Description
The IUD is a small T-shaped plastic device placed by a doctor into the uterus to prevent pregnancy. There are 2 types: those containing hormones and those with copper.
There are several copper-coated types available in Canada: Liberté, Flexi-T and Mona Lisa.
How it works
Contraceptive is effective for 10 years.
- 380 mm2 of copper
- Copper wire wrapped around the stem and arms
- Hysterometer included
In the hormonal IUD, the vertical stem is covered with a small tube that contains progesterone (a hormone), which slowly releases into the uterus. There are 2 types: Mirena and Kyleena
Effectiveness
Copper IUD
Copper destroys sperm as they pass through the uterus. Copper also changes the endometrium (lining of the uterus).
Hormonal IUD
The progesterone released by these IUDs thickens the mucus in the cervix to prevent sperm from entering the uterus. Progesterone also thins the lining of the uterus to prevent implantation.
Effectiveness
This is a very effective contraceptive method. Copper IUDs can be left in place for 5 to 12 years, depending on the type. Kyleena can be left in for 5 years, and Mirena for 7 years if you had it inserted at age 25 or older. Your doctor will tell you. Copper or hormonal IUDs are almost as effective as female sterilization (tubal ligation) (99.8%).
Cost
The price of a copper IUD (around $80-$110) can vary from one pharmacy to another. Copper IUDs are not reimbursed by the Québec Prescription Drug Insurance Plan, and very few private insurers pay for them. The copper IUD is free if inserted immediately after a surgical abortion (not free after a medical abortion). The prices of hormonal IUDs range from $300 to $450. Mirena and Kyleena IUDs are reimbursed by the Québec Prescription Drug Insurance Plan and by private insurance. However, a doctor’s prescription is required to purchase them from a pharmacy.
Indication
Any woman who wants effective contraception can have an IUD fitted, whether or not she has had children.
Contraindications
Absolute contraindications for IUD placement include the following:
- uterine malformation
- uterus is too small
- acute pelvic infections (infection of the fallopian tubes)
- possibility of pregnancy
- uterine bleeding of unknown cause
- allergy to copper or another component of the IUD
There are also other conditions that limit IUD insertion. Your doctor will discuss them with you.
Placement
An IUD is usually placed during the menstrual period to ensure that the woman is not pregnant. If an effective contraceptive method is already in use, the IUD can be placed at any time.
An IUD can be inserted immediately after a miscarriage or an abortion. Following childbirth, it can be placed after four weeks. Before an IUD is placed, all women should have vaginal swabs taken (screening for sexually transmitted diseases, or STDs), even if they are in a stable relationship. The swab can be taken at the same time as the IUD is inserted. IUD insertion is not very painful, but sometimes causes cramps similar to menstrual pain. These can last for a few hours after placement. The cramps can be alleviated by taking an anti-inflammatory medication (e.g. Advil, Naprosyn) one hour before the procedure.
Side effect
Copper IUDs
On average, they lengthen the menstrual period by one to two days. Blood loss is heavier in the first three months, but usually decreases thereafter.
Copper IUDs can also increase menstrual cramps. Your doctor may prescribe an anti-inflammatory medication to reduce cramping and menstrual flow.
Mirena/Kyleena hormonal IUDs
With these IUDs, women may experience irregular bleeding for the first two to three months. Thereafter, periods are usually much lighter or stop altogether. This is very beneficial for women who have heavy, long and painful periods.
The progesterone may cause some women to initially experience abdominal pain, breast tenderness and nausea (rare).
These side effects are not dangerous and cease within the first few months after placement.
Complications
Pelvic inflammatory disease
The IUD does not increase the risk of pelvic inflammatory disease (salpingitis and fallopian tube infection) – except in the first 3 weeks. If this infection occurs, it is often associated with sexually transmitted diseases and not with the IUD.
Ectopic pregnancy
The incidence of ectopic pregnancy (pregnancy in the fallopian tubes) is very rare in women with IUDs. However, if a woman becomes pregnant using an IUD, she should consult her doctor as soon as possible.
NOTE: Any unusual bleeding or pain in a woman using an IUD needs to be checked by her doctor.
Removal
Your IUD can be removed at any time during the menstrual cycle as long as you haven’t had sexual intercourse since your last period, or if you want to become pregnant.
Choosing the right IUD
The choice depends on your needs and gynecological history. Women are more likely to use hormonal IUDs if they have heavy, long and painful periods. However, a woman who has regular, light and painless periods, or who wants hormone-free contraception, will be very happy with a copper IUD.
Talk with your doctor to get good advice.
The morning-after IUD
A copper IUD can be inserted within seven days of unprotected sexual intercourse. This will prevent pregnancy in almost all cases. It should therefore be considered if the deadline for post-coital contraception (morning-after pill) has passed. Hormonal IUDs are not yet recommended as a morning-after contraceptive.
Last update : June 2023