, with your knees bent, legs open, and supported in stirrups.
• You might receive a numbing injection near your cervix to reduce pain or discomfort.
• Your doctor will use a speculum to widen your vagina. You may experience mild to intense cramping when the IUD is inserted.

After the procedure

You might not observe any side effects, or you could encounter mild to intense pain. It is advisable to allocate some time for recovery just in case. If possible, take the remainder of the day off from work.

You might be experiencing the following after the procedure:

• Cramps or backaches
• Encounter spotting or minimal bleeding.
• Dizziness or light-headedness

Utilizing Over-The-Counter (OTC) NSAIDs and applying heating pads can alleviate the pain. Panty liners and pads are useful for managing any bleeding.

Outcome

Paragard offers immediate effectiveness as a contraceptive method. However, when it comes to hormonal IUDs, their ability to prevent pregnancy depends on your menstrual cycle. If you have a hormonal IUD inserted while you’re on your period, it provides immediate protection. If the insertion is not during your period, it may take up to a week for the hormonal IUD to offer full contraceptive protection. To ensure consistent contraception during this period, it is advisable to use alternative forms of birth control while waiting for your hormonal IUD to take full effect.