Intrauterine Contraceptive Device (IUD, IUCD)

2. Another type of IUCD releases the hormone progesterone, which causes the cervical mucus to become thicker so the sperm cannot reach the egg. The hormone also changes the lining of the uterus, so implantation of a fertilized egg cannot occur. This type of IUD can be kept in for 5 years.

The IUD is 98-99% effective. However, there are side effects associated with IUCD. They include infection of the fallopian tubes and ovaries (pelvic

The IUD is 98-99% effective. However, there are side effects associated with IUCD. They include infection of the fallopian tubes and ovaries (pelvic inflammatory disease), painful and heavy periods and backaches. The hormone-released IUCD is associated with lighter and irregular menstrual periods.

Copper T IUD (Intrauterine Device)
An IUD is a small device that is shaped in the form of a "T". Your health care provider places it inside the uterus. The arms of the Copper T IUD contain some copper, which stops fertilization by preventing sperm from making their way up through the uterus into the fallopian tubes. If fertilization does occur, the IUD would prevent the fertilized egg from implanting in the lining of the uterus.

The Copper T IUD can stay in your uterus for up to 12 years. It does not protect against STDs or HIV. This IUD is 99% effective at preventing pregnancy. You will need to visit your doctor to have it inserted and to make sure you are not having any problems.

Progestasert IUD (Intrauterine Device)
This IUD is a small plastic T-shaped device that is placed inside the uterus by a doctor. It contains the hormone progesterone, the same hormone produced by a woman's ovaries during the monthly menstrual cycle. The progesterone causes the cervical mucus to thicken so sperm cannot reach the egg, and it changes the lining of the uterus so that a fertilized egg cannot successfully implant.

The Progestasert IUD can stay in your uterus for one year. This IUD is 98% effective at preventing pregnancy. You will need to visit your doctor to have it inserted and to make sure you are not having any problems.

Intrauterine System (IUS, Mirena IUD)
The IUS is a small T-shaped device like the IUD and is placed inside the uterus by a doctor. Each day, it releases a small amount of a hormone similar to progesterone called levonorgestrel that causes the cervical mucus to thicken so sperm cannot reach the egg.

The IUS stays in your uterus for up to five years. It does not protect against STDs or HIV. The IUS is 99% effective. You will need to visit your doctor to have it inserted and to make sure you are not having any problems.

How does the IUCD work as a contraceptive?

It works mainly by stopping the egg and sperm from meeting. It may also prevent the fertilised egg from attaching to the lining of the uterus. The copper also has a spermicidal effect (kills sperm).

How effective is the IUCD for contraception?

Modern IUCDs are 99% effective or more. This means that up to 1 woman in 100 will become pregnant each year using this method of contraception. (Compare this with when no contraception is used. More than 80 in 100 sexually active women who do not use contraception become pregnant within one year.) There are many different types of IUCD. They can stay in place for between 5-10 years, depending on the type of IUCD inserted.

What are the advantages of the IUCD?

Once an IUCD is inserted you can forget about contraception. So, unlike the pill, you don't need to think about contraception every day. It does not interfere with sex. It is not an hormonal method so it has no side-effects on the rest of the body. This means that it will not affect your mood, weight or libido. Having an IUCD does not increase your risk of having any type of cancer in the future. Most women can have an IUCD if they wish.

What are the disadvantages of the IUCD?

Although the majority women with an IUCD have no problems, the following may occasionally occur:

Heavy, painful periods
Some women find that their periods become heavier, longer or more painful with an IUCD. This tends to be in the first few months after insertion and then often settles. This means that the IUCD may not be suitable if you already have heavy or painful periods. There is a special IUCD called the intrauterine system (IUS), which is like an IUCD, but it also releases a progestogen hormone into the uterus. This is an effective treatment for heavy periods as well as a contraceptive.

However, painful and heavy periods can still be treated in the same way as in women who do not have an IUCD. For example, by taking anti-inflammatory painkillers or other medicines during your periods.

Infection
There is a small risk of an infection of the uterus (pelvic infection). The main risk of infection is within the first 20 days after insertion. A check for infection of the vagina or cervix may be advised by taking a swab before an IUCD is inserted. You should not have an IUCD inserted if you have an infection which has not been treated.

Ectopic pregnancy
The chance of becoming pregnant is very small if you use an IUCD. However, if you do become pregnant, there is a slightly increased risk of having an ectopic pregnancy. This means the pregnancy is in the Fallopian tube and not in the uterus. This is rare, but serious. See a doctor urgently if you miss a period and develop lower abdominal pain.

Expulsion
Rarely, the IUCD may come out without your noticing.

Damage to the womb
The fitting of an IUCD can very rarely cause damage to the uterus (womb).

How is the IUCD fitted?

An IUCD can be removed at any time by a trained doctor or nurse. If you plan to have it removed, but do not want to get pregnant, then you should use other methods of contraception (such as condoms) for seven days before it is removed. This is because sperm can last up to seven days in the uterus and can fertilise an egg after the IUCD is removed.

You can use sanitary towels or tampons for periods with an IUCD in place.

You should consult a doctor if any of the following occur:

• Prolonged abdominal pain after an IUCD is inserted.
• A delayed period, or bleeding between periods.
• A delayed period and lower abdominal pain (which may be due to an ectopic pregnancy).
• Vaginal discharge with or without pain (which may indicate infection).
• If you suspect that the IUCD has come out or is coming out. It is usually possible to feel the threads of the IUCD inside the vagina to check it is in place. If you cannot feel the threads then use other contraceptive methods (such as condoms) until you have been checked by a doctor or nurse.

Further information

Your GP and practice nurse are good sources of information if you have any queries.

The fpa (formerly the family planning association) also provides information and advice.
fpa's helpline: 0845 310 1334 or visit their website www.fpa.org.uk

References

• Long-acting reversible contraception, NICE Clinical guideline (October 2005); (the effective and appropriate use of long-acting reversible contraception)
• The copper interuterine device as long-term contraception, Faculty of Family Planning and Reproductive Health Care RCOG (January 2004)
• Contraception, Clinical Knowledge Summaries (2008)

Related topics
* Sexual Health Advice & Leaflets