Contraception Intrauterine Devices Iud

Overview

An intrauterine device (IUD) is a small, soft, T-shaped piece of plastic that a doctor or nurse puts inside your womb (uterus) to stop you getting pregnant. Most people call it the coil. There are two main types. The copper IUD contains no hormones and works by making sperm unable to swim properly. The hormonal IUD, sometimes called an IUS or intrauterine system, slowly releases a tiny amount of a hormone called progestogen, which thickens the mucus at the neck of the womb and thins the lining of the womb. Both types are long-acting, which means you do not have to remember anything each day.

Yes. IUDs are one of the most widely used kinds of contraception in the world. Millions of people use them, and they are fitted every day in GP surgeries and sexual health clinics.

Symptoms

Common symptoms

• Period-like cramping for a few hours, or up to a few days, after the device is fitted
• Spotting or irregular bleeding for the first 3 to 6 months
• With the copper IUD: periods that are heavier, longer or more painful, especially at first
• With the hormonal IUD: periods that become lighter, and often stop altogether after a year or so
• With the hormonal IUD: headaches, breast tenderness or acne in the first few months, which usually settle
• You should be able to feel two thin threads high in the vagina with your fingers, but you should not be able to feel the hard body of the device itself

Symptoms in children

• IUDs are not normally used before puberty, because a young person is not usually able to become pregnant before their periods start
• Teenagers who can get pregnant can safely use an IUD. It can be a good choice because it lasts for years and nothing needs remembering daily
• Younger people and people who have never been pregnant may find fitting more uncomfortable, but it is not more dangerous
• Confidential contraception is usually available for young people. Ask your doctor or local sexual health service what the rules are where you live

Symptoms in older adults

• An IUD can be used right up to the menopause and beyond
• A hormonal IUD is sometimes used as the progestogen part of hormone replacement therapy (HRT) to protect the lining of the womb
• When you no longer need contraception, the IUD can be removed at any time. This is a quick clinic procedure, not an operation
• Bleeding after the menopause should always be checked by a doctor, even if you have an IUD

Causes

Main causes

• An IUD is not an illness, so it is not caused by anything. It is a method of contraception, and this section explains how it works
• Copper IUD: the copper is harmful to sperm, so they cannot swim well enough to reach and fertilise an egg
• Hormonal IUD: the progestogen thickens the mucus at the neck of the womb so sperm cannot get through, and thins the lining of the womb so a fertilised egg is unlikely to settle
• Both types mainly work before an egg is fertilised. They do not cause an abortion
• Neither type contains oestrogen, so they can often be used by people who cannot take the combined pill

Risk factors

• Having an untreated infection in the pelvis or cervix at the time of fitting
• Being pregnant, or possibly pregnant, when the device would be fitted
• Unusual vaginal bleeding that has not yet been checked
• Certain shapes of the womb, or fibroids that press on the inside of the womb, can make fitting harder
• A previous pregnancy outside the womb (ectopic pregnancy). Talk this through with your doctor first
• The device coming out by itself (expulsion) or, very rarely, making a small hole in the womb (perforation). Both are most likely in the first few months
• A higher chance of infection in the first 20 days after fitting
• Feeling very anxious or having had a painful fitting before. Tell your nurse so they can plan extra support

When to see a doctor

See a doctor urgently if:

• Severe belly pain, a high temperature, or feeling faint and unwell
• Heavy bleeding with clots and dizziness
• You cannot feel your threads and you have pregnancy symptoms or a missed period
• You think the IUD has come out
• Fever or bad-smelling discharge in the weeks after fitting
• New severe pain during sex

Book a routine appointment if:

• Before you choose a method, to talk through all your options
• A check of the threads 3 to 6 weeks after fitting, if your clinic offers one
• If your periods become troublesome, very heavy, or you develop low iron symptoms such as tiredness and breathlessness
• When you want the device removed or replaced
• If you need emergency contraception, as a copper IUD can be fitted up to 5 days after unprotected sex
• Any time you have a new sexual partner and want advice on STI testing

Diagnosis

There is no test to diagnose an IUD. Instead you decide together with a doctor or nurse that it is the right method for you. They will ask about your health, your periods, any pregnancies, and any infections. They will check your blood pressure and may offer a test for sexually transmitted infections. They will explain the good and not-so-good points of each type. If you decide to go ahead, the device is usually fitted at the same visit or a follow-up appointment.

Tests that may be done

• A pregnancy test, to make sure you are not already pregnant before fitting
• A test for sexually transmitted infections if you might be at risk. This can often be done on the same day
• A pelvic examination so the doctor can check the size and position of your womb
• Sometimes a swab or an ultrasound scan if the shape of your womb is unclear
• A thread check 3 to 6 weeks later, to make sure the device is still in the right place

What to expect at your appointment

Fitting usually takes about 5 to 10 minutes and is done in a clinic room. You will lie on your back with your legs supported, and a speculum is gently used to hold the vagina open. The doctor or nurse will then place the device through the neck of the womb. Many people feel period-like cramps at this point and some feel light-headed for a few minutes. Ask your clinic about pain relief beforehand, and tell them if you feel anxious, because extra steps can be taken to make you more comfortable. You can usually go home the same day and drive yourself if you feel well. Some clinics use a local anaesthetic to numb the neck of the womb.

Treatment

The IUD is itself the treatment. The care you need is choosing the right type, having it fitted safely, and knowing what to expect afterwards. There is nothing you have to do each day, which is one of the main reasons people choose it.

Self-care at home

• Take it easy for the rest of the day after fitting. Rest, and a warm heat pad on your lower belly, can help with cramps
• You can usually have sex as soon as you feel comfortable, but use condoms for the first 7 days if it was fitted partway through your cycle. Your nurse will tell you exactly when it becomes effective
• Check your threads about once a month and after your period. Wash your hands, then feel high in the vagina for two thin threads
• Use condoms as well to protect against sexually transmitted infections. An IUD does not protect against them
• Write down the date it needs to be replaced, and set a reminder in your phone
• If you use a menstrual cup, release the suction before pulling it out, and ask your nurse for advice about using one with an IUD

Medical treatments

Most people need no medicine at all after fitting. If cramps are troublesome, your doctor or pharmacist can advise on pain relief that is safe for you. If an infection is found, it will be treated. If the IUD turns out not to be right for you, it can be removed at any time, and there are many other methods to try, including the implant, the injection, the daily pill, the patch, the vaginal ring, condoms, and fertility awareness methods. Your doctor or nurse can talk you through the pros and cons of each.

When is surgery considered?

Removal is not surgery. It is a quick procedure in a clinic: the doctor or nurse gently pulls the threads and the device slides out. You may feel a brief cramp. Occasionally, if the threads cannot be found, a small procedure may be needed to remove the device. This is uncommon and your doctor will explain what is involved.

Living with this condition

Once it is in, an IUD is mostly something you can forget about. The main habits are checking your threads once a month, noting when it needs replacing, and getting any pain, unusual bleeding or fever checked promptly. Some people like to keep a note of their periods on their phone, which makes it easier to tell what is normal for you and what has changed.

Lifestyle tips

• You can swim, cycle, run and play sport as normal
• You can use tampons as usual
• Your partner should not be able to feel the device during sex. Sometimes the threads can be felt, but they are soft and usually curl out of the way
• Nothing about your diet, travel or work needs to change
• If you have a pelvic scan for any reason, tell the person scanning that you have an IUD

Diet and exercise

No special diet or exercise is needed. If your periods are heavier with a copper IUD, it is worth eating iron-rich foods such as beans, lentils, leafy greens, eggs and meat, and drinking enough water. Regular movement helps with cramps for many people. If you feel very tired, breathless, or unusually pale, ask your doctor about a blood test for low iron.

Mental health and emotional wellbeing

Some people feel anxious about pain, about the device moving, or about changes to their periods, and this is very common. Others feel relieved to have a method they do not have to think about. Both feelings are normal. If worry, low mood or difficult past experiences around your body or sex are affecting you, it can really help to talk to someone, whether that is your GP, a sexual health clinic nurse, or a person you trust. If you ever feel you cannot cope, contact your local emergency number or a crisis support service in your country straight away.

Prevention

This topic is about preventing pregnancy, and an IUD does that very well. It cannot prevent sexually transmitted infections, so condoms are still worth using with new or casual partners. You can also reduce the small risks of using an IUD by having a check for infections before fitting, knowing how to check your threads, and contacting your clinic if you get pain, fever or unusual bleeding.

Screening programmes

You do not need any screening test to use an IUD. It is sensible to have regular STI tests if you have new or multiple partners. Cervical screening (smear tests) should continue at the ages your local service recommends. Having an IUD does not change that, and the sample can be taken with the device in place.

Complications

If left untreated

• An infection in the pelvis that is not treated can become serious and, in rare cases, affect future fertility
• A pregnancy that happens with an IUD in place has a higher chance of being outside the womb, so early checks matter
• A device that has slipped out without you noticing leaves you unprotected, even if you feel fine
• Very heavy periods with a copper IUD can lead to low iron (anaemia) in some people, which causes tiredness and breathlessness

Long-term outlook

The outlook is very good. Most people with an IUD get on well with it, have no problems, and find that it quietly does its job for years. If the first few months bring cramps or spotting, these usually settle. If a particular type does not suit you, it can be removed quickly, and your fertility returns straight away, so you can try something different. Being aware of the warning signs to watch for means that the rare problems can be caught early and sorted out.

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