There are two main kinds of Intra Uterine Devices in Canada, but about 14 types that are approved for use.
An IUD is a small T shaped object that fits in the uterus to prevent pregnancy. It is made with a plastic frame with either copper or hormone (levonorgestrol) added to make it effective. Sometimes the hormone one is called IUS, or intra uterine system- because it is a system to deliver medication to your body. One or two strings hang from the T shape device through the cervix so that the IUD can be removed when it is no longer needed, or when the recommended time is up.
Why would I choose an IUD?
Many couples like an IUD because it is the best reversible method of contraception. It prevents pregnancy without needing to think about doing something every time you have sex (diaphragm or condom) or taking medication regularly (pill, patch, ring or shot). Some women are unable to take estrogen and so methods like the pill, patch and ring are not safe. Some women get pregnant really easily, so IUD is the best method.
Which IUD should I use?
Copper IUD's are available at the clinic, and not available on many drug plans. The ones we use are approved by Health Canada for use up to 5 years. Many women like them because they have no hormones. Copper IUDs can make your period heavier with more cramps so they are not recommended for women who already have longer heavier painful periods. If you are not bothered by your periods and you really do not like using hormones, this is the right choice for you.
Levonorgestrel IUS (Mirena®, Kyleena® & Jaydess®) are more expensive and can be purchased at any pharmacy with a prescription. Because it is a medication, many plans will cover the cost. The Mirena® & Kyleena® is effective for 5 years, and the Jaydess® for 3 years. The timing is related to the amount of hormone contained in the capsule and how long on average it will last. Women who cannot take estrogen are good candidates for the IUS, and women who have heavy and painful periods. Mirena® will suppress or stop the periods in about 20% of women, but the Kyleena® & Jaydess® is less likely to do this. With any IUS, there is likely to be spotting for 4-6 months following insertion.
When is it inserted?
An IUD is inserted by one of our physicians at a short clinic visit. The best time is just at the end of your period, but anytime is fine, as long as there is no risk of pregnancy. If you are using the IUD for contraception, we recommend that you abstain from sex from your period until the insertion day. The copper IUD is immediately effective, but the IUS will take 10 days to be effective unless it is inserted while you are on your period.
How is it inserted?
The doctor checks the size and position of your uterus. She puts a speculum into your vagina to see the cervix, and may offer local anesthetic if you wish. She holds the cervix, checks that she can get through it, and then inserts the IUD to the top of your uterus, usually about 7cm. She will then cut the string. The position will be checked by an ultrasound either on the day it is inserted or a few weeks later at the clinic.
Are there any risks?
No medical procedure is without risk. For IUD insertion, these are small, but include expulsion, pregnancy, infection and perforation. Expulsion is the most common, occurring 1-5% of the time. Usually this happens within the first few months. Pregnancy is rare, about 1 in 100 for women with a copper IUD or Jaydess® IUS, and about 1 in 1000 for women with the Mirena® IUS. Risks of infection are only high for 3 weeks following insertion, and are more common if you already have a vaginal infection or STI so we recommend screening before insertion. Rates of infection are less than 1%. Perforation, or putting the IUD through the uterus instead of inside it, is uncommon, about 1 in 1000 insertions. It is done at the time of insertion, by the physician, and most often noticed at the time. That is why we do ultrasounds at our clinic. If perforated, the IUD must be removed, sometimes needing laparoscopic surgery.
Does it hurt?
Sometimes. If you have not had a vaginal delivery, your cervix might be tight so that you experience a strong cramp when the IUD is passed into your uterus. Most women have a short strong twinge and feel fine in a few minutes. Occasionally, some women might feel queasy or lightheaded. Taking ibuprofen before you come will help. Best to bring someone to drive you if you think you might have discomfort.
Are there other benefits to IUD or IUS?
Because it has medication, IUS is often used to control troubling period symptoms such as heavy bleeding and harsh cramping. For this reason, some women are not using the IUS for contraception, but for period control.