Family doctor

Overview:

• An IUCD is a contraceptive which sits in the womb
• It is 99 percent effective at preventing pregnancy and avoids having to take 'the Pill'
• It is suitable for women in a monogamous relationship who have had a child
• It is best inserted at period time
• An IUCD can stay in the womb for five years
• It can cause heavy periods (except Mirena)
• There is a slight risk of ectopic pregnancy
• Removal is quick and painless

What is it?

An IUCD is a small device, usually plastic and copper, that sits in the womb. It is a reliable method of preventing pregnancy that avoids taking daily hormones.

It prevents pregnancy by stopping sperm reaching the egg and by preventing a fertilised egg settling in the womb.

It is 99 percent effective.

Who can use it?

Most suitable for women who have had a child already and are in a stable monogamous relationship. It is easier to insert in women who have had a child. A stable relationship is important because it is very important to avoid sexually transmitted diseases (STDs) with IUCDs. If an infection such as chlamydia is present with an IUCD, the overall infection will be worse with much more chance of tubal damage and threat to future fertility. All women should be screened for STDs prior to insertion.

Who cannot use it?

• Women with a copper allergy (except Mirena)
• Women with uterine abnormality
• Women with current genital infection, cancer or suspected cancer of the cervix
• Pregnant women
• Those with abnormal bleeding from the uterus

Advantages:

• No need to take pills
• One can stay in for five years
• No interference with sex
• Can be used when breastfeeding
• Low pregnancy rate
• Non-hormonal (except Mirena)
• Light periods (Mirena only)

Disadvantages:

• Can cause heavy periods (except Mirena)
• Slightly greater risk of ectopic pregnancy
• If pregnancy occurs (1 percent), miscarriage risk is higher than normal
• Infection - risk is very low if a woman is not at risk of an STD and is screened first

How is it put in?

It is best inserted at period time. The woman should have had a recent PAP smear and STD screen with the results available. The doctor checks the uterus first then inserts a speculum. After cleaning with an antiseptic the IUCD is inserted via a plastic tube. This procedure is uncomfortable, sometimes painful, though just for a very short time. Pain can be minimised by taking a mild analgesic such as ibuprofen beforehand. Some women feel faint - you can minimise this by ensuring a good meal has been eaten earlier in the day.

The IUCD has strings attached to it, enabling the patient and the doctor to check it is in place.

How is it removed?

An IUCD can stay in for a maximum of five years. Removal is quick and painless, and is usually done at period time.

Mirena

This is a new IUCD that releases a tiny dose of progesterone hormone into the womb. It is very effective (more than 99 percent), and is especially suitable for women with heavy periods as the hormone thins the lining of the womb. Periods are much lighter. It has a success rate the same as tubal ligation, with the advantage of being reversible.

Women with diabetes or on certain drugs (anti-epileptics) need to discuss this with a specialist carefully because the progesterone may have risks.

Common questions:

1. Does an IUCD affect future fertility?

Only if you have an infection, which is very rare if you have been screened properly for STDs and you are in a stable relationship.

2. Can I fall pregnant as soon as it has been removed?

Yes, there is no need to wait.

3. Does copper get absorbed into the body?

Yes, but only a tiny, insignificant amount. Most is lost in vaginal fluids.

4. Does the IUCD cause cancer?

No, there is no evidence for this.

5. Is the IUCD safer than the pill?

Yes. The risk of a serious life threatening condition is greater with the pill (e.g. blood clot or stroke). However, the IUCD can affect future fertility, but only if you have an infection. (See first question).

6. Can the IUCD cause an abortion in the way that it works?

The IUCD sometimes prevents a fertilised egg from implanting. (More often it prevents sperm reaching the egg). If you believe that contraception should never operate after fertilisation, then you should choose another method.