Intra-Uterine Device (IUD)

Intra-Uterine Device (IUD)

WHAT ARE THEY?

IUDs (intra-uterine devices), also known as IUSs (intra-uterine systems) are small “T” shaped devices that are inserted into the uterus to prevent pregnancy. There are two kinds of IUDs: copper (Liberte, Flexi-T, Nova-T) and hormonal (Mirena, Jaydess, Kyleena). These devices, once inserted, provide birth control coverage for 3 – 10 years, depending on the brand, and can be removed at any time. For most people, IUDs are the most effective and safest form of birth control. The Canadian Paediatric Society now says that IUDs are the best option for front-line birth control for youth.

 

HOW DOES IT WORK?

Copper IUDs work by changing the chemistry of the uterus, which thickens cervical mucus, thereby inhibiting sperm from reaching the uterus. Copper IUDs can also be used as an emergency contraceptive.

Hormonal IUDs uses a synthetic progesterone, levonorgestrel, on a small cylinder. It does not contain estrogen. This cylinder slowly releases the hormone that acts on the lining of the uterus. The lining of the uterus becomes thinner and the cervical mucus becomes thicker, which makes it harder for sperm to enter the uterus.

Both kinds of IUDs need to be inserted by a doctor. To receive an IUD at HSHC, you will need two appointments. The first appointment is a pre-IUD consultation. At this appointment, you will discuss your contraceptive options, get up to date STI swab testing, go over our pre-IUD insertion instructions, and get your prescription for your IUD. This is mandatory, even if you have already discussed IUDs with another doctor or already have a prescription.

The pre-IUD instructions that we give to all of our clients are as follows:

  • Do not have any uprotected sex prior to your IUD insertion to prevent pregnancy and STIs
  • Take 600mg of Ibuprofen 1 hour prior to your appointment
    • Take only if you have had no reaction to Ibuprofen in the past
  • If you are getting the Mirena, Jaydess, or Kyleena inserted, you will require a prescription. You will need to puchase it at the pharmacy prior to your IUD insertion.
  • If you are getting a copper IUD, we will sell one to you at your insert appointment. The cost is $80. We accept debit, credit, and cash.
  • Please bring a pad to use after the IUD insertion, as there may be some light spotting post insertion. Pads must be worn post insertion for 1 week,NO tampons,NO diva cups during this week
  • An IUD can be inserted when you are on your period
  • If you are planning to use the Diva Cup with the IUD, please discuss this with your prescribing physician.
  • Please be prepared to give a urine sample when you come in for your insertion.This is for a pregnancy test.
  • Please arive 15 minutes before your appointment.

The second appointment is the insertion. This can take place at least two weeks from the consultation during a pre-selected clinic time. There is less flexibility and longer wait times in booking an IUD insertion than a regular appointment. If you are booked for an IUD insertion and miss your consultation, your insertion will be automatically cancelled.

If you are getting a copper IUD, you can purchase them at our clinic for $80. If you are getting a hormonal IUD, you will need to purchase it at a pharmacy before your insertion appointment and bring it with you. These cost approximately $400 – $500, but are often well covered by private medical insurance. At HSHC, we have a Compassionate IUD and Birth Control program, and may be able to provide you with an IUD. If that may be necessary for you, please mention it to the administrator who books your pre-IUD consultation, to the nurse who will do an intake history, and to the doctor at the consultation appointment.

An IUD is inserted by a doctor at the office. A speculum (like what you experience during a Pap test) will be inserted into your vagina. You may be given a local anesthetic or freezing agent to help with discomfort. The doctor will measure your uterus and insert the IUD through the opening of the uterus, the cervix. You may feel some cramping, as the process is usually uncomfortable. If you currently have an IUD and are getting a new one, a removal and insertion can be done in the same appointment. The insertion process only lasts a few minutes. You will then book an appointment for a checkup approximately 5-6 weeks after the insertion.

After your insertion, check your IUD strings at least once a month. To check, use one or two fingers to locate your cervix. The cervix is at the back of the vagina and feels firm like the tip of your nose.  Once you have located the cervix, move your finger in a circular motion over the surface.  You will feel an indentation in the centre of the cervix; this is the cervical opening.  Your IUD strings extend through this opening into the vagina.  They will feel like soft nylon fishing line. Do not use a tampon, Diva Cup, or have penetrative sexual activity for one week after your insertion. If you have a hormonal IUD, after your first week with no penetrative sexual activity, your first week of regular sexual activity should be protected with a barrier method. The IUD does not protect against STIs. Ensure that you continue to use barrier methods, such as condoms, for protection from STIs. Your schedule for Pap testing is unchanged with an IUD.

Once your IUD has expired after 3 – 10 years, you repeat this process if you desire to continue using an IUD. It is best if you do not leave your IUD inserted beyond their time limit. If you realize that you have left your IUD too long, begin using another form of barrier birth control, such as condoms, and book an appointment with a doctor.

 

HOW EFFECTIVE IS IT?

Copper IUDs are 99% effective and Hormonal IUDs are 99.7% effective. IUDs do not have the risks of typical vs perfect use like other birth control methods do, as there is no user error…it is always there!

 

WHAT ARE THE RISKS/ SIDE-EFFECTS?

Copper IUDs

Complications associated with the IUD are rare but may occur. Possible complications of inserting an IUD include irregular bleeding or spotting, perforating the uterus (making a small hole in the uterus), infection, or expulsion (the IUD falls out).

People with the copper IUD may find that their periods get heavier and/or more crampy.

Hormonal IUDs

Complications associated with the IUD are rare but may occur. Possible complications of inserting an IUD include irregular bleeding or spotting, perforating the uterus (making a small hole in the uterus), infection, or expulsion (the IUD falls out).

Side effects from the hormonal IUD are usually mild. Some side effects could even be considered positive! Hormonal IUDs can produce similar side effects as oral birth control pills, such as irregular bleeding or spotting, bloating, breast tenderness, nausea, or mood changes, but these should disappear within the first 3 months following the insertion. Most people notice that their periods are less heavy, and 20 – 30% will stop having periods altogether. This is called amenorrhea.

THINGS TO LOOK OUT FOR:

Late period: If you have a copper IUD, you will still get regular periods. If you have missed a period or have very irregular periods, book an appointment for an assessment.  If you have a hormonal IUD, it is normal that your periods will lighten or go away completely. If you have any signs of pregnancy, please take a pregnancy test and book and appointment for an assessment.

Abdominal pain: Any severe abdominal pain needs to be assessed immediately, particularly if you are also experiencing fever or chills. Please go to your local Emergency department.

Excessive vaginal bleeding:  If you are changing a pad or tampon every 1-2 hrs or passing large clots, you need to be assessed as soon as possible. Please go to your local Emergency department.

Unable to feel IUD strings: Make an appointment to have the doctor do an exam to ensure the IUD strings are present. In the mean time, you should use a back up form of barrier birth control, such as condoms.

DOES IT AFFECT MY ABILITY TO BECOME PREGNANT AFTER IT IS REMOVED?

Neither copper nor hormonal IUDs impact the ability to become pregnant after having it removed. A removal of an IUD must be done by a doctor. If you have a hormonal IUD, it may take some time for your cycles to return to normal after your IUD in removed.  

ADVANTAGES AND DISADVANTAGES

Copper IUD

ADVANTAGES:
  • No hormonal medications
  • Does not interfere with breast feeding
  • Low cost after initial purchase
  • 5 – 10 years of consistent birth control
  • Does not impact fertility
  • Can be used as an emergency contraceptive
  • Do not have to remember to take it every day
  • Continue to have your period
  • Can be inserted any time during the menstrual cycle
DISADVANTAGES:
  • Increased chance of crampier and heavier periods
  • Does not protect against STIs
  • People who use an IUD have a lower rate of ectopic pregnancy than people who do not use any birth control at all. However, if pregnancy should occur, the chance of it being an ectopic pregnancy is higher than other forms of birth control.
  • Must be inserted and removed by a doctor
  • High upfront cost
  • Difficult to use Diva Cups with IUDs
  • Uncomfortable insertion process

Hormonal IUD

ADVANTAGES:
  • Decreased to no periods at all
  • Less painful/crampy periods
  • May be appropriate for people who cannot take estrogen
  • Does not interfere with breast feeding
  • Low cost after initial purchase
  • 3 – 5 years of consistent birth control
  • Does not impact fertility
  • Do not have to remember to take it every day
  • Can be inserted any time during the menstrual cycle
DISADVANTAGES:
  • Does not protect against STIs
  • People who use an IUD have a lower rate of ectopic pregnancy than people who do not use any birth control at all. However, if pregnancy should occur, the chance of it being an ectopic pregnancy is higher than other forms of birth control.
  • Must be inserted and removed by a doctor
  • Possibility of having no periods at all, which may feel concerning to some people
  • High upfront cost
  • Difficult to use Diva Cups with IUDs
  • Uncomfortable insertion process
  • Hormonal side effects

 

HOW TO BOOK AND PREPARE FOR YOUR APPOINTMENT

BOOKING AN APPOINTMENT

Booking an appointment with us is easy! Give us a call at 902.455.9656 ext. 0. You will be speaking with either a volunteer or a medical administrator. We cannot book appointments by email or Facebook. You cannot book an appointment for someone else, even if they are your partner or child. We will need to speak with them directly. To book, we will need your full name, birth date, phone number, and a very brief reason for your visit. That’s it! The person on the phone will outline anything you need to know to prepare for your appointment. They will book both the IUD consultation and IUD insertion if the schedule is available.

Make sure you bring your valid provincial health card with you to your appointment. Clients without health cards are subject to doctors and lab fees.

Are you a youth? You do not need parental consent for any of our appointments.

Don’t have access to or lost your health card? You are entitled to your health card information! Call MSI toll-free at 1-800-563-8880 (in Nova Scotia) or at 902-496-7008 from Monday – Friday, 8am-5pm. We require the number and the expiry date. Another tip: take a picture of your card! You will never lose it again!