Contraception – intrauterine devices (IUD)

What is an intrauterine device (IUD)?

An intrauterine device (IUD) is a small contraceptive device that is put into the uterus (womb) to prevent pregnancy. The 2 types available in Australia are the:

• copper IUD (also called the non-hormonal copper IUD)
• hormonal IUD (Mirena™ and Kyleena™).

Kyleena is a lower dose version of Mirena and has been available in Australia since 2020.

The copper IUD is designed to stay in place for up to 10 years and the hormonal IUDs (Mirena™ and Kyleena™) for 5 years. Both can easily be removed sooner, if needed.

Like the contraceptive implant, IUDs are known as long-acting reversible contraception (or LARC) because they work over a number of years.

Copper IUD

The copper IUD is a small, T-shaped, plastic and copper device. It constantly releases a small amount of copper into the uterus.

The copper IUD can also be used for emergency contraception instead of the emergency contraceptive pill (‘morning after pill’) if it’s within 5 days of unprotected sex.

Hormonal IUD

The hormonal IUDs are small, T-shaped, plastic devices (sold as Mirena™ and Kyleena™ in Australia). They slowly releases a hormone (progestogen) into your uterus. Progestogen is like the hormone produced by the ovaries.

Effectiveness of IUDs

Both copper and hormonal IUDs are more than 99% effective at preventing pregnancy.

IUD insertion

Sexual Health Victoria’s Medical Director Dr Kathy McNamee provides some advice on preparing and managing pain from an IUD insertion.

Your doctor or nurse practitioner will write you a script and you can get the IUD from a pharmacy. Sometimes you can buy a copper IUD from the clinic providing the IUD insertion. The IUD is inserted inside your uterus by a trained doctor or nurse.

The IUD has a fine nylon thread attached to it which comes out through the cervix (opening to the uterus). If you feel high up inside your vagina, you can check that the thread is there and know the IUD is still in place. Because it is high up in the vagina, the thread cannot be seen.

It’s good idea to make a record of the date when you had the IUD inserted. You will need to make sure it is taken out before it expires (5 or 10 years, depending on the type, after being inserted).

Cost of IUDs

The hormonal IUD prescription is covered by the Pharmaceutical Benefits Scheme in Australia. It costs around $7 if you are a Health Care Card holderExternal Link and around $43 if you are not.

The copper IUD is not covered by a Health Care Card. The cost in pharmacies can be around $70 to $120. There may also be an insertion cost from the health professional.

The overall cost of the procedure will vary depending on whether you attend a private or public provider. If you don’t have a Medicare card or private health insuranceExternal Link, it will be more expensive.

Advantages of IUDs

Advantages of copper or hormonal IUDs include:

• They are more than 99% effective in preventing pregnancy.
• They last for a long time – Mirena™ and Kyleena™ can last for 5 years, and the copper IUD can last for 10 years.
• They are safe to use if you are breastfeeding.
• No medications stop them from working.
• They provide another contraceptive choice if you have difficulty taking the hormone oestrogen. (The combined pill and the vaginal ring contain both oestrogen and progestogen.) The hormonal IUD only contains progestogen and the copper IUD has no hormones.
• Once put in, you don’t need to do anything more apart from checking the thread each month after your period to ensure it has not moved out of the correct position.
• The device can be taken out at any time by an appropriately trained doctor or nurse.
• Your chance of getting pregnant will go back to normal as soon as the copper or hormonal IUD has been taken out.

Advantages of the hormonal IUD include:

• Most users have no vaginal bleeding at all, or a light regular period.
• Periods may be less painful.

Advantages of the copper IUD include:

• It is a choice for those who do not want to use hormonal contraception.
• It is a very effective method of emergency contraception.

IUD possible side effects

Possible side effects include:

• When first inserted, some may experience period-type cramping that usually settles after a few days.
• Sometimes the IUD can come out. This is more common in the first 3 months of it being inserted.
• Your period will change. Spotting or frequent bleeding is common in the first 3 to 6 months. By 6 months around 90-95% of people may have a light regular period or no bleeding at all (this is not harmful to the body).
• You may experience tender breasts, headaches, skin changes and mood changes. These side effects nearly always settle with time. The hormonal IUD has not been shown to cause weight gain.

Copper IUD possible side effects

Possible side effects from the copper IUD include:

• Spotting or frequent bleeding in the first 3 months. This nearly always settles with time and your regular bleeding pattern will return.
• Heavier periods.

IUD and potential health risks

In about 1 in 500 people, a small hole in the wall of the uterus (womb) may be created while the IUD is being inserted. The IUD can move through the hole and sit in the wrong place. If this happens, keyhole surgery (known as a laparoscopy) is required to have the IUD removed.

Around 1 in 300, may get an infection when the IUD is first inserted. This can be successfully treated with antibiotics.

It is very unlikely to get pregnant when using an IUD. If you do get pregnant with an IUD in place, there is a higher chance of ectopic pregnancyExternal Link. This means that the pregnancy may settle in the fallopian tubes (pathway of the egg to uterus). If this happens, seek urgent medical assistance.

When an IUD is not suitable

An IUD might not be a good option for you if you have:

• a uterus that is not the usual shape
• a current pelvic infection.

The hormonal IUD might not be a good option for you if you have:

• been treated for breast cancer
• severe liver disease.

The copper IUD might not be a good option for you if you have:

• heavy periods
• low iron levels
• endometriosis.

Pregnancy when using an IUD

If you become pregnant while using an IUD, see a doctor or nurse as soon as possible and have the IUD removed. The doctor or nurse will also need to rule out a pregnancy in your fallopian tubes (ectopic pregnancy).

If the IUD is removed, you can choose to continue or terminate the pregnancy (have an abortion).

If the IUD is not removed and you continue with the pregnancy, there is a higher risk of miscarriage or delivering the baby early (premature labour).

Using an IUD after the birth of a baby

You can have an IUD inserted within 2 days after giving birth.

If it’s not inserted straight after birth, then you need to wait at least 4 weeks.

IUDs are safe to use if you are breastfeeding.

Conceiving a baby and IUDs

If you want to become pregnant, an IUD can be removed at any time by a doctor or a nurse. Your fertility will quickly return.

Other types of contraception

There are many contraceptive methods available in Australia. When choosing the method of contraception that best suits your needs, it can help to talk to a doctor or nurse about your options. Different methods may suit you at different times in your life.

A doctor or nurse can give you information about:

• the benefits and risks of using various methods of contraception
• how well each method works
• the possible risks and side effects
• how easy it is to use
• how much it costs
• how each method meets your current and future needs.

Other methods include the contraceptive implant or injection, the vaginal ring or the combined oral contraceptive pill.

IUDs do not protect you from STIs

Neither type of IUD gives protection from sexually transmissible infections (STIs). It’s important to practise safer sex, as well as to prevent an unintended pregnancy.

The best way to lessen the risk of STIs is to use barrier methods (such as external or internal condoms) for oral, vaginal and anal sex with all new sexual partners. Condoms can be used with IUDs.

The following information is available from Health Translations DirectoryExternal Link:

The hormone-releasing IUD (PDF)External Link by Family Planning NSW

• Arabic
• Assyrian
• Burmese
• Chinese (simplified)
• Dinka
• Farsi (Persian)
• Khmer (Cambodian)
• Korean
• Lao
• Serbian (Cyrillic)
• Swahili
• Thai
• Turkish
• Vietnamese

The copper IUD (PDF)External Link by Family Planning NSW

• Arabic
• Assyrian
• Burmese
• Chinese (simplified)
• Dinka
• Farsi (Persian)
• Khmer (Cambodian)
• Korean
• Lao
• Serbian (Cyrillic)
• Swahili
• Thai
• Turkish
• Vietnamese

Long acting reversible contraception – LARC (PDF)External Link by Royal Women’s Hospital, Victoria

• English
• Karen
• Nuer
• Oromo
• Somali
• Tigrinya

Where to get help

• Your GP (doctor)
• Your school nurse or welfare coordinator. Some secondary schools provide access to an adolescent health trained GP on site
• Your local community health service
• Your pharmacist (including after hours Victorian Supercare Pharmacies)
• Many community health services and some public hospitals have clinics including family planning, sexual health and women’s health
• Private clinics offering abortion also offer contraceptive services
• 1800 My OptionsExternal Link – Victoria’s sexual and reproductive health information and phone line service Tel. 1800 My Options (1800 696 784)
• Sexual Health Victoria (SHV)External Link – book an appointment onlineExternal Link or call Melbourne CBD Clinic: (03) 9660 4700, Box Hill Clinic: (03) 9257 0100 or (free call): 1800 013 952 (Monday to Friday 9 am – 5 pm). These services are youth friendly
• Melbourne Sexual Health CentreExternal Link (Monday to Friday 8:30 am – 5 pm) Tel. (03) 9341 6200 or 1800 032 017 or National Relay Service (for people with a hearing impairment) (03) 9341 6200
• Thorne Harbour Health (formerly Victorian AIDS Council)External Link Tel. (03) 9865 6700 or 1800 134 840 (toll free)
• The Centre ClinicExternal Link, St Kilda Tel. (03) 9525 5866
• Equinox Gender Diverse Health CentreExternal Link (Monday to Friday 9 am – 5 pm) Tel. (03) 9416 2889 or email: [email protected]
• PRONTO!External Link Clinic for men who have sex with men. Book online or Tel. Tel. (03) 9416 2889
• Ballarat Community Health Sexual Health ClinicExternal Link – book online or Tel. (03) 5338 4541
• Bendigo Community Health Sexual Health ClinicExternal Link – book online Tel. (03) 5406 1200 or (03) 5448 1600
• Gateway Health Sexual and Reproductive Health – Clinic 35External Link, Wodonga (Monday to Friday 9 am – 5 pm) Tel. (02) 6022 8888 and Wangaratta Tel. (03) 5723 2000 or email: [email protected]
• Sunraysia Community Health Services,External Link Mildura (Monday to Friday 8:30 am – 5 pm) Tel. (03) 5022 5444 or email to: [email protected]
• Barwon Health Sexual Health ClinicExternal Link (no GP referral, walk-in service Tuesdays 2 pm – 6:30 pm) Tel. (03) 5226 7489
• Victorian Aboriginal Health ServiceExternal Link Fitzroy: Tel. (03) 9419 3000 and Preston Tel. (03) 9403 3300 (Monday to Friday 10 am – 4 pm) and after-hours locum service Tel. 132 660 or Epping: Tel. (03) 8592 3920 (Monday to Thursday 9 am-5 pm, Friday 9 am-4 pm)

Intrauterine devices (IUD): MedlinePlus Medical Encyclopedia

An intrauterine device (IUD) is a small plastic T-shaped device used for birth control. It is inserted into the uterus where it stays to prevent pregnancy.

An IUD is often inserted by your health care provider during your monthly period. Any type of IUD can be inserted quickly and easily in the provider’s office or clinic. Before placing the IUD, the provider washes the cervix with an antiseptic solution. After this, the provider:

• Slides a plastic tube containing the IUD through the vagina and into the uterus.
• Pushes the IUD into the uterus with the help of a plunger.
• Removes the tube, leaving two small strings that dangle outside the cervix within the vagina.

The strings have two purposes:

• They let the provider or woman check that the IUD stays properly in position.
• They are used to pull the IUD out of the uterus when it is time to remove it. This should only be done by a provider.

This procedure can cause discomfort and pain, but not all women have the same side effects. During insertion, you may feel:

• Little pain and some discomfort
• Cramping and pain
• Dizzy or lightheaded

Some women have cramps and backaches for 1 to 2 days after insertion. Other may have cramps and backaches for weeks or months. Over-the-counter pain relievers can ease the discomfort.

IUDs are an excellent choice if you want:

• A long-term and effective birth control method
• To avoid risks and side effects of contraceptive hormones

But you should learn more about IUDs when deciding if you want to get an IUD.

An IUD can prevent pregnancy for 3 to 10 years. Exactly how long the IUD will prevent pregnancy depends on the type of IUD you are using.

IUDs can also be used as an emergency contraception. It must be inserted within 5 days of having unprotected sex.

A newer type of IUD releases a low dose of a hormone into the uterus each day for a period of 3 to 8 years. This increases the effectiveness of the device as a birth control method. It also has the added benefits of reducing or stopping menstrual flow. It may help protect against cancer (endometrial cancer) in women who are at risk for developing the disease.

While uncommon, IUDs carry some risks, such as:

• There is a small chance of getting pregnant while using an IUD. If you do get pregnant, your provider can remove the IUD to lower the risk for miscarriage or other problems.
• A higher risk of an ectopic pregnancy, but only if you do get pregnant while using an IUD. An ectopic pregnancy is one that occurs outside the womb. It can be serious, even life threatening.
• An IUD may penetrate the uterine wall and require surgery to remove.

Talk with your provider about whether an IUD is a good choice for you. Also ask your provider:

• What you can expect during the procedure
• What your risks might be
• What you should watch for after the procedure

For the most part, an IUD can be inserted at any time:

• Right after giving birth
• After an elective or spontaneous miscarriage

If you have an infection or your vagina, cervix or uterus, you should not have an IUD inserted until the infection is cured.

Your provider may advise you to take an over-the-counter painkiller before getting the IUD inserted. If you are sensitive to pain in your vagina or cervix, ask for a local anesthetic to be applied before the procedure starts.

You may want to have someone drive you home after the procedure. Some women have mild cramping, low backache, and spotting for a couple of days.

If you have a progestin-releasing IUD, it takes about 7 days for it to start to work. You do not need to wait to have sex. But you should use a backup form of birth control, such as a condom, for the first week.

Your provider will want to see you 2 to 4 weeks after the procedure to be sure the IUD is still in place. Ask your provider to show you how to check that the IUD is still in place, and how often you should check it.

In rare cases, an IUD can slip partly or all of the way out of your uterus. This is generally seen after pregnancy. If this happens, contact your provider right away. DO NOT try to remove an IUD that has come part of the way out or has slipped out of place.

Contact your provider right away if you have:

• Flu-like symptoms
• Fever
• Chills
• Cramps
• Pain, bleeding, or fluid leaking from your vagina

Mirena; ParaGard; IUS; Intrauterine system; LNG-IUS; Contraception – IUD

Bonnema RA. Contraception. In: Kellerman RD, Rakel DP, Heidelbaugh JJ, Lee EM, eds. Conn’s Current Therapy 2023. Philadelphia, PA: Elsevier; 2023:1219-1223.

Curtis KM, Jatlaoui TC, Tepper NK, et al. U.S. Selected Practice Recommendations for Contraceptive Use, 2016. MMWR Recomm Rep. 2016;65(4):1-66. PMID: 27467319 pubmed.ncbi.nlm.nih.gov/27467319/.

Gilner JB, Rhee EHJ, Padro A, Kuller JA. Reproductive genetics. In: Gershenson DM, Lentz GM, Valea FA, Lobo RA, eds. Comprehensive Gynecology. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 2.

Glasier A. Contraception. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 134.

Updated by: John D. Jacobson, MD, Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Intrauterine device: pros and cons of this method of contraception

What is an intrauterine device?

This is a special tool in the form of a thin elastic plastic wire about 3 cm long. The most modern models are shaped like a T, earlier spirals can be F-shaped or resemble a circle.

The coil is inserted into the uterine cavity once every 3, 5 or 10 years to prevent unwanted pregnancy, and some of them may still have a therapeutic effect.

What are spirals?

All coils are divided into two types, depending on the presence of a medicinal substance in their composition:

Coils containing copper, or non-hormonal

Such coils have only a contraceptive effect.

Hormone coils

These devices additionally contain the hormone levonorgestrel, which is a synthetic progestogen. The hormone has an antiestrogenic and weak antiandrogenic effect, that is, it suppresses the action of female sex hormones estrogens and is an antagonist of male androgen hormones. All these effects are manifested only in the uterine cavity, practically without a general effect on the body, and are used in the treatment of endometrial diseases associated with hormonal disorders.

How does the spiral work?

Spirals increase the viscosity of cervical mucus. This slows down the movement of sperm and prevents them from entering the uterus. The presence of a foreign body in the uterine cavity causes a weak local reaction in the endometrium, which does not allow a fertilized egg to attach.

The copper contained in the spiral prevents the appearance of microbes and prevents the development of inflammation in the uterine cavity.

Hormonal coils have an additional membrane, through which the slow release of levonorgestrel occurs, which provides a therapeutic effect for several years.

How is the coil installed?

The coil can only be installed by a gynecologist. This should be done on the 5th-12th day of the menstrual cycle and better on the 5th than on the 12th, because at this time there may still be menstrual flow, the cervix is ​​​​ajar, so the installation of the spiral will cause less discomfort and pain.

What are the benefits of an intrauterine device?

The main advantage of the intrauterine device is the prevention of unwanted pregnancy, while its effectiveness is more than 99%. The spiral begins to work immediately after installation, and the action continues until it is removed from the uterine cavity. Restoration of childbearing function occurs immediately after the removal of the spiral.

Ease of use and long shelf life are additional advantages.

In addition, the therapeutic effect of the use of hormonal coils is of great importance. At the same time, compared with oral hormonal contraceptives, the spiral does not have a general effect on the body, therefore it does not affect the level of blood pressure, does not change the hormonal background and the emotional state of the woman.

More additional effects: over time, the pain of menstruation decreases and the abundance of menstrual bleeding decreases.

What are the disadvantages of the spiral?

This method of contraception also has disadvantages:

At first, heavy periods may appear with the release of blood clots. Abundant menstruation can lead to the development of iron deficiency anemia, so monitoring of blood tests is required.
The coil is a foreign body, therefore, in the first weeks after its installation, inflammation may develop in the uterine cavity, which will require the appointment of treatment.
The intrauterine device cannot protect against sexually transmitted diseases (STDs). Therefore, you should not rely on a spiral with a new partner, you must use a condom. The spiral is suitable for use only with a permanent partner.

Due to the above disadvantages, intrauterine contraceptives cannot be used for young girls and women who have not yet become mothers. And first of all, because of the risk of developing inflammation in the uterine cavity, which can cause infertility in the future.

Therefore, the main “target audience” for intrauterine devices are healthy women who have children and want to prevent pregnancy in the coming years.

In our clinic you can consult a gynecologist. The specialist will tell you in detail which spiral is better for you to install and what effects it will have.

types, features and replacement of contraceptives

Contraception remains one of the important issues for maintaining women’s health. The intrauterine device has proven to be one of the most reliable methods of protection, does not require constant monitoring and successfully prevents unwanted pregnancy.

General description

Intrauterine device – a mechanical contraceptive that is inserted into the uterus and prevents the ovum from fixing in its cavity. The device is implanted for up to 10 years and provides up to 98% protection against unplanned conception. After the expiration date or in the process of planning a pregnancy, the coil is easily removed without leaving traumatic injuries. Fertility is restored immediately after removal of the contraceptive

There are two types of intrauterine devices:

1. Metal-containing coils. They are made in the form of a ring, spiral or T-shaped plastic base, with copper or silver wire winding.

2. Hormone containing devices (HS). The T-shaped plastic model contains a built-in container (capsule) that contains the hormone levonorgestrel (synthetic progesterone).

Metallic IUDs are more commonly used in women with regular to moderate menstrual cycles, and HC can be used in women prone to menorrhagia.

How the intrauterine device works

Copper and silver contraceptives prevent fertilization by gradually oxidizing the metal. Free ions change the composition of cervical mucus, which leads to a decrease in the motor activity of spermatozoa. The metal and plastic components of the coils also create a moderate mechanical effect, provoking endometrial microcontractions. Muscle contraction accelerates the movement of the egg and prevents it from fixing in the uterine cavity.

Hormone-containing coils gradually release a hormonal preparation that promotes changes in the structure of endometrial tissues, which leads to the following results:

· delayed mucosal proliferation leads to rejection of the fertilized egg;

· Increased viscosity of the cervical secretion inhibits the penetration of spermatozoa into the uterine cavity.

The main component levonorgestrel in some cases can inhibit ovulation.

IUD features

The copper and silver components of the intrauterine devices have antiseptic properties, which minimizes the likelihood of inflammation in the uterus and fallopian tubes. Hormone-containing spirals, like other hormonal agents, have a pronounced anti-inflammatory effect and inhibit the development of the endometrium. GS is recommended for heavy periods – prolonged contact with a hormonal contraceptive reduces blood loss, preventing the development of iron deficiency anemia and alleviates pain.

Insertion and removal of the intrauterine device

Insertion of the IUD is a fairly simple and almost painless procedure. It must be performed after a preliminary examination (ultrasound, smear, blood tests) in order to exclude a probable pregnancy and diseases in which intrauterine contraception is contraindicated. The installation procedure is performed by the doctor, who also selects the most suitable type of contraceptive.

It is recommended to install an IUD for women who have given birth, and if necessary, you can resort to this method of contraception in the period after an abortion made at I trimester.

The coil is inserted in the first 7 days from the start of the menstrual cycle. At this time, the neck is ajar, so the introduction of the device is quick and painless. The spiral is placed into the uterus using a flexible tube, which is gently inserted into the cervix. Threads remain in the vaginal cavity, which serve as a control marker and help to remove the device at the end of its service life.

Replacement of the coil is necessary in the following cases:

expiration date;

Spontaneous IUD prolapse.

Removal of the coil is also performed by a specialist, by removing the IUD by the threads. If the device is displaced, it is pulled out with a special gynecological instrument (traction hook).