Overview of Intrauterine Device
Intrauterine devices (IUDs) are a type of birth control device that is placed inside the womb. These were found to be one of the most effective types of birth control available today, almost as reliable as sterilization. The IUDs popularly used in the United States are those containing copper and those containing a hormone called levonorgestrel. They are almost 100% successful in preventing pregnancy; the chances of getting pregnant while using these devices are 0.08% and 0.02% respectively.
Since 1995, more and more women in the United States have been using a long-lasting yet reversible birth control method called Long Acting Reversible Contraception (LARC) – which includes IUDs and hormonal implants. Because of this, the percentage of women using a form of LARC for contraception has continued to rise each year – with 14% of contraception users opting for LARC. Along with the increased usage of LARC, we have seen a reduction in unplanned pregnancies.
Benefits of IUDs are not limited to their preventative capabilities. They are easy to use, reversible if you decide to have children, and people report being satisfied with them due to its long-term application and the reduced financial burden.
Anatomy and Physiology of Intrauterine Device
All the Intrauterine Devices (IUDs) available in the United States are T-shaped and are placed inside the womb. This T-shape lodges at the top of the inner space of the womb. These devices have a width between 28-32 millimeters and a length between 30-36 millimeters. It’s generally thought that these sizes would fit all women. However, recent studies using ultrasound technology have shown that the inner space of the womb in women who haven’t had children may be narrower than the width of these devices.
Therefore, it’s important to consider the different options for IUDs available. The smallest IUDs, which are 28 millimeters wide and 30 millimeters long, are often the best fit for young women and women who haven’t had children yet. When a doctor is placing or removing an IUD, they need to locate two key parts of the female reproductive system – the cervix (the passage forming the lower end of the womb) and the uterus (the womb).
The doctor will find the womb by conducting a bimanual exam which means they will use both hands to examine the size, shape, positioning, and to check for any abnormal structures. The cervix will be found during the speculum examination, which is a procedure where a tool called a speculum is used to open the vagina and allow for examination.
Why do People Need Intrauterine Device
There are two types of intrauterine devices (IUDs) available for use: levonorgestrel and copper IUDs and each has their own uses. Both are primarily used for birth control.
The levonorgestrel IUD comes in different strengths: 13.5 mg, 19.5 mg, and 52 mg. All these strengths are equally effective at preventing pregnancy. However, the stronger 52 mg IUD is also used to treat heavy periods (known as menorrhagia) and to protect the lining of the uterus during hormone replacement therapy. The 13.5 mg IUD can be used up to 3 years, while 19.5 mg and 52 mg IUDs are good for up to 5 years.
The copper IUD can prevent pregnancy for up to 10 years. Interestingly, it can also be used as emergency contraception if inserted within 5 days of unprotected sex. The chance of it failing in this use is very low, roughly around 0.1%.
An IUD can also be inserted shortly after childbirth, within 10 minutes of delivering the placenta, or a few weeks later, within 4-6 weeks of delivery. It can also be inserted after an abortion, as long it wasn’t due to an infection.
There are also reasons why an IUD may need to be removed. The main reason is if the user decides they no longer want it, for any reason, including wanting to get pregnant, experiencing irregular or heavy bleeding, or feeling discomfort or pain which could mean the device has moved. Copper IUDs are more likely to cause heavier bleeding, which might make a user want to have it removed. If a pregnancy occurs with an IUD in place, it should usually be removed, but only if its removal strings can be easily found within the cervix. Leaving the IUD increases the chances of miscarriage by 40% to 50%, but it does not increase the risk of birth defects. Removing it reduces this risk to 20%. Levonorgestrel IUDs may also need to be removed in case of a diagnosis of cancer of the cervix or uterus, or if someone becomes jaundiced. Finally, an IUD should be removed if it’s been there longer than its approved effective duration: 5 years for 19.5 mg and 52 mg devices, 3 years for 13.5 mg devices, and 10 years for the copper IUD. However, these durations may change, so it’s best to check the specific product’s information for the most current advice.
When a Person Should Avoid Intrauterine Device
There are two types of intrauterine devices (IUDs), and each type has specific situations where they should not be used. However, there are also shared situations where neither type should be used.
There are general situations where the use of any type of IUD is not recommended:
– If you are or may be pregnant.
– If you have a sexually transmitted infection or a lower genital tract infection like cervicitis (cervix infection) or vaginitis (vagina infection) at the time you want to insert the IUD.
– If you have a birth defect that has deformed the shape of your uterus, making it hard to insert an IUD.
– If you have a current severe infection in your pelvis.
– If you have had a severe infection in your pelvis before, unless you’ve successfully gotten pregnant after the infection.
– If you’ve had an abortion with an infection or an infection after giving birth in the last 3 months.
– If there’s confirmed or suspected cancer in your uterus or cervix.
– If you have abnormal uterine bleeding whose cause isn’t known.
– If you have a condition that increases your risk of getting pelvic infection.
– If you have an IUD that hasn’t been removed.
In addition, if you’re allergic to any part of an IUD, you shouldn’t use it.
For the IUD that releases a hormone called levonorgestrel, you should not use it if:
– You have confirmed or suspected breast cancer or other cancers that are sensitive to the hormone progestin.
– You have tumors in your liver, whether they’re benign (not cancerous) or malignant (cancerous).
– You currently have liver disease.
For the IUD made of copper, you should not use it if:
– You have Wilson disease, a disorder in which copper builds up in your body.
– You’re allergic to copper.
Equipment used for Intrauterine Device
Regardless of the kind of intrauterine device (IUD) – a small device put inside the uterus to prevent pregnancy – being put in or taken out, the tools required are mostly the same, with the only exception being the specific IUD being inserted. The tools required to insert an IUD include:
- Gloves – two pairs, which include a pair of clean, unused gloves
- Speculum – a tool that helps the doctor look into the vagina and cervix (lower part of the uterus)
- An anti-septic solution with applicators – this is used to clean the area and avoid infection
- Sterile uterine sound – A tool used to measure the depth and direction of the uterus
- Sterile tenaculum – A tool used to hold and stabilize the cervix
- An IUD in sterile packaging – the actual device being inserted
- Anesthesia with appropriate materials if planning to perform a paracervical block – this is a type of numbing medication used to block pain around the cervix
- Sterile sharp – a clean, precise, and uninfectious cutting tool
- Long-handled scissors – used in the process for precision
Meanwhile, the equipment needed to remove an IUD involves gloves for hygiene, a speculum to keep the vagina open for the procedure, sterile forceps (a gripping instrument), and a cytobrush, a tool used for collecting cells during the procedure.
Who is needed to perform Intrauterine Device?
Putting in or taking out an IUD (Intrauterine Device, a type of birth control) should be done by a health professional who knows how to use the special tools. The companies that make IUDs teach these health professionals how to use them. They even have a lot of resources online that can help. It’s also good to have at least one more person there to pass the materials they need.
There’s a chance that the IUD could move out of place or even make a hole in the uterus (womb) if it’s placed by someone who doesn’t have a lot of experience. This is why it’s important that the health professional has been trained and has done the procedure before.
Preparing for Intrauterine Device
Before deciding to use an intrauterine device (IUD), it’s important for patients to understand all the types of birth control available. IUDs and subdermal implants are types of long-acting reversible contraception (LARC) and are highly effective in preventing pregnancy, as effective as getting your tubes tied or having a vasectomy. These methods are also recommended as the first choice for preventing teenage pregnancies because they are safe for this age group. The Contraceptive CHOICE project has found that when people understand their choices and can get these methods free of charge, about two-thirds of the women chose IUDs or implants. So, unless there is a specific reason not to, most people should consider IUDs as a birth control option. The final decision lies with the patient herself, considering what works best for her. After picking a method, she should check her insurance coverage or seek prior authorization if needed.
If a patient decides to go with an IUD, several steps need to be taken before the insertion. First and foremost, make sure the patient is not pregnant through a pregnancy test. There’s a quick start method that allows counseling and insertion on the same day, but it isn’t suitable if there’s a chance the patient might be pregnant due to recent unprotected sex. If pregnancy can’t be ruled out in this way, temporary methods like oral contraceptives, condoms, or injections may be used. After 3 or 4 weeks, a second pregnancy test can be done to confirm, and if negative, the IUD can be placed. A copper IUD is effective immediately, but if a levonorgestrel IUD is inserted more than 7 days after the start of menstruation, the patient should use additional birth control for a week.
Also, screening for sexually transmitted infections may be necessary depending on the patient’s sexual history. If an infection is discovered after the IUD is inserted, the IUD should remain in place, and antibiotics must take care of the infection. If there are signs of an active infection before insertion, it’s better to delay IUD insertion and treat the infection first.
Before the procedure begins, ensure that the patient fully understands the process, the potential risks, and changes they may experience, such as pain during insertion, the risk of uterine perforation, bleeding, possible expulsion of the IUD and even changes in menstrual patterns. While a copper IUD might increase the heaviness and duration of menstrual bleeds, a levonorgestrel IUD often leads to a reduction or even a complete stop in menstrual bleeding.
As for managing pain during the procedure, pain relievers like naproxen or tramadol taken before insertion might help. Misoprostol, a medicine that helps open (dilate) the cervix, is not generally recommended due to potential delays in IUD insertion. A local anesthesia cream or gel can offer some relief when the medical instrument that holds the cervix (tenaculum) is positioned and during the insertion procedure itself. The effectiveness of injecting a local anesthetic (paracervical block) to help with pain during IUD insertion is still up for debate. In conclusion, the use of IUDs provides an efficient and dependable form of long-term contraception, with the choice of the best method and pain control during insertion being tailored to the needs of each individual patient.
How is Intrauterine Device performed
Getting an Intrauterine Device (IUD) put in place requires several steps.
First, your doctor will make sure you not pregnant with a simple test. After this, they explain to you the procedure and confirm your agreement to proceed (this is called ‘informed consent’). You’ll then need to lie down on the examination table with your legs apart, which doctors refer to as the dorsal lithotomy position.
Your doctor will put on gloves and perform a gentle internal examination with their fingers, checking to see if your uterus tilts forwards or backwards. After this, they use a medical instrument called a speculum to look at your cervix (the lower part of the uterus that connects to the vagina). They will then clean the cervix and the surrounding area with a cleansing solution. If you are allergic to the routinely used cleaning solution like iodine, they’ll use a product called chlorhexidine gluconate instead.
If you’re worried about pain, we may apply an anesthetic gel or give you a paracervical block, which numbs the area.
Your doctor then switches to sterile gloves, uses an instrument to hold the cervix steady and loosen it slightly. Using a small tool called a uterine sound, they’ll measure the depth of the canal leading up to your uterus, which helps determine if the IUD can safely be placed. If the canal is too tight, a device called a cervical dilator may be used to assist with the placement.
After the depth is measured, the doctor follows instructions specified to the type of IUD being used. They’ll insert the device, and then cut the strings to a manageable length of about 3 to 4 cm. They’ll then remove the speculum, check for any bleeding, and ensure the area is clear.
You’ll need to make a follow-up appointment in about a month to six weeks to check that everything is in order.
When it’s time for the IUD to be removed, the doctor will take similar steps. After you’ve provided informed consent, you’ll be asked to assume the same position as before. The doctor will then identify the location of the cervix and the strings attached to the IUD. If they can’t see the strings, they may use a small brush to locate them. Then, using an instrument called a ring forceps, they’ll gently pull on the strings, removing the IUD. To finish off, the doctor will ensure that the entire IUD was removed without any issues.
Possible Complications of Intrauterine Device
When discussing the risks involved with inserting an IUD (short for Intrauterine Device, a type of birth control), it’s crucial to remember that some specific factors might lead to complications. There was a study done that showed complications are more common when the IUD is being inserted by a healthcare professional with less experience or in women who’ve never given birth vaginally. These women might face difficulties during the insertion, issues with their cervix opening up properly, and a slowed heart rate or fainting symptoms.
On top of this, older women also tend to encounter more issues with their cervix opening up fully. A crucial aspect to lower these complications is the expertise of the healthcare professional handling the IUD insertion. Hence, it’s a good practice to have a detailed discussion with patients about the potential risks involved, based on their specific medical history.
There are actually very few complications associated with the process of inserting an IUD. The most frequent complication is the IUD moving out of place or coming out altogether after insertion, mostly within three months. The risk of this happening increases if the IUD is placed after vaginal delivery or an abortion. However, putting an IUD in patients right after birth does have its advantages, as not all patients make it back for a post-birth check-up and IUD placement, possibly putting them at risk for an unwanted pregnancy.
Another concern is the rare possibility of becoming pregnant even with an IUD. The chance of getting pregnant even with a copper IUD is around 0.6%, and about 0.2% for a 20 mg levonorgestrel IUD(a version of IUD).
Another rare risk is a small chance that the uterus might get punctured when the IUD is being inserted. This risk is also difficult to measure as sometimes the puncture is not caught when it happens. The levonorgestrel IUD appears to carry a slightly higher risk for puncture compared to the copper based IUD, although the study used a larger levonorgestrel device.
With both the putting in and taking out of IUDs, there’s a potential risk of experiencing a slowed heart rate or fainting symptoms when dealing with the cervix. These symptoms are usually managed as they occur and are more common in women who’ve never given birth or those who experience more pain during the procedure.
What Else Should I Know About Intrauterine Device?
In the United States, two types of intrauterine devices (IUDs) are used to prevent pregnancy: copper-containing IUDs and levonorgestrel-containing IUDs. These devices work differently to avoid conception. The copper IUD impedes the movement and survival of sperm within the uterus by creating a small, toxic, inflammation reaction. Because of this particular action, copper IUDs can also be used as a highly effective emergency contraceptive, if inserted within five days of unprotected sex.
On the other hand, levonorgestrel-containing IUDs work by using progesterone, a type of hormone, to suppress the growth of the endometrium (the lining of the uterus). The endometrium becomes less sensitive to another hormone, estradiol, produced by the ovaries. This IUD also thickens the cervical mucus (fluid secreted by the cervix), which inhibits the movement of sperm, hence preventing pregnancy.
Due to their effectiveness, reliability, and reversibility, these devices are often a great option for women to prevent pregnancy. Certain levonorgestrel-containing IUDs, particularly those with higher doses, can also be beneficial for treating heavy menstrual bleeding (menorrhagia) and for protecting the endometrium during hormone replacement therapy. An added advantage of IUDs is that they can be inserted just after childbirth, within 10 minutes of delivering the placenta. This results in improved patient compliance and effectively increases the rate of contraception.