Let’s have an IUD (coil) talk

What is an IUD (coil)?

An IUD is a type of long-acting, reversible contraceptive. The small, T-shaped device is placed in the uterus and left in place to prevent pregnancy for between three and twelve years, depending on the type. It is one of the most effective forms of birth control available, in part because it decreases opportunities for human error, unlike, for instance, the birth control pill, which must be taken daily. 

IUDs are very safe and highly effective. There are both hormonal and non-hormonal types. Hormonal IUDs use the hormone progestin to prevent pregnancy, and work by thickening mucus in the cervix to keep sperm from reaching the egg. They can also suppress ovulation. The copper IUD, which does not rely on hormones, is wrapped with a small piece of copper that is toxic to both sperm and egg.

Research also shows that IUDs can be an effective form of emergency contraception if the device is placed within five days of unprotected sex.

Are IUDs suitable for everyone?

There are specific contraindications for each type of IUD. Some of them include:

• Pregnancy

• Genital infection at the time of insertion or acute pelvic inflammatory disease

• Not all shapes of the uterus are suitable for IUDs

• History of septic abortion or history of postpartum endometritis within the last 3 months

• Confirmed or suspicion of breast, uterine or cervical cancer and liver tumors

• Abnormal uterine bleeding of unknown origin

• Confirmed or suspicion of breast malignancy or other progestin-sensitive cancer 

• Acute liver disease 

• Wilson disease and sensitivity to copper

Ultrasound and IUDs

Ultrasound portrays a significant role before and after the insertion/removal of an IUD to simplify the procedure and minimise risk.

Initially, it’s important to confirm that the shape of your uterus is compatible with the use of IUDs. At East Anglia Ultrasound Services your sonographer will assess this by performing a 2D/3D Pelvic Ultrasound Scan. With 3D, they will move to a coronal plane view and conclude if there are any contraindications. They will see the exact shape of the uterine cavity and measure the volume and the length of it.

This information is especially important, considering research that shows most conventional IUDs are too big to fit inside the uterine cavities of many individuals.

After the successful insertion, ultrasound can be used to confirm that the device is placed in the right location. This is also helpful as IUDs most of the time cannot be felt and this can lead to concerning feelings or uncertainty. Detailed ultrasound images of the IUD in the right position can enable individuals to feel a lot more at ease and confident about their birth control.

Experiencing pelvic pain, abnormal bleeding, excessive discharge or fever is always advised to be investigated. The above can also be indication of a migrated IUD and this can be easily confirmed by a Pelvic Scan.

Before removal, an ultrasound can be performed to confirm that the IUD is intrauterine. A 3D Pelvic Ultrasound is ideal if there is concern that an IUD arm is embedded, but standard 2D sagittal and transverse views will be adequate in identifying an intracavitary IUD.

How is the IUD Inserted?

A doctor or nurse practitioner can insert the IUD during an appointment. Insertion only takes a few minutes. IUDs are typically inserted during the menstrual period as the cervix will open easier. The doctor opens the cervix by placing a rod called a dilator. Once the cervix is open, the doctor inserts the IUD using a narrow plunger. Insertion can cause sensations similar to menstrual cramps which stop soon after insertion is complete. After insertion, it is advised that the patient avoids intercourse and maintains low impact physical activity for a few days. Follow up afterwards is one month after insertion to ensure proper placement.

How Is the Device Removed?

IUD removal is a similar process to insertion. A woman visits her gynaecologist who will locate the strings on the outside of the cervix and use forceps or clamps to slowly and gently remove the device. The doctor will pull the device out of the uterus at a specific angle to allow the flexible arms of the device to fold and pass easily.  The device should never be removed by anyone except a licensed healthcare provider. The IUD may be removed by the provider at any point that the patient desires to discontinue its use.  

Pros and cons

IUDs have certain benefits.

• They are more than 99% effective at preventing pregnancy

• After having an IUD the individual doesn’t need to think about birth control each time they engage in sexual activities

• One IUD can last for 3 to 10 years and this makes it one of the most economic forms of birth control

• Fertility gets restored again almost immediately after an IUD is removed

• Copper-releasing IUDs do not have hormonal side effects and may help protect against uterine (endometrial) cancer

• Both types of IUDs may lower the risk of developing cervical cancer

There are also downsides.

• IUDs do not prevent sexually transmitted diseases (STDs). To avoid STDs the gold standard is to abstain from sex, be in a mutually monogamous relationship, or use condoms

• A provider needs to insert or remove the IUD

• While rare, an IUD can be misplaced and need to be removed

• Copper-releasing IUDs can cause cramps, longer and heavier menstrual periods, and spotting between periods

• Progestin-releasing IUDs can cause irregular bleeding and spotting during the first few months

• IUDs may increase the risk for ectopic pregnancy

• Some types of IUDs may increase the risk for benign ovarian cysts, such cysts usually do not cause symptoms and they usually resolve on their own.

• IUDs do not appear to increase the risk for pelvic infection or affect fertility, as mentioned before, once an IUD is removed, fertility is fully restored

Do IUDs cause weight gain?

Both hormonal and non-hormonal IUDs are unlikely to cause weight gain. For some women, the progestin hormone (levonorgestrel) present in hormonal IUDs can cause water retention. Typically, any weight gain from hormonal IUD is most likely due to water retention and not fat gain. 

To summarise things to think about…

You may want to consider an IUD if you:

• Want or need to avoid risks for contraceptive hormones

• Can't take hormonal contraceptives

• Have a heavy menstrual flow and want lighter periods (hormonal IUD only)

You should not consider an IUD if you:

• Are at high risk for STDs

• Have a current or recent history of pelvic infection

• Are pregnant

• Have abnormal Pap tests

• Have cervical or uterine cancer

• Have a very large or very small uterus

Sources:

ISUOG Basic Training Examining the Uterus, Cervix, Ovaries & Adnexae: Normal Findings, United Nations; Department of Economic and Social Affairs. World contraceptive use 2011, United Nations, 2011. Teal SB, Sheeder J (2012) IUD use in adolescent mothers: retention, failure and reasons for discontinuation. Contraception 85: 270–274. Rasheed SM, Abdelmonem AM (2011) Complications among adolescents using copper intrauterine contraceptive devices. Int J Gynaecol Obstet 115: 269–272. Kaislasuo J, Suhonen S, Gissler M, Lähteenmäki P, Heikinheimo O (2013) Uterine perforation caused by intrauterine devices: clinical course and treatment. Hum Reprod 28: 1546-1551. Shipp TD, Bromley B, Benacerraf BR (2010) The width of the uterine cavity is narrower in patients with an embedded intrauterine device (IUD) compared to a normally positioned IUD. J Ultrasound 2010 Dec;29(12):1848. NHS.uk