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, Kyleena, Jaydess). These devices, once inserted, provide birth control coverage for 5 – 12 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:

Refrain from unprotected intercourse from your last menstrual period or if you have irregular cycles then no unprotected sex for at least three weeks prior to your insertion date
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 or Kyleena inserted, you will require a prescription. You will need to purchase 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.
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 arrive 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 4-6 weeks after the insertion.

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

You are encouraged to return to the Halifax Sexual Health Centre 4-6 weeks after your insertion for an IUD check.
REMINDER: We recommend nothing in the vagina for 7 days post-insertion (i.e. vaginal intercourse, tampons, sex toys, etc).
REMINDER: IUDs do NOT protect against sexually transmitted infections so you should continue to use condoms
If you use a menstrual cup, DO NOT use it until you come for your IUD check. Then, use with caution, making sure you release the suction before removing to avoid pulling on the IUD strings, which can displace the IUD.

Uterine cramping is common after IUD placement for several days (sometimes longer). You can help relieve the discomfort with heating pads or ibuprofen/naproxen.
Irregular bleeding and spotting is NORMAL for the first few weeks to months after the IUD is placed. In some cases, people may experience irregular bleeding or spotting for up to 3-6 months after the IUD is placed.
Often, your first period with any IUD may be more crampy, heavier and longer than previous. Then, your period will likely become shorter and lighter (or stop altogether) with a Mirena or Kyleena IUD. Your period may be heavier and longer with a copper IUD.
If you had the IUD placed for birth control, the copper IUD is effective immediately. The Mirena or Kyleena IUD is effective immediately IF it was inserted within 7 days after the start of your period. If you have Mirena or Kyleena inserted at any other time during your menstrual cycle, it is only effective after 7 days.
Rarely, it is possible for the IUD to come out of the uterus, which is most likely to happen in the first few weeks after insertion. To make sure your IUD is in place, you can feel for the IUD strings between periods. To check for strings, wash your hands. Place one finger into your vagina until you feel your cervix. It will feel hard and rubbery, like the end of your nose. The string ends should be coming through your cervix. Do not pull on the strings. If the strings feel much longer than before, if you feel the hard plastic part of the IUD, or if you cannot feel the strings at all, the IUD may have moved out of place. Please call the clinic and use a back-up form of birth control, such as condoms, until you are seen.
Pregnancy is unlikely after IUD placement, but can happen. If you have early pregnancy symptoms like nausea and vomiting, breast tenderness, frequent urination, or abdominal pain, you can take a pregnancy test. Please call the clinic if you have any concerns or if your pregnancy test is positive.

THINGS TO WATCH OUT FOR

Call the clinic or seek medical attention if any of the following occur:

Severe abdominal pain or cramping
Unusual/heavy bleeding (i.e. soaking a pad every hour for several hours in a row, much heavier than a period)
Unexplained fever or chills
Vaginal discharge or vaginal bleeding that is foul-smelling
Positive pregnancy test

Your schedule for Pap testing is unchanged with an IUD.

Once your IUD has expired after 5 – 12 years, you repeat this process if you desire to continue using an IUD. We can remove an old IUD and insert a new one in the same appointment. It is best if you do not leave your IUD inserted beyond their time limit (however, it is not dangerous to the body – no need to panic!). 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.

When booking for just an IUD removal (without the insertion of a new replacement IUD), we will need to know if you can feel your strings. If you cannot feel your strings, we will have you do a urine pregnancy test before removal.

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

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.

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 – 12 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
5 – 8 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

HSHC is proud to be a RAICE Clinic.

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!