The IUD is a small device (about 2 centimetres), usually made of copper and plastic, which when inserted into the uterus acts as a deterrent to the implantation of an embryo. It is very effective in doing this, with a failure rate around 1 to 3 per cent (or one to three pregnancies per 100 women years). Over the years it has suffered bad press because of inappropriate use, and the inherent risks associated with inserting a foreign body into the uterus. In the right person the IUD can be a very effective and satisfactory contraceptive and is now becoming more popular.
The side-effects fall into two major categories: nuisance (more common) and unpleasant (rare). The nuisance problems women may notice include heavier periods, which may also be more painful. In many instances this is also associated with the withdrawal of the beneficial side-effects of the oral contraceptive pill which tends to make the periods lighter and less painful. So in many cases it may be that these ‘heavier’ periods are in fact more typical of the woman’s ‘usual’ periods.
Expulsion may in fact occur. If it is going to happen, it will usually be with the first menstrual period, but may go unnoticed with the menstrual flow, particularly if it is heavy. If expulsion is occurring there is usually pain associated with this. It is preferable that the woman checks each month, after the period, that the strings of the IUD can be felt, to ensure that it is still in place.
Women who have not yet had a baby (‘nulliparous’ women) have generally been considered less suitable for lUDs because of potential risks to fertility, and the physical difference in the cervix. It can be more difficult to insert the device into a nulliparous cervix. Despite this some nulliparous women do choose IUDs and have no problems.
The rarer, but more serious hazards include infection and the possibility of ectopic pregnancy (a pregnancy in the tube, not in the uterus where it is supposed to be). Both of these occurrences may risk future fertility.
Another problem is the very small risk that the IUD may perforate the uterus, and go out into the pelvis or abdomen. This could potentially damage the uterus, and require surgical removal of the IUD. This risk is minimised by attending an experienced doctor for insertion of an IUD.
Infection can be due to an overgrowth of bacteria which were in the region prior to insertion (‘normal flora’), and are aggravated by the presence of a ‘foreign body’. The symptoms of pain, fever and discharge may develop. If infection is going to develop, it is most likely to occur in the first three weeks following insertion. To help prevent this it is recommended that women have antibiotics at the time of insertion.
Infections may also be sexually transmitted, often without either partner being aware of having an infection. The risk of such infections increases with the number of sexual partners a woman has, so IUDs are not recommended for use in women with multiple or casual sexual partners. IUDs do decrease the risk of pregnancy to between 1 to 3 per cent. However, if a woman it unlucky enough to become pregnant with an IUD in her uterus there is an increased risk of that pregnancy being ectopic compared with non-IUD users. The normal rate of ectopic pregnancy has been reported as one in every 150 to 250 pregnancies. Women who become pregnant despite IUDs should see their doctors early for an ultrasound to assess where the pregnancy is if a woman does have a pregnancy in the uterus, and an IUD in there as well the pregnancy might spontaneously miscarry. If it does not, and the woman wishes to continue with the pregnancy, the IUD can be removed during early pregnancy. This manoeuvre carries a risk of inducing miscarriage, but the pregnancy may continue normally. If the IUD is left and the pregnancy progresses there is an increased chance of premature labour, or early rupture of the membranes (waters breaking) in the later part of the pregnancy.
So the IUD is best suited to women who do not have heavy or painful periods, do not have infections, have only one sexual partner, and have previously had children.
Removing an IUD is simple. Your doctor visualises the strings and, with a pair of forceps, gives a quick pull and the IUD comes out. Sometimes an anaesthetic is required to insert a standard IUD. There is also a stringless variety of IUD available overseas, called the Graffenberg Ring,
which is always inserted and removed under general anaesthetic.
There are now a couple of different types of IUDs available in Australia. One type should be changed every two to three years, but there is a newer type which needs to be changed only every eight to ten years.
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