Intrauterine Contraceptive Device (IUD)

This article is on intrauterine contraceptive device (IUD). 

What is an IUD?

It is a small, inert, T-shaped device that is inserted into the uterus. It sits in the cavity of the uterus, with 2 short threads attached to its end that passes out through the cervix for easy removal. An IUD lasts for 5 years, and prevents pregnancy by thickening the cervical mucus, preventing fertilisation of the egg and making it difficult for implantation of a fertilized egg. Only 1-2 out of 100 women on IUD will become pregnant over 5 years, which makes it a highly effective birth control method. 

There are 2 types of IUD – the copper IUD (known as the copper-T or copper coil), and the Mirena IUD (this contains progesterone hormone). The copper IUD works immediately after insertion, while Mirena takes 7 days to start working. Both are as effective for birth control, but the Mirena IUD has additional functions of treating heavy periods, bad menstrual cramps and endometriosis.

Both can be inserted (or removed) in the clinic if you have had sex and/or given birth before. IUD can also be inserted together with other surgeries e.g. hysteroscopy dilation and curettage, surgical abortion.

The IUD does not protect you against sexually transmitted infections (STIs) – you should use condoms in addition for that.

What are the risks of IUD insertion?

Common (affecting 1-5% of patients):

• Discomfort for a few hours and light bleeding for a few days following insertion
• 1:20 risk of IUD expulsion (most common within 1^st year)
• Menstrual disturbances especially in the first 3-6 months (e.g. light/heavy periods, long periods, bleeding in between periods, irregular periods, menstrual cramps). 30-40% of Mirena users will have light/infrequent periods or no periods by the end of the 1^st year. 

Uncommon (affecting 0.1-1% of patients)

• Difficult insertion (especially if you have not given birth vaginally before)
• Malpositioned IUD: this may require removal and insertion of a new IUD, or hysteroscopy to remove if threads are missing 
• Pelvic inflammatory disease (especially within first 20 days of insertion)
• Failure rate (getting pregnant on IUD)

Rare (affecting <0.1% of patients):

• Uterine perforation: IUD migrates out of the womb, requiring surgery to remove 
• Ectopic pregnancy: risk of this in IUD users are lower compared to women not using any contraception

How soon can I put an IUD in after giving birth?

You should wait at least 6 weeks after giving birth for your uterus to shrink back to its normal size before inserting an IUD. Breastfeeding can make your uterus soft and there can be a slightly higher risk of uterine perforation.

What should I take note of when I have an IUD inserted?

There should be no change required in your lifestyle – you should be able to go back to work and your usual activities on the day of or the next day of IUD insertion. Resume your exercise, swimming and sex as usual after the initial discomfort and spotting following insertion have stopped. You may use tampons and pads for your periods. If using menstrual cups, wait for 6 weeks after IUD insertion and check for your IUD threads after each period if you can.

See your gynaecologist earlier for a check-up if you:

• experience foul smelling vaginal discharge, fever, lower abdominal pain 
• have menstrual disturbances that persist or worsen beyond a few months after IUD insertion
• suspect that your IUD may have fallen out or if you may be pregnant  

What are the risks of IUD removal?

Common (affecting 1-5% of patients):

• Discomfort for a few hours and light bleeding for a few days following removal

Uncommon (affecting 0.1-1% of patients)

• Incomplete removal (especially if IUD is malpositioned or has been left inside for a long time)
• Pelvic inflammatory disease

Rare (affecting <0.1% of patients):

• Embedded IUCD or fragments: surgery may be required to remove this 
• Uterine perforation during removal, requiring surgery

When can I try for pregnancy after my IUD is removed?

You can try for pregnancy immediately after your IUD is removed as there is no delay to your fertility returning. Do take note of preconception care.