IUD (Intrauterine Device) Contraception: Types, Benefits, and What to Expect

In short: The IUD is a small device placed in the uterus to prevent pregnancy. There are two types: the non-hormonal copper IUD, which works for 5–10 years depending on the model and may make periods heavier, and the hormonal IUD, which contains levonorgestrel and reduces bleeding. Pain and cramps may follow fitting. A check-up is advised 3 months after fitting and then every 6 months.

The intrauterine device (IUD) is one of the most widely used and effective forms of contraception worldwide. It works by placing a small, safe device inside the uterus to prevent pregnancy. Many women choose the IUD because it offers long-term, reliable protection without needing daily attention …

HISTORY

In 1909, Richard Richter from Germany showed the efficacy of mechanical contraception by inserting a silk-worm gut suture in the endometrial cavity.

Between 1928 and 1930, Grafenberg from Berlin presented three reports on silk-based devices, and he is known as the pioneer of the IUD.

The Ohta ring was used by Ishihama from Japan. The ring was first made of gold and later from plastic.

In the early 1960s, the Lippes loop and Margulies spiral, made of biologically inert polyethylene, appeared.

In the 1970s, hormone-releasing IUDs were developed, though their widespread use began in 1995.

TYPES OF Intra-uterine Contraceptive Devices

1. Medicated IUD:

These IUDs release biologically active hormones into the uterine cavity, such as the levonorgestrel-releasing device (MIRENA). This intrauterine system (LNG-IUS) has a sleeve containing 52mg of levonorgestrel around its stem, releasing about 20 micrograms per day, and it can now be used for contraception for up to eight years (five years when used with menopausal hormone therapy). Smaller hormonal IUDs with lower doses are also available. A key advantage of medicated IUDs is that the device itself can be smaller and gentler on the uterus.

2. Non-medicated IUD:

These devices contain no added hormones. They are made of plastic (polyethylene) and copper, and there are many types available. The most commonly used are Copper T, TCU 380A, Multiload 375, and Nova T.

Newer designs aim to reduce side effects and lower the rate of expulsion by creating smaller and

lighter IUDs.

HOW IUDs WORK

1. Their main action is to prevent fertilization, by making the uterus and tubes toxic to sperm and eggs; preventing implantation is a secondary effect.

2. They create a mild, localized inflammatory response in the uterine lining due to the presence of a foreign body, which has a spermicidal effect. Copper enhances this effect and increases local prostaglandin release, further reducing the chance of pregnancy.

3. They thicken the cervical mucus, making it harder for sperm to travel through the cervix toward the egg (this effect is seen with hormonal IUDs).

4. Hormone-releasing devices cause changes in the uterine lining that lead to gland thinning; most women still ovulate normally.

WHEN THE IUD IS INSERTED

An IUD can be inserted on any day of the menstrual cycle as long as it is reasonably certain that the woman is not pregnant; insertion during or just after a period is often convenient.

After childbirth—whether vaginal or by cesarean section—an IUD can be inserted within 48 hours of delivery, or from 4 weeks after delivery onwards; insertion between 48 hours and 4 weeks is avoided.

Following a spontaneous or therapeutic abortion, an IUD can usually be inserted right away, though the risk of expulsion is higher after a second-trimester procedure.

REMOVAL OF Intra-uterine Contraceptive Devices

If pregnancy is not desired, an IUD is best removed during a period, or the woman should avoid sex or use condoms for 7 days before removal (or start her new method 7 days beforehand), because sperm from recent intercourse could cause a pregnancy once the IUD is out.

If a woman reaches menopause, the IUD should stay in place for one year after her last menstrual period if she is over 50, or two years if she is under 50. A copper IUD fitted at age 40 or over, or a hormonal IUD fitted at age 45 or over, can often stay until contraception is no longer needed.

• If the IUD thread cannot be seen, pregnancy should be ruled out, condoms used, and an ultrasound done to locate the device. If it is correctly placed it can stay; if removal is needed, it is performed using a specially designed hook or forceps, ideally with ultrasound or hysteroscopic guidance.

POSSIBLE SIDE EFFECTS OF IUD USE

1. MENSTRUAL CHANGES:

This can include irregular cycles and heavier bleeding (menorrhagia), and sometimes painful periods (dysmenorrhea).

However, levonorgestrel-releasing IUDs tend to reduce monthly blood loss over time.

IUD Penetrating the

wall of the uterus

2. PERFORATION

This rare complication can occur during insertion, with an incidence of about 1.3 per 1,000 cases. It can often be prevented by carefully straightening the uterine axis using gentle traction on the cervix and performing a bimanual exam beforehand to check the uterus’s position.

3. EXPULSION OF the Intra-uterine Contraceptive Device

Expulsion rates range from about 1 to 7 per 100 women in the first year of use, and are most common in the first three months. Because of this, regular follow-up visits are recommended, and women are encouraged to check for the IUD thread themselves from time to time.

4. PELVIC INFECTION

This can occur if bacteria enter the uterus at the time of insertion, though pelvic infections after insertion are usually linked to sexually transmitted infections. If untreated, these infections can lead to complications such as salpingitis, tubo-ovarian abscess, pelvic peritonitis, or tubal blockage. Mild to moderate pelvic infections are treated with antibiotics and the IUD can usually stay in place; it is removed only if the infection does not improve within 2-3 days of treatment.

5. PREGNANCY WITH AN IUD IN PLACE

Pregnancy with IUD

This is uncommon and usually only happens if the IUD has shifted from its proper position within the uterine cavity.

ECTOPIC PREGNANCY

While an IUD is effective at preventing pregnancy within the uterus, it does not fully protect against ectopic pregnancy, so the relative risk of ectopic pregnancy may be somewhat higher among IUD users who do conceive.

Overall, IUD users have a lower risk of ectopic pregnancy than women using no contraception, but any woman with an IUD who has a positive pregnancy test should see her doctor promptly for an ultrasound.

SPONTANEOUS ABORTION

Studies have reported a spontaneous abortion rate of up to 55% in women who become pregnant with an IUD still in place and not removed. However, if the IUD thread is visible, removing it can lower this risk, and the pregnancy may otherwise continue without further complications. If the thread isn’t visible, probing the uterus is generally avoided due to increased risks of perforation, miscarriage, or infection.

PREMATURITY

Some cases of preterm delivery have been reported in women with an IUD left in place during pregnancy.

HOW EFFECTIVE ARE Intra-uterine Contraceptive Devices

Over the years, pregnancy rates among IUD users have steadily decreased. Modern copper IUDs (with at least 300mm² of copper, such as the TCu380A) have pregnancy rates of less than 1 in 100 women per year, and hormonal IUDs about 2 in 1,000, making them among the most effective methods available.

WHO SHOULD BE CAUTIOUS ABOUT USING AN IUD

RELATIVE CONTRAINDICATIONS for Intra-uterine Contraceptive Devices

1. Complicated valvular heart disease (the IUD can generally still be used; the insertion may be done in hospital in selected heart patients)

2. Moderate to severe anemia (for the copper IUD; the hormonal IUD reduces blood loss and may be preferred)

3. Hypermenorrhea or menorrhagia (for the copper IUD only; the hormonal IUD is actually a first-line treatment for heavy periods)

4. Wilson’s liver disease

5. Copper allergy

6. Advanced HIV disease that is not controlled by treatment (women with HIV who are well can use an IUD)

7. High risk of sexually transmitted disease

IUDs are suitable for women who have never given birth and for women who have had an ectopic pregnancy.

ABSOLUTE CONTRAINDICATIONS for Intra-uterine Contraceptive Devices

1. Known or suspected pregnancy
2. Current pelvic inflammatory disease, cervicitis, or vaginal infection
3. Infection of the uterus after childbirth or after a septic abortion
4. Uterine anomalies or fibroids that distort the cavity
5. Cervical or uterine cancer awaiting treatment (current breast cancer is also a contraindication for the hormonal IUD)
6. Unexplained vaginal bleeding that has not yet been investigated

Who Might Consider Intrauterine Contraception

Women of any reproductive age who are looking for a long-term, highly effective, and reversible contraceptive option may find the IUD to be a good fit, ideally after discussing their personal health history with their gynecologist.

CONCLUSION

For most women, the benefits of using an IUD outweigh the risks, which mainly relate to the rare chance of pregnancy occurring with the device in place. IUDs are widely recommended as a safe, long-lasting, and cost-effective contraceptive option for many women. If you’re considering an IUD or want to explore which contraceptive method suits you best, the team at Dr. Najeeb Layyous’s clinic is here to guide you through your options with personalized care.

Dr Najeeb Layyous F.R.C.O.G

Consultant Obstetrician, Gynecologist and Infertility Specialist