IUD: Benefits, Effectiveness, Risks

Intrauterine devices, or IUDs, are highly effective reversible birth control options for those seeking to prevent unplanned pregnancies. In addition, they empower women to have autonomy over their reproductive health and enjoy greater comfort in their lives.

What Is an IUD?

An intrauterine device (IUD) is a small T-shaped plastic or copper device placed in your uterus to prevent pregnancy. This form of birth control option is generally used as a long-term protective measure and can last 5 to 10 years, based on the type of IUD.

How Do IUDs Work?

Two types of IUDs are currently available - hormonal and copper. 

Hormonal or Levonorgestrel (LNG) IUDs release a small amount of progestin, a synthetic form of the hormone progesterone, into the uterus. Progestin thickens the cervical mucus, making it more difficult for sperm to reach the egg. It also thins the uterus lining, making it less receptive to a fertilised egg.

A copper IUD acts similarly to its counterpart by making the egg impossible to fertilise. The sperm's swimming pattern to the egg depends on the chemical composition of the reproductive tract. Copper ions released from the IUD alter the composition of the cervical mucus and uterine lining, thus disrupting the sperm's attempts to reach the egg.

Are IUDs Effective?

Current research indicates IUDs to be one of the most effective methods of contraception, with a failure rate of less than 1%. 

If used correctly, most available contraceptive options can effectively prevent pregnancy. However, these options may involve taking a regular pill or replacing a device every few days. On the other hand, IUDs are low maintenance, offering a minimal chance of user failure as they are inserted into the body.

While not commonly used for emergency contraception, a copper IUD can be inserted as a highly effective form of emergency contraception if done within a certain timeframe. The copper IUD can be inserted up to 120 hours (5 days) after unprotected intercourse.

What Are the Benefits of IUDs?

As one of the most effective long-acting reversible contraceptives, IUDs give users unique benefits that are unavailable from other contraceptive options.

1. They provide 5-10 years of protection against pregnancy.

Both types of IUDs mentioned above give you the benefit of long-term protection against pregnancy. The FDA states that a progestin-releasing IUD - the levonorgestrel-intrauterine system (LNG-IUS), offers users up to 5 years of protection.

Copper IUDs can offer protection for up to 10 years. Copper IUDs are available for those who want hormonal-free contraceptives as a personal choice or due to medical conditions. These IUDs only use copper ions to prevent pregnancies.

2. They can be removed when required.

When a woman wants to start a family, she can have her IUD removed by a doctor. Both hormonal and copper IUDs are reversible and do not affect fertility. Therefore, pregnancy is possible after removal.

3. They are low maintenance.

IUD insertion is generally a short, one-time procedure, and no effort is required to maintain it. Depending on the type and brand of IUD inserted, a replacement may not be needed for up to 10 years.

4. They are cost-effective.

The long-lasting protection offered by the IUD outweighs the up-front investment in installing the device. We recommend following up with your doctor by scheduling annual check-ups.

5. They improve a woman’s quality of life.

As IUDs are a low-maintenance alternative with no extra effort required to prevent pregnancy, they can provide significant relief for the user. In addition, hormonal IUDs also help alleviate acne and period cramps due to progestin secretion. 

Another benefit of hormonal IUDs is that they have been effective in treating menstrual periods for women with abnormally heavy and prolonged periods.

What Are the Disadvantages of IUDs?

The following are some disadvantages of IUDs to be aware of before deciding if this is the suitable contraception method for oneself:

• Hormonal or copper IUDs do not protect against sexually transmitted infections (STIs) or HIV. So, it is recommended that sexually active women use barrier methods such as condoms, especially if they have a new sexual partner.
• The initial cost of obtaining and inserting an IUD can be relatively high.
• Some individuals may experience pain or discomfort during the insertion procedure, which typically takes only a few minutes.
• Some individuals may experience increased cramping, especially during the first few weeks or months after IUD insertion. 
• Copper IUDs do carry a risk of inducing heavier and more painful periods. However, after a year of use, these symptoms generally reduce. Nevertheless, tracking your side effects can be helpful, especially if they are unbearable and require you to consult a doctor.
• Initial IUD insertion does come with a slight risk of infection, which can be avoided with necessary safety precautions.

What Are the Risks Associated with IUDs?

It is normal for your body to adjust to a foreign object like an IUD when inserted into the uterus. Side effects may occur during the initial weeks following the insertion as your body gets used to the device. 

Although rare, long-term risks can also occur. Some of these include:

1. Pelvic infection

A small risk of developing pelvic inflammatory disease (PID), infection of one or more of the upper reproductive organs, including the uterus, ovaries and fallopian tubes, can occur following the first 20 days of an IUD installation.

If you experience any of the symptoms below following insertion, consult a doctor:

• Pain in the lower abdomen.
• Abnormal discharge and a foul vaginal discharge.
• Pain and/or bleeding during sex. 
• Unusual bleeding between periods. 
• Burning sensation when urinating.
• Fever.

2. Thrush

Limited research indicates that IUDs can make you susceptible to recurring thrush (also known as yeast infections). However, inserting an IUD during an existing yeast infection may cause it to spread during the initial three months.

3. Damage to the womb

Incorrect insertion of an IUD carries a minor risk of puncturing your uterus. However, this is very rare, with the chances being one in 1000 insertions. 

4. Ectopic pregnancy

An embryo that implants itself outside the uterus, usually in the fallopian tube, is known as an ectopic pregnancy. 

5. IUD getting expelled by the womb or moved

Your IUD may be expelled fully or even partially from your body due to your body reacting negatively to a foreign device. You can check to ensure that your IUD is in place. 

Consult a healthcare professional if you notice any of the following symptoms:

• Feeling pain in the insertion area.
• Feeling the IUD.
• The IUD strings are shorter or longer than usual.
• Abnormal bleeding.

How Is an IUD Inserted in the Uterus?

IUD insertion can be an overwhelming and scary thought for some women. So, understanding what a typical IUD insertion process entails can reduce any anxieties surrounding it.

1. Prepare for IUD insertion

Firstly, deciding whether a copper or hormonal IUD is best suited for you is crucial. After discussing your preferences and health conditions, your doctor can help you decide. 

Suppose your body cannot handle hormonal IUDs due to certain medical conditions; in that case, opting for hormone-free options rather than a progestin-releasing IUD is better. Similarly, having copper allergies means a hormonal option would be a better fit for you. 

Things to do to ensure a smoother IUD insertion procedure: 

• Avoid having unprotected sex from the first day of your period until your appointment.
• If you are not using reliable contraceptive methods and your menstrual cycles are irregular,it is advised to abstain from sexual activity for 3 weeks prior to an IUD insertion. You may need to do a pregnancy test to ensure that you are not pregnant. 
• Have a light meal before going to your appointment.
• Take a painkiller such as paracetamol or ibuprofen 60 minutes before the procedure.
• Ask a friend or family member to provide you with support for the day.
• Avoid driving post-procedure.
• Prepare to rest for the rest of the day following the procedure. 

2. IUD insertion process

• A device called a speculum will be inserted into your vagina to be able to see your cervix.
• The length of your uterus will be measured, and the IUD will be inserted. 
• Once the IUD is placed, the threads will be trimmed before removing the speculum. 
• The procedure usually takes approximately 5-10 minutes. 

Who Can Use an IUD?

IUDs can be safely used by most healthy women with a uterus. 

However, IUDs are not suitable for women who are:

• Pregnant.
• Have abnormal vaginal bleeding.
• Have untreated STI or pelvic infection

A pre-insertion test, which includes a pap smear, pregnancy test, STD screening and breast and pelvic exam, will help determine if you are a suitable candidate for an IUD procedure.

More About IUDs

Make an Appointment at Pantai Hospitals

IUDs are a highly effective and convenient birth control option that provides long-lasting, reversible protection with minimal user failure. While there are some disadvantages and risks to consider, the benefits of IUDs make them a compelling choice for many women. 

Speak with your doctor to know more about IUDs and if they are the right choice for you. 

Get in touch with us to book an appointment with our team of gynaecologists today, or find out more about our Obstetrics and Gynaecology Services at your nearest Pantai Hospital.

Pantai Hospitals have been accredited by the Malaysian Society for Quality in Health (MSQH) for its commitment to patient safety and service quality.