Intrauterine Device: Types, Uses, Function, Procedure, Advantages, Risks and Complications

An intrauterine device, or IUD, is a birth control treatment that a medical practitioner implants into your uterus. The intrauterine device (IUD) is the most widely used type of long-acting, reversible contraception (LARC). 

When an IUD is put in, birth control is not a worry until it needs to be replaced, which could occur in three to 10 years, depending on the type. LARCs, the most effective non-surgical method of birth control, include contraceptive implants and IUDs. If you decide to become pregnant, your provider can remove your IUD.

Unlike other techniques like condoms, contraceptive IUDs do not prevent sexually transmitted infections (STIs). Condoms and IUDs can help prevent conception and reduce the risk of contracting a sexually transmitted infection.

Types Of Intrauterine Devices

There are two types of IUDs: copper and hormonal. Both have plastic frames that grow into a T shape once within your uterus. The threads that extend into your vagina and are attached to the bottom of your IUD allow your doctor to remove it whenever necessary.

• Copper IUDs: A thin copper wire encircles the stem portion of the "T" on Paragard's IUD. To prevent your cervix from being punctured, the IUD stem ends in a smooth ball when your physician inserts it.
• Hormone IUDs (levonorgestrel): The progestin hormone levonorgestrel is found in the upper part of the "T" and travels through the stem. One hormone that your body naturally produces is progesterone. This hormone is also available in synthetic form as progestins. Liletta and Mirena are a little bigger than Skyla and Kyleena.

Each type has characteristics that allow imaging procedures to see them. Your provider can examine the positioning of your IUD at wellness visits to ensure it is in the right place.

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How often are IUDs used?

IUDs are the second most used reversible birth control method, after birth control tablets. Approximately 23% of women and people who identify as female at birth (AFAB) globally who use contraception prefer IUDs. 

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Who should use an IUD?

It is not appropriate to use an IUD if:

• You are pregnant.
• You are infected with a sexually transmitted infection (STI).
• It is thought that you have a greater chance of contracting an STI.
• You are either a victim of cervical or uterine cancer.
• There doesn't seem to be any connection between your vaginal bleeding.
• If you have Wilson disease, an inherited condition that results in the accumulation of copper in the body, or if you have a copper allergy, you should not use copper IUDs.
• Hormonal IUD use is not advised if you have breast cancer or a severe liver disease. You should not use them if you are considered to have a high risk of developing breast cancer.

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How do IUDs function?

Every IUD triggers an immune response. When your body perceives an IUD as an intruder, it goes on the offensive to protect itself. The result of this mechanism is inflammation.

Because of uterine inflammation, sperm cannot live in a toxic environment. This means that sperm cannot fertilize an egg in your fallopian tubes. Furthermore, copper's special properties and hormonal IUDs prevent sperm from leaving your uterus.

• Copper-based IUDs: Inflame the endometrium, the lining that coats your uterus, by raising the inflammatory response. Even if sperm could fertilize an egg, the lining of your uterus would prevent the fertilized egg (embryo) from implanting and growing there.
• Hormonal IUDs: Release trace levels of the progestin hormone levonorgestrel gradually. Levonorgestrel makes it more difficult for sperm to get through cervical mucus and into fallopian tubes. It also thins the lining of your uterus and reduces the amount of eggs that are released during your monthly cycle.
• The amount and pace at which levonorgestrel is released from each hormonal IUD varies. Liletta and Mirena exhibit a higher release of progestin compared to Skyla and Kyleena. Talk about the brands you prefer with the doctor.

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How long does an IUD last?

The FDA has authorized the use of IUDs based on the following timeline:

• Paragard: 10 years of birth control.
• Mirena: 8 years of birth control.
• Liletta: A period tablet that lasts for six years.
• Kyleena: five contraceptive years.
• Skyla: Three contraceptive years.

Your doctor may advise you to wear a device for longer periods while still receiving the same level of protection, depending on factors including your age and overall health. Follow your provider's recommendations.

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What is the procedure for inserting an IUD?

Only a medical practitioner is qualified to implant, modify, or remove an IUD.

Considering your lifestyle and overall health, your doctor will determine if you are a good candidate for an IUD. You might need to get an STI test or do a pregnancy test beforehand.

Talk to your provider about pain management before surgery. A lot of people can tolerate having an IUD inserted without any problems. Because they are worried about how an IUD would feel, some people choose not to have one. Your provider may suggest taking painkillers beforehand to ease any discomfort or pain you may be experiencing. They could also numb the area before the procedure.

By speaking with your doctor, you can ease your anxiety about getting an IUD.

When the needle is inserted, what happens?

An IUD can be inserted in fifteen minutes or less. Your doctor can finish the procedure during an office visit.

Just like for a Pap smear, you will be positioned on a table with your legs apart, knees bent, and stirrups to support yourself. You can receive a numbing shot around your cervix to relieve any pain or discomfort.

Using a speculum, your doctor will enlarge your vagina. You may experience mild to severe cramping as your healthcare provider implants the IUD.

You might not experience any negative effects at all, or you might endure mild to severe discomfort. You should allow yourself some time to heal, just in case. Try not to work the rest of the day if at all possible.

You might:

• Experience dizziness or faintness.
• Have cramps in your back.
• Feel light drops or spots.
• Using over-the-counter (OTC) NSAIDs and heated pads can help reduce the pain. Pantyliners and pads could perhaps help manage any bleeding.

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When will my IUD start to work?

Paragard immediately sets to work. Your cycle determines when hormonal IUDs begin to prevent pregnancy. They go right to work when you start menstruation. If you're not menstruating, it could take them a week to offer you protection. Use alternative forms of birth control while you wait for your IUD to become effective.

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Can IUDs stop a pregnancy?

IUDs have a 99% success rate in preventing conception. IUDs and contraceptive implants are now the most effective nonreversible birth control options available.

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What are the advantages of using an IUD?

IUDs:

• Reach a 99% success rate.
• Spare you the headache of having to locate contraception before having intercourse.
• Are both affordable and approved by most commercial insurance companies, including Medicaid.
• Can be removed if you decide to become pregnant or alter your birth control regimen.
• Prevent you from getting pregnant for an extended period without requiring your continued attention.
• It will spare you the anxiety that comes with forgetting to take a birth control pill, get a shot, etc.
• Based on specific studies, some IUD brands may reduce the risk of endometrial cancer, ovarian cancer, cervical cancer, and pelvic inflammatory disease (PID).

There are further advantages to hormonal IUDs. Research on Liletta and Mirena have shown that they are capable of:

• Reduce heavy menstrual bleeding (Mirena has been approved by the FDA to treat HMB).
• Minimize cramping and agony associated with endometriosis during the menstrual cycle.
• Additional advantages of copper IUDs
• Paragard is an effective emergency contraceptive technique. By taking Paragard five days after having unprotected sex, you can prevent becoming pregnant.

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What risks are associated with IUD use?

IUDs are regarded as safe and effective devices. Complications, however rare, can include:

• Expulsion: There's a chance your IUD will come loose. When this occurs, it usually occurs during your menstrual cycle in the initial few months following the device's implantation.
• Perforation: The uterine wall may be perforated during implantation.
• High-risk pregnancy: The chances of becoming pregnant are slim. If, in the improbable event that you become pregnant, things go wrong, the chances of problems throughout pregnancy are higher. By making sure you don't use your IUD after its expiration date, you can prevent becoming pregnant.
• Infection: Bacteria may enter your body after your IUD is implanted and result in an infection. Infections are most likely to occur in the first 20 days following insertion. Your healthcare provider will clean your cervix following IUD implantation to lower the risk.

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What Complications Are Associated With IUD Use?

Menstrual irregularities may result from an IUD:

• Copper IUDs, in particular, have the potential to exacerbate monthly cramps and increase the amount of blood in your period in the first few months after implantation.
• Hormonal IUD users may experience irregular periods, especially in the first few months after implantation. Menstruation may not occur (amenorrhea).
• You or your spouse may feel that the IUD's strings are initially stiff during intercourse. With time, the strings ought to get softer. Speak with your clinician if your IUD causes you pain during sexual activity or prevents you from leading a healthy sexual life.
• Most IUD users still ovulate, or release an egg, once a month throughout their menstrual cycle. Ovarian cysts are benign growths that can develop as a result of ovulation and usually disappear on their own. Cysts are prevalent, depending on where you are in your menstrual cycle.

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