Intrauterine contraceptive devices (IUCDs)
What are IUCDs?
IUCDs are small, flexible plastic devices that are inserted into the uterus via the cervix.
What are IUCDs used for?
IUCDs were primarily designed to prevent pregnancy. With the introduction of the Mirena IUCD, an additional indication became the control of heavy periods and management of endometriosis symptoms.
Types of IUCD
Historically, there are many types of IUCD. In terms of current, Western, medical practice there are only 4 types in use:
These are all small devices but there is evidence to suggest that the smallest devices are easier to pass through the cervix into the uterus. The mini Mirena was approved in the USA for use in nulliparous (never had a baby) women in 2013.
The procedure can be done with you awake as an office procedure or in an approved day case operating theatre under sedation or a light general anaesthetic.
- The cervix is cleansed.
- The cervix is grasped with a tenaculum (this will straighten and stabilise the cervical canal).
- The length of the uterus will be measured using a uterine sound.
- You may have local anaesthetic injected into the cervix before insertion.
- The IUCD is removed from the packaging.
- The packaging is retained for recording of the batch number and expiry date of the IUCD.
- The marker on the stem will be set to correspond with the recorded length of the uterus.
- The IUCD is inserted through the cervix into the uterus as per manufacturers guidelines.
- The inserter is withdrawn from the uterus leaving the device position within the fundus of the uterus.
- The thread of cut leaving about 1.5-2cm protruding from the cervix.
- The tenaculum is removed from the cervix and the procedure is complete.
Insertion of the IUCD is best done towards the end or immediately after a period because the cervix is softest at this time and it is most likely that you are not pregnant.
Your doctor may require you to have a negative pregnancy test immediately before the IUCD is inserted.
In some circumstances it may be appropriate for your doctor to carry out a hysteroscopy prior to insertion of the IUCD.
The IUCD sited in the uterus
How long can the ICUD stay in place?
How do IUCDs prevent pregnancy?
Prevention of the egg meeting a sperm which might result in fertilisation
- Making the endometrium hostile to implantation of a fertilised egg.
- Through a ‘foreign body’ presence.
- The Multiload and Copper T through release of Copper.
- The Mirena and mini Mirena through release of the progesterone Levonorgestrol.
Side effects & complications common to all IUCDs
Spotting or intermenstrual bleeding
Lower abdominal cramping &/or back pain
Ineffective because it slips out of the uterus (most common during the first few months)
If pregnancy occurs with the IUCD in situ, there is an increased risk of an ectopic pregnancy
The risk of having a pelvic infection is higher in the first few months after insertion of the IUCD
Perforation of the uterus during insertion
The IUCD is pushed partly through the uterus or completely through the uterus into the pelvis during insertion
This patient complained of severe pelvic pain and cramping at the time of IUCD insertion by her local doctor. The pain persisted. No thread was seen on examination. An ultrasound scan revealed that the IUCD was not in the uterus. At laparoscopy it was found outside the uterus in the pelvis.
The IUCD was freed from bowel entanglement and removed through laparoscopic surgery. The patient was able to return home on the same day as surgery.
Things worth remembering
Give your doctor your complete medical history including medications
Hypersensitivity reactions to copper and progesterones are rare but they do occur
IUCDs are very cost effective and low maintenance methods of contraception
The Mirena and mini Mirena IUCDs can reduce symptoms of heavy menstrual flow and endometriosis
Tell your doctor if you have any symptoms suggestive of PID before or after insertion or if you have pain or discharge that is not settling
All the IUCDs can stay in for different periods of time. All can be removed early but know when they need to be removed/changed
During an attempt to remove the IUCD, the thread may break and removal of the IUCD may need to be done as a short stay hospital procedure
Practice how to check for the strings of the IUCD. Do this every month. If you cannot feel it, inform your doctor and use additional methods of contraception
Contraindications to using an IUCD
- Known increased risk of having an ectopic pregnancy.
- Any history of pelvic inflammatory disease within the previous 12 months.
- Hypersensitivity to plastic.
- Hypersensitivity to copper (Multiload/Copper T).
- Hypersensitivity to progesterones (Mirena devices).
- Pregnancy; actual or suspected (*see below).
- Vaginal bleeding of unknown cause.
- Uterine or cervical tumours.
- Abnormalities of the uterus or cervix.
- An infected miscarriage or abortion within the past 3 months.
The Multi load and Copper T IUCDs, if inserted within 5 days of unprotected intercourse can reduce the risk of pregnancy.