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Intrauterine Device (IUD) - Fitting, Removal & Possible Complications

Types of IUD and time until expiry.

There are two types of Intrauterine Device's (IUD):

  • Copper IUD's prevent pregnancy by slowly secreting copper, and last up to 10 years.
  • Hormone IUD's prevent pregnancy by slowly releasing hormones, and last up to 5 years.

How does an IUD work?

'An IUD stops sperm from reaching the egg. It does this by releasing copper or hormones into the body, which changes the make-up of the fluids in the womb and the fallopian tubes. These changes prevent sperm from fertilising eggs. IUD's may also stop fertilised eggs from travelling along the fallopian tubes and implanting in the womb.

How effective is the IUD?

'An IUD is 98-99% effective at preventing pregnancy. Newer models that contain more copper are the most effective (over 99% effective). This means that less than one in every 100 women who use the IUD will get pregnant in a year. As a long-lasting method of contraception, the IUD is very effective. You do not need to remember to take or use contraception to prevent pregnancy. However, it does not protect you against Sexually Transmitted Infections (STI).

Can anyone have one?

The majority of women can have an IUD fitted, including women who have never had a baby, and those who are HIV positive. A consultation with your GP or nurse, to gain your medical history, will check to ensure an IUD is a suitable form of contraception for you.

An IUD is not suitable if you have:

- Any untreated sexually transmitted infections (STI's) or a pelvic infection. o Any problems with your womb or cervix.

- Any unexplained bleeding from the vagina, for example, between periods or after sex.

Women who have had an ectopic pregnancy/recent abortion/or who have an artificial heart valve, should consult their GP before having an IUD fitted.

You should not have an IUD if you have a chance of being pregnant, or if either your partner or yourself have a risk of catching an STI. An IUD is most appropriate for women with one long term partner, who is confident that they do not have an STI. If you or your partner is not entirely sure, go to your local GP or sexual health clinic to be tested for STI's.

Using an IUD after giving birth.

- An IUD is usually fitted around 4-6 weeks after giving birth (vaginal or caesarean).

- An IUD is safe to use when you are breastfeeding, and will not affect your milk supply.

Intrauterine Device (IUD) Patient Fact Sheet

The fitting process.

- Your GP or nurse can advise you based on your medical history, whether an IUD is the best method Of contraception for you.

- You may be tested for any infections including sexually transmitted infections. It is always best to do this before the fitting on an IUD so that any infections can be treated. (Sometimes antibiotics can be given at the same time as a fitting).

- The procedure may produce some discomfort, especially if you have not had children and the cervix is not stretched. Mild analgesics can be taken before hand to reduce discomfort, ask your GP for advice.

- A pelvic examination is performed, to assess the size, shape, depth and position Of the uterus.

- The vagina is held open with a speculum (like it is during a cervical smear test), and the IUD is inserted through the cervix and into the womb.

- 'Once fitted, an IUD has two thin threads that hang down a little way from your womb into the top Of the vagina. The GP or nurse, who fits your IUD will teach you how to feel for these threads, and check the IUD is still in place'

- 'Your partner should not be able to feel your IUD during sex. If this is the case, go back to your GP and get them to check that your IUD is in place, and cut the strings shorter if still in place'

- 'Once an IUD is fitted, it will need to be checked by a doctor/nurse after 3-6 weeks. Speak to your GP or nurse if you have any problems after this initial check or if you want the device to be removed'

- 'You may get period-like pain and bleeding for a few days after having an IUD fitted. This is normal, and taking pain killers before and after the procedure can ease this'

- 'It is very unlikely that your IUD will come out, but if you can not feel the threads or you think that the IUD has moved, you may not be fully protected against pregnancy. See your GP or nurse immediately and use extra contraception until your IUD has been checked. If you have had sex recently, you may need to use emergency contraception'

- 'If you feel unwell, have pain in your lower abdomen, have a high temperature or a smelly discharge after having an IUD fitted, see your GP , as you may have an infection'

Possible risks

Most complications with IUD's happen in the first year after fitting

Pelvic infections

Pelvic infections can occur in the first 20 days after the IUD is fitted, although the risk Of infection is small. Less than one in 100 women who are at low risk Of sexually transmitted infections will get a pelvic infection.

Usually your GP or nurse will check for existing infections before an IUD is fitted through an internal examination.

If you get any pain in the lower abdomen/ have a high temperature or smelly discharge in the first three weeks after your IUD is fitted, see your GP immediately. Pelvic inflammatory disease (PID) can lead to infertility.

Rejection

Occasionally the IUD can be rejected by the womb (expulsion) or can move (displacement). This is not common and is more likely to happen soon after it has been fitted. Your GP or nurse will show you how to check that your IUD is in place.

http://mnv.nhs.uk/Conditions/lntrauterine-device•(lUD)/pages/Risks.aspx (accessed 29, 09, 2011)

Perforation

In very rare cases, an IUD can go through and perforate the womb/neck Of the womb (cervix) when inserted, and can cause pain in the lower abdomen, but does not usually cause any Other symptoms. If the person fitting your IUD is experienced, the chance Of this happening is very low.

If perforation occurs, you may need surgery to remove the IUD. Always contact your GP immediately if you experience a lot Of pain after having an IUD fitted, as perforation needs to be treated straight away.

Intrauterine Device (IUD) Patient Fact Sheet

Periods

0 A side effect Of the IUD is longer and heavier periods (especially if you have always had heavy periods). For some people, this eases within a few months, but others continue to have longer heavier periods. The most common reason for women having their IUD removed is vaginal pain and bleeding. http•.//vo.•.n.v nhs.           aspx (accessed 29, 09, 2011)

Removal.

Reasons for IUD removal:

When an IUD expires and needs to be removed, a new one can be fitted at the same time if requested 0 If someone wanted to get pregnant, their IUD would be removed. Sometimes unpleasant side effects can occur, and some women prefer the IUD to be removed. 0 IUD's are typically removed after the first year Of a woman experiencing the menopause.

The removal process

The procedure starts with a routine gynaecological examination, in which the doctor first ascertains the position Of the uterus by inserting his/her fingers into the vagina and palpating the abdomen with the Other hand. This examination also tests for tenderness or physiological changes, which can indicate a medical problem. At the same time the doctor locates the IUD strings to ensure it is still present.

Next, a speculum is inserted into the vagina to allow the doctor a better view, followed by a Tenaculum (a medical instrument which stabilises the uterus). 0 The doctor then takes hold Of the IUD strings with either a forcep or clamps, and gently pulls the IUD out Of the uterus. As it emerges, the arms Of the IUD should retract, to allow it to be pulled out.

If the IUD does not seem to want to move, it may mean that the doctor might need to change the angle Of the clamps, or the IUD may be embedded within the uterine wall, in which case the patient would need an anaesthetic, so the doctor can insert forceps in the uterus to free the IUD. Sometimes, a surgical procedure may be required to free an embedded IUD (this is the most serious potential complication Of removal).

Some times an ultrasound may need to be performed if the doctor cannot feel the IUCD strings, to ensure the IUD has not accidently come out. If the strings have retracted into the uterus, an ultrasound will help the doctor find the strings, in order the pull the device out.

Some cramping and bleeding can be expected during removal, and therefore, some women choose to take a mild pain killer before the procedure

If you are not planning to have another IUD put in and do not want to become pregnant, another form Of contraceptive needs to be used (such as condoms) for seven days before your IUD is removed. This is to stop sperm getting into the body, sperm can live for seven days in the body and could cause pregnancy when the IUD is removed. (As soon as the IUD is removed, your normal fertility should return to normal).

An IUD can be removed at any time by a trained GP or nurse.

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