Intrauterine Device

What is an Intrauterine Device?

An intrauterine device is a contraceptive device that is inserted into the uterus. Contraceptive devices prevent the fertilization of the ova (eggs) by the sperms, thereby preventing pregnancy. Before choosing a contraceptive method, it is important to consult a doctor for the available options and understand the advantages, disadvantages, contraindications and risks of all the available contraceptive methods.

An intrauterine device is long-term, reversible and very effective method of contraception which last for years. So women who opt for it don't need to think about contraception every now and then. Once inserted inside the uterus, it is there for years, till you get it removed.

How does an Intrauterine Device Work?

An intrauterine device is inserted into the uterus of the female who opts for contraception. It is a T-shaped device with threads in the end that hang around at the lower opening of the uterus, which is called the cervix. The cervix lies at the top of the vagina. The threads are helpful in ensuring that the intrauterine device is in correct position, and therefore, women should be encouraged to feel the threads on regular basis at home. The threads also help to remove the device when required.

The type and size of the intrauterine device differs based on the need and suitability of the woman. There are two major types of intrauterine devices; copper intrauterine device and hormonal intrauterine device.

• A copper intrauterine device is a plastic device with copper wrapped around it.
• A hormonal intrauterine device contains the hormone progestin (levonorgestrel) which is gradually released in the woman's body. It reduces menstrual bleeding and is mainly helpful to those women who have very heavy periodical menstrual bleeding.

An intrauterine device blocks the passage of the sperms floating their way from the vagina through the uterus to the egg, thereby stopping them from fertilizing the egg and preventing conception. Hormonal intrauterine devices release hormones which further help by changing the lining of the uterus, so that it doesn't support the pregnancy; therefore, even if an egg gets fertilized, it cannot get implanted in the uterus. They also thicken the cervical mucus so that the sperm cannot travel up to the egg. The copper in the copper intrauterine devices makes the uterine environment hostile to sperms.

How is an Intrauterine Device Inserted?

An intrauterine device is inserted by a doctor or trained nurse as an outpatient procedure. A medical history of the woman will first be obtained to check for the suitability of the device. This will be followed by a gynecological examination, where a local infection will also be ruled out. A speculum is then inserted into the vagina and the intrauterine device is inserted into the uterus through the cervix. Its two arms block the opening of the fallopian tubes into the uterus. This entire process of insertion takes about 5-10 minutes.

An intrauterine device can be inserted at any time of the menstrual cycle. The lady might feel slight cramping or discomfort during the insertion. That lasts only for a minute or two. The lady might also experience spotting or cramping after the insertion, which goes off gradually.

How Effective are Intrauterine Devices for Contraception?

It is reported that intrauterine devices are more than 99% effective as a contraceptive measure. The effectiveness of an intrauterine device is primarily associated with its permanency, since it is effective till the lady opts to get it removed. Unlike with other contraceptive methods like pill, condom or contraceptive gel, the couple does not have to bother about using a contraceptive before every sexual act.

What are the Disadvantages of Intrauterine Devices?

Usually, an intrauterine device is very safe. Very rarely, one or more of the following complaints might be reported:

• Heavy periods - Some women might report heavy bleeding during their monthly menstrual cycle. This is reported in the initial few months following intrauterine device insertion, especially with the copper intrauterine device. The bleeding reduces gradually to normal. In case of the hormonal intrauterine device, the periods become less heavy.

• Uterine Perforation - Uterine perforation is one of the rarest complications of intrauterine device insertion. If lady reports severe pain during insertion, the procedure should be stopped immediately and signs of bleeding need to be assessed.
• The hormonal intrauterine device may cause non-cancerous growths in the ovaries called ovarian cysts, which usually go away with time.
• The hormonal intrauterine device can cause hormonal side effects such as breast tenderness, mood swings, headache and acne.
• Very rarely, an infection might occur in the uterus due to the insertion of the intrauterine device. It is very important to remove the intrauterine device and treat the infection on time or else it might have a very serious impact on the fertility of a women.
• The intrauterine device prevents pregnancy but does not protect against sexually transmitted diseases. In case the female needs protection from sexually transmitted diseases, it is suggested to use condom also.
• Though the intrauterine device is more than 99% effective, there is a small chance that the woman can get pregnant while using the device.

What are the Contraindications for Intrauterine Device Usage?

The intrauterine device is safe for most of the women except for those suffering from following medical conditions:

• Sexually transmitted diseases
• Pelvic Infection; the insertion should only be done 3 months after the treatment is complete and the reports have been negative for 3 months consistently
• The presence of pregnancy
• Cancer of cervix
• Cancer of uterus
• Copper allergy
• Breast cancer ( in case of hormonal intrauterine device )
• Anatomical abnormalities in the uterus
• Gestational trophoblastic disease with persistently elevated beta HCG levels

What are the Risks Associated with the Intrauterine Device Insertion?

• Slipping out of uterus - The intrauterine device might slip out of uterus completely or partially, while having sex or using tampons during periods. Therefore, the lady should be vigilant about the same and should be taught and encouraged to feel the intrauterine device strings in place every now and then. If she feels the strings have come too low or have gone too high, she should report to the doctor immediately for correcting the placement.
• Pregnancy - You might get pregnant with the intrauterine device in place. But it is most likely that the pregnancy might be an ectopic pregnancy. Ectopic pregnancy happens when egg gets fertilized by the sperm outside the uterus, for example, in the fallopian tube. The embryo therefore starts growing in the fallopian tube instead of getting implanted in the uterus. Ectopic pregnancy is a serious threat to women and is a medical emergency as it can cause the fallopian tube to burst. In case the lady experiences symptoms of pregnancy despite having intrauterine device inserted, she should immediately report to the doctor.

When to Report to the Doctor - Warning Signs?

Usually, an intrauterine device is very safe and doesn't pose any threat to the lady, but still it is important to be vigilant about following warning signs:

• If the lady feels a hard plastic thing coming out of vagina
• If the lady has conceived
• Cramping, pain, soreness in abdomen
• Severe pain during intercourse
• Fever, chills, respiratory distress
• Abnormal vaginal discharge other than periods
• Delayed period and one-sided abdominal pain (which may be a sign of ectopic pregnancy).

How is an Intrauterine Device Removed?

Removing an intrauterine device is easier then placing it. Removal is done by a doctor or a trained nurse. A speculum is inserted in the vagina as it was done during insertion, a clamp is placed on the intrauterine device threads, and the device is gently pulled out. Some women may experience mild cramping or discomfort during the removal.

Women can get the device removed at any time when they wish to get pregnant. If the device had been there inside the body for its maximum effective time period as informed by the doctor during insertion, (usually five or ten years, depending on the device), the same needs to be changed for another one.

Reference:

1. IUD - (https://www.plannedparenthood.org/learn/birth-control/iud)

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