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Information

Editors

AnneliKivijärvi

Intrauterine Device

Essentials

  • A copper-releasing IUD is a safe Intrauterine Device for Contraception and effective method of contraception.
  • There are several T-shaped IUDs with 380 mm2 of copper on the market.
  • The so-called 5-year copper IUD can be used for up to 10 years if there are no adverse effects. If a woman is 40 years old when she is fitted with a HASH(0x2fdd378) 300 mm2 copper IUD, the IUD can be used until 1 year has passed after her last menstrual period.

Advantages of an IUD

Contraindications of IUD use

Absolute

  • Pregnancy (or suspicion of it)
  • Pelvic inflammatory disease
  • Undiagnosed abnormal bloody vaginal discharge
  • Suspected or observed malignancy of the cervix or endometrium
  • Increased bleeding tendency
  • Wilson's disease or known true allergy to copper
  • Abnormal anatomy of the vagina, cervix or corpus of uterus, which prevents succesful insertion and use of an IUD (e.g. fibroids, intrauterine septum)

Relative

  • Anaemia
  • Profuse menstrual bleeding or very painful menstruation
  • Less than two months from childbirth as the soft uterus may increase the risk of perforation Risk of Uterine Perforation in IUD Insertion
  • High risk of sexually transmitted infections (changing partners)

Insertion of an IUDImmediate Post-Partum Insertion of Intrauterine Devices, Risk of Uterine Perforation in IUD Insertion, Timing of Copper Intrauterine Device Insertion after Medical Abortion, , Interventions for Pain with Intrauterine Device Insertion

  • It is not necessary to investigate a Pap smear or infection samples in an asymptomatic woman.
  • Insert the IUD preferably during the menstrual flow (within 10 days after the beginning of bleeding). An IUD can be inserted at any phase of the menstrual cycle, as long as the woman is not pregnant. It can also be inserted immediately after abortion Timing of Copper Intrauterine Device Insertion after Medical Abortion, .
  • Follow the insertion instructions of the manufacturer and use aseptic technique.
  • After insertion, cut the threads to the standard length (2.5-3 cm).
  • There is no need for medication or abstinence from intercourse after insertion.
  • There is no use in advising the woman to check for the presence of the threads herself.

Disadvantages of an IUD and problematic situations

  • An IUD may increase bleeding and duration of menses. Increased pain is also possible. Consider changing the IUD if adverse effects appear (an uncorrectly positioned IUD in the uterine cavity may cause problems). About 5 out of 100 IUDs become expelled completely or partially during the first year of use.
  • Heavy bleeding and pain caused by the IUD can be treated with prostaglandin inhibitors Nsaids for Heavy Bleeding or Pain Associated with IUD Use. In such situations the IUD is readily changed to a hormone-releasing IUD Hormonal Contraception.
  • Although all IUDs tend to descend, total expulsion is rare. It is acceptable for an IUD to descend 2 cm from the fundal position, but an IUD positioned partly or totally in the cervical canal must be changed.
  • Sometimes the threads disappear, i.e. they are retracted into the cervical canal. If there is uncertainty about the position of the IUD, ultrasonography can be used to check whether the IUD lies in the uterine cavity. Only a radiograph will, however, provide certainty about whether the IUD is in the abdominal cavity or whether it has been expelled by itself without the woman noticing.
  • Bacterial vaginosis Vulvovaginitis as well as Actinomyces on Pap smear are found more often in IUD users than in other women. An asymptomatic patient with Actinomyces on Pap smear does not need any intervention. If there is leucorrhoea, remove the IUD and insert a new one after an interval of 2 months.
  • If pregnancy occurs with an IUD, remove the IUD as early as possible (in primary care or, if needed, at a hospital outpatient clinic).
  • If the IUD has to be removed because of adverse effects, best time is during the menstruation. While removing the IUD some other time, give the patient postcoital hormonal contraception Postcoital Contraception, if unprotected (no condom) intercourse has occurred during the previous week.
  • Curved uterine forceps and an IUD hook are good instruments for removing of the IUD. If removal is not successful, refer the patient to a hospital outpatient clinic.