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In lay language the intrauterine device (IUD) is sometimes also called the coil. This is because, in the past, some forms of IUD were in fact shaped like a coil. Today's IUDs are usually made of plastic and are T-shaped. The most frequently used IUDs have a copper wire wound around the shaft. This wire has a silver core which prevents it from breaking. Retrieval threads are attached to the bottom end of the vertical shaft.
The intrauterine device (intrauterine = in the womb) is inserted in the uterine cavity by a doctor or nurse practitioner. It is usually inserted during a period when the cervix is slightly open. A thin flexible plastic tube is used to introduce the IUD into the uterus. You will be able to feel this but it is not usually particularly painful. The doctor will check the position of the device by ultrasound. Further check-ups will be performed about once or twice a year.
The lifetime of an IUD depends on the product used. The most commonly used copper IUDs can be left in the uterus for 5 years.
The IUD is removed by the doctor by carefully pulling the retrieval threads.
Effectiveness of the IUD
The mode of action of the IUD is not fully understood even today. IUDs made of plastic alone prevent implantation of an egg through their mere presence in the uterus (foreign body effect). The copper ions released by the copper-containing IUDs have additional contraceptive action. They reduce the motility of the sperm and the egg and suppress the ability of the sperm to fertilize an egg.
Advantages of the IUD
IUDs are suitable for women who want long-term contraception but cannot or do not wish to use hormonal preparations.
Like the emergency pill ('morning after pill') the IUD can also be used as emergency contraceptive, i.e. it can be used to prevent a pregnancy after unprotected sexual intercourse or after the failure of another method (e.g. burst condom). For this purpose the intrauterine device must be inserted postcoitally (after intercourse) within 5 days after the estimated date of ovulation. After emergency insertion the device can be left in the uterus for continued contraception.
Disadvantages and side-effects of the IUD
The IUD is a potent medical device which can also have side-effects. The following information gives a general outline of the side-effects and risks of the IUD. However, in case of conflicting information the product information of the preparation you have been prescribed always takes precedence. It is therefore important to read the product information carefully and follow any advice given by your doctor.
After insertion of the IUD you may initially experience pelvic pain but this usually subsides after a short time. Persistent pain and heavier bleeding can be a sign that the IUD has not been inserted properly.
Use of an IUD can lead to bleeding abnormalities. Your periods may become longer or you may have more frequent bleeding between periods. Your periods may also become heavier.
Pelvic infections can occur, particularly if you or your partner have multiple partners. Pelvic infections must be treated immediately as they can compromise fertility and increase the risk of an ectopic pregnancy.
In very rare cases – usually during insertion – the IUD can penetrate the wall of the uterus. This risk is increased shortly after giving birth.
The muscular contractions of the uterus during menstruation can sometimes shift the IUD from its correct position or expel it from the uterus. Pain and unaccustomed bleeding may be a sign that this has happened. You should check regularly that you can feel the threads just outside the cervix.
Although ectopic pregnancies are possible when using the IUD the currently available data indicate that IUD users do not have a higher risk of ectopic pregnancy than women not using any form of contraception.
Who is the IUD not suitable for?
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