Intra Uterine Device (IUD)

What is an intrauterine device (IUD)?

An intrauterine device (IUD) is a small, flexible device designed for placement inside the uterus to prevent pregnancy. 

How does an IUD work?

Shaped like a 'T,' typically crafted from plastic or metal and occasionally coated with copper or hormonal substances, an IUD operates by modifying the uterine environment. This alteration creates conditions that are less favorable for both fertilisation and implantation.

What are the different types of IUDs?

There are two main types of IUDs:

1. Hormonal IUDs

2. Copper IUDs

Hormonal IUDs

Hormonal IUDs release the hormone progesterone into the uterus. There are different brands of hormonal IUDs that last for different lengths of time. Depending on the brand, they are approved for up to 3 to 8 years of use. Examples: Mirena and Kyleena.

Copper IUDs

Copper IUDs release copper into the uterus. This type of IUD does not contain hormones. It is approved for up to 5-10 years of use. Examples: Multiload, Mona Lisa, and Nova-T.  

What is the effectiveness of the IUD?

• Hormonal IUD: Over 99% at preventing pregnancy.

• Copper IUD: Over 99% at preventing pregnancy.

Who needs an IUD?

The IUD caters to diverse individuals, offering a lasting contraceptive option for those seeking extended protection. It is an excellent choice for women who have completed their families or those unable or unwilling to use hormonal contraceptive methods.

How much does an IUD cost in Singapore?

• The insertion and removal of IUDs are charged differently according to the type of IUD used.

• The overall cost comprises expenses for the IUD itself, along with insertion fees, potentially ranging from $150 to $1000.

Where can you get an IUD fitted?

The insertion and removal of IUD should only be done by trained healthcare professionals in healthcare clinics as it requires examination of your internal reproductive organs. It can be administered in polyclinics, family planning clinics, women’s clinics, and some trained GP clinics.

Pros and Cons of IUD

Pros of IUD

• Long-term effectiveness: The IUD stands out for its long-lasting protection, with certain types offering contraceptive efficacy for up to 10 years.

• High effectiveness rate: Over 99% at preventing pregnancy.

• Convenience: Once inserted, individuals can enjoy freedom from daily or monthly contraceptive management.

• User satisfaction: Approximately 90% are satisfied with the usage of IUD.

• Hormonal and non-hormonal options: The IUD is available in both hormonal and non-hormonal (copper) variants, catering to individual preferences and health considerations, offering a range of choices.

• Quick reversibility: Unlike some contraceptive methods, fertility can promptly return after the removal of an IUD.

Cons of IUD

• Initial cost: Although cost-effective in the long term, the upfront expense, covering consultation and insertion, can be relatively high, and it might be up to $1,000.

• Side effects: Some users may experience side effects during the initial months, such as cramping, irregular bleeding, or changes in menstrual flow.

• Insertion discomfort: The process of inserting the IUD can be uncomfortable or painful for some individuals.

• Lack of STI protection: It does not protect against sexually transmitted infections (STIs).

FAQ

How long does an IUD last?

Hormonal IUDs can remain effective for a duration of 3 to 8 years, while copper IUDs can provide last for a period of 5 to 10 years.

Is having an IUD painful?

The experience of getting an IUD can vary from person to person, and while some individuals may not find it particularly painful, others may experience discomfort or cramping during the insertion process. The level of pain varies depending on factors such as individual pain tolerance and the provider's technique. Some individuals may experience mild cramping or discomfort for a few days after the IUD is inserted. This is generally temporary and can be alleviated with over-the-counter pain medication.

How long is pain normal after IUD insertion?

Some individuals may experience mild to moderate cramping pain for a few days after getting an IUD. This is often the body's response to the presence of a foreign object in the uterus. While most people find that any pain or discomfort resolves within a week, others may experience intermittent cramping for a longer period. If pain persists or becomes severe, it's essential to contact your healthcare provider.

What should I not do with an IUD?

While IUDs are generally safe and effective forms of contraception, there are certain precautions and considerations to keep in mind to ensure their proper functioning and to minimise any potential risks. Here are some things you should avoid with an IUD:

• Self-removal: You should not attempt to remove the IUD on your own. If you wish to have it removed or if you are experiencing any issues, schedule an appointment with your healthcare provider for professional removal.

• Ignoring pain or discomfort: If you experience persistent or severe pain, discomfort, or other unusual symptoms after IUD insertion, do not ignore them. Contact your healthcare provider immediately for a consultation.

• Skipping follow-up appointments: It's important to attend any scheduled follow-up appointments with your healthcare provider. These appointments are crucial to ensure that the IUD is properly in place and functioning as intended.

• Not checking the strings: Regularly check the IUD strings to make sure they are still present and haven't changed in length. If you cannot feel the strings, or if they seem longer or shorter than usual, contact your healthcare provider.

• Ignoring signs of infection: If you experience symptoms of infection, such as unusual vaginal discharge, foul odour, or fever, do not ignore them. Contact your healthcare provider for evaluation and appropriate treatment.

• Not communicating with your healthcare provider: If you have any concerns or questions, or if your health status changes (such as a pregnancy or the development of certain medical conditions), inform your healthcare provider promptly. They can provide guidance based on your circumstances.

When can I have sex after an IUD?

Copper IUD (Non-hormonal):

You can generally have sex immediately after the insertion of a copper IUD. There is no waiting period for it to become effective, as it starts working right away.

Hormonal IUD:

• If you have a hormonal IUD (such as Mirena, Skyla, or Kyleena), it may take some time to become fully effective. Your healthcare provider will provide guidance on when it becomes effective, and you may need to use additional contraception during the first week.

• If the hormonal IUD is inserted within seven days of the start of your menstrual period, it is usually effective immediately.

• If it is inserted at any other time during your menstrual cycle, additional contraception may be needed for the first seven days.

Can I use a menstrual cup or tampon with an IUD?

Using menstrual cups or tampons is generally safe with an IUD. However, there is a slight risk of dislodging the IUD if the removal strings become tangled. It's important to be cautious when inserting and removing these products and to check the strings regularly to ensure they are in place.

Does IUD stop period?

The effect of an IUD on menstrual periods can vary depending on the type of IUD. 

Hormonal IUDs (e.g., Mirena, Skyla, Kyleena):

• Many individuals using hormonal IUDs experience changes in their menstrual bleeding patterns. This may include lighter periods, irregular bleeding, or, in some cases, the absence of menstruation altogether.

• Over time, some people using hormonal IUDs may experience a significant reduction in menstrual bleeding, and some may stop having periods altogether. This is often referred to as "amenorrhea," or the absence of menstrual periods.

Copper IUDs:

• Copper IUDs are not known to suppress menstrual periods. In fact, some individuals may experience heavier or more intense menstrual bleeding as a side effect of the copper IUD.

What happens if you don't get an IUD removed?

If you do not get an IUD removed and it remains in place beyond its recommended duration, there are potential risks and complications:

• Reduced effectiveness: As time passes, the contraceptive effectiveness of the IUD diminishes. The risk of unintended pregnancy increases.

• Displacement or expulsion: IUDs can sometimes shift position or be expelled from the uterus. This is more likely to occur if the IUD is left in place beyond its recommended lifespan.

• Infection: Prolonged use of an IUD may increase the risk of pelvic infection.

• Perforation: In rare cases, an IUD may perforate the uterus and migrate to nearby organs. This risk is generally higher if the IUD is left in place for an extended period.

Can an IUD lead to infertility?

In general, IUDs are considered safe and effective forms of contraception and do not typically lead to infertility. 

What are the side effects of IUDs?

Commonly reported side effects include cramping and changes in menstrual flow, particularly within the first 3 to 6 months of use, typically resolving over time.

When should the IUD be inserted?

IUDs can be inserted at any phase of the menstrual cycle, as long as the individual is not pregnant. It is advisable to go for regular check-ups to monitor and ensure the proper positioning of the device.

When is an IUD not recommended?

• Pregnancy or suspected pregnancy 

• Sexually transmitted infection (STI) at the time of insertion, including cervicitis, vaginitis, or any other lower genital tract infection 

• Congenital uterine abnormality: This distorts the shape of the uterine cavity making insertion difficult.

• Pelvic inflammatory disease

• Recent history of infection: History of septic abortion or history of postpartum endometritis within the last 3 months

• Uterine or cervical malignancy/neoplasia: either confirmed or suspicion

• Abnormal uterine bleeding of unknown origin

• Any condition that increases the risk of pelvic infection

• History of retained IUD: If there is a history of a previously inserted IUD that has not been removed.

• Hypersensitivity to any component of the device 

• For hormonal IUDs, additional contraindications include: 

  • Confirmed or suspicion of breast malignancy or other progestin-sensitive cancer 

  • Liver tumors: benign or malignant 

  • Acute liver disease 

• For copper IUDs, additional contraindications include: 

  • Wilson disease 

  • Sensitivity to copper