Intra-Uterine Device (IUD) Patient Information
What is an IUD? An IUD is a form of birth control; it is a device placed inside the uterus to prevent pregnancy. In some cases, your doctor may recommend an IUD for other uses such as to control heavy periods. Two types of IUD are available: Mirena and Nova T.
The Mirena IUD is a T-shaped piece of soft plastic which contains a small amount of slow release synthetic sex hormone known as levonorgestrel (a progestin).
The Nova T is a similar piece of soft plastic which contains copper. It does not contain hormone. Am I a Candidate for an IUD? Mirena IUD: You probably should not use the Mirena IUD if you have: -a sensitivity to the hormone levonorgestrel, silicone or polyethylene -a history of infection of the uterine tubes or ovaries (pelvic inflammatory disease) -a history of tubal (ectopic) pregnancy -an abnormal uterus/certain fibroids -can get infections easily (multiple sexual partners, intravenous drug abuse, immunosuppressant drugs) The Mirena IUD may be the right choice for you if you have: -only one sex partner who has sex only with you -a desire for an effective form of contraception which does not need to be remembered every day -a reason not to take birth control taking estrogen (such as heart disease, migraines or blood clots) because this IUD does not contain estrogen -heavy periods (Mirena usually significantly reduces the amount of bleeding with your cycle)
You should probably NOT use a copper IUD if you have: -an allergy to copper -a history of infection of the uterine tubes or ovaries (pelvic inflammatory disease.) -a history of tubal (ectopic) pregnancy -very heavy or very painful periods (the copper IUD may make these problems worse) A copper IUD may be the right choice for you if you have: -a desire for contraception that does not contain hormone -a desire for a less expensive form of intrauterine contraception (compared to Mirena) How does an IUD work? Mirena IUD Mirena likely works by a combination of several mechanisms. It slowly releases levonorgestrel into the uterus. This thickens the cervical mucous, preventing passage of sperm through the cervical canal. It also reduces the normal monthly thickening of the lining of the uterus. In some cases it may also prevent ovulation. Nova T IUD The mechanism of action of Nova T is not certainly known. However, it seems to have a direct toxic effect to sperm and also makes the uterine lining inhospitable, preventing implantation. How effective is an IUD? Both types of IUD are very effective, preventing pregnancy in 97-99% of women. An IUD does not offer protection against sexually transmitted diseases. When should an IUD be inserted? An IUD should be inserted during your period or within 7 days of starting. Following childbirth, an IUD can be inserted after 12 weeks post partum. A pregnancy test will be done prior to or at the time of insertion. An alternate form of contraception must be used for one month prior to insertion to ensure you do not become pregnant shortly before insertion. How often should I have my IUD checked? The IUD should be checked 4-6 weeks after insertion by your doctor, then annually during pelvic examination. A pelvic ultrasound will be arranged after your IUD is inserted to ensure optimal positioning. Back-up contraception should be used until proper positioning is confirmed by ultrasound. You will only be notified if the positioning of the IUD is unsatisfactory. How can I check my IUD? After each menstrual cycle or about once a month, you should check by feeling if the two threads of the IUD are still in place. If you cannot feel the treads, use alternate
contraception and follow-up should be arranged with your doctor. You should not use tampons or have sexual intercourse for 2 weeks after your IUD is inserted. What are the side effects of an IUD? Most women experience cramping and bleeding upon insertion of an IUD. This initial bleeding may last a few days. Irregular periods are also common after insertion of an IUD and may continue as long as you have your IUD. Mirena generally causes irregular bleeding for 3-6 months after insertion. After this, the amount of bleeding during a period usually decreases significantly. After several months, many women do not get a period at all while they have a Mirena IUD. Nova T causes an increase in the amount of bleeding and pain that occurs with periods in some women. Other less common side effects do exist. You can discuss these with your physician at your IUD consultation appointment. What are the risks of an IUD? While IUDs are not thought to cause infections, if you have a vaginal or cervical infection at the time of insertion, the infection may be spread upwards to your uterus and uterine tubes. This occurs less than 1% of the time. For this reason, your doctor may screen you for infections prior to inserting the IUD. The IUD must be placed in the correct position within your uterus to be effective. Sometimes, the IUD is placed too low or too high in the uterus. Your doctor may order an ultrasound, at her discretion, to confirm the placement of your IUD. If the IUD is in an unsatisfactory position, it will need to be removed and can be reinserted if desired. There is an approximately 1/1000 chance of perforation of the uterus with an IUD. This occurs when the device is placed through the uterine wall. In rare cases, this may require a surgery to remove the device. If you are pregnant at the time of insertion, placement of the IUD may cause a miscarriage. A pregnancy test will be done prior to insertion and you should use another form of contraception for 1 month prior to insertion to prevent pregnancy which may be too early to be detected by the pregnancy test. Ovarian cysts may occur while on Mirena. These usually are not clinically significant and disappear. Although rare, if pregnancy occurs with an IUD, the pregnancy may be in the uterine tubes (ectopic pregnancy). This may be life threatening and may lead to infertility.
How long can I use an IUD? An IUD is immediately effective upon insertion. The IUD can safely remain in place for up to 5 years and then needs to be replaced. You should see your doctor if: -you experience severe cramping or increased pain in the lower abdomen or back -you have pain or bleeding during sex -you have unexplained or foul-smelling discharge -you cannot feel the strings of your IUD or you can feel the lower end of the IUD -you think you might be pregnant
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