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INTRODUCTION TO IUD CONTRACEPTION
The intrauterine device is one of the most commonly used methods of fertility regulation, especially in developing country programs. It is a safe and effective method for women who are in a monogamous sexual relationship and not at risk of sexually transmitted infections. World Health Organization (WHO) estimates that more than 150 million women use IUDs, with more than 74 million users in China alone. A review of studies confirmed that: (1) IUDs are not abortifacients; (2) newer comprehensive IUDs are highly effective and long-lasting; (3) IUDs can be safely used by lactating women; and (4) IUD use is not associated with an increased risk of pelvic inflammatory disease (PID), of ectopic pregnancy, or of subsequent infertility.
Since the 1970s, WHO has conducted 10 large trials to compare and evaluate the safety and efficacy of six different IUDs. One trial began in 1989 to compare the Copper T 380A and the Multiload-375; it involved nearly 4,000 women in eight countries. Although all the modern IUDs are very effective at preventing pregnancy, this long-term comparison found that the Copper T380A was nearly twice as effective as the Multiload-375, with reported pregnancy rates of 3.4 versus 5.4 percent after 10 years (WHO 2002).
IUDs and Pelvic Inflammatory Disease (PID)
The most definitive review of IUD safety, particularly regarding PID, is the World Health Organization review of 12 studies involving nearly 23,000 IUD users around the world. That 1992 study found that, overall, the rate of PID among IUD users was very low; the PID rate was highest during the first 20 days after insertion and was low and stable after that, even among users who had an IUD in place for eight years or more. PID among IUD users was found to be most strongly related to the insertion process rather than the IUD.
Efforts by the Technical Guidance Working Group, a panel of family planning experts from around the world, has helped refine key precautions that will help IUD providers minimize PID risk during insertion. Chief among these are client screening and aseptic insertion technique. Results of a randomized clinical trial in Nigeria found that use of a systemic antibiotic at the time of IUD insertion did not significantly reduce the incidence of PID during the first three months of IUD use. Careful screening of IUD candidates and sterile insertion technique were suggested as more cost-effective interventions to control IUD-related PID than use of expensive antibiotic therapy.
A recent review of the issue of antibiotic prophylaxis for IUD insertion by the Cochrane Library in 2002 confirmed that use of either 200 mg of doxycycline or 500 mg azithromycin taken orally before IUD insertion confers little benefit. Although use of prophylactic antibiotics before IUD insertion produced a marginally significant reduction in the likelihood of an unscheduled visit to the provider, no other benefits were observed. A uniform finding in the studies was the low risk of IUD-related infection, with or without use of antibiotic prophylaxis.
New Generation of IUDs
The newest generations of copper IUDs combine high continuation rates with very low pregnancy rates. Since little can be done to increase the efficacy of these devices, recent research has focused on developing devices to address side effects, particularly bleeding and pain, which account for a significant number of removals. The levonorgestrel-releasing IUD, a device with high effectiveness and acceptability, reduces menstrual blood loss compared to pre-insertion levels. The levonorgestrel-releasing IUD, Mirena®, has been available in Europe for 10 years and has been used by 2 million women; it was approved for sale in the United States in December 2000. Frameless IUDs, such as the Gynefix have been specifically designed to reduce cramping and pain. This device consists of a surgical nylon thread that holds copper sleeves and is anchored to the uterine fundus during insertion. It recently became available in Europe, and is licensed for five-year use. Studies suggest that the Gynefix is as effective as the Copper T380A, and expulsion rates are less than 1 per 100 women years.
Continuing Research
Other research has looked at improving IUD services by training non-physicians to provide IUDs. IUD insertions by trained non-physicians is increasing, and some countries, such as the Philippines, have initiated training programs specifically for non-physicians. Studies in Brazil, Turkey, and the Philippines found that trained health care workers can provide IUDs as safely and effectively as physicians in many settings. Additional training may be required to ensure correct placement of the IUD in the uterine fundus to reduce the likelihood of expulsions. Training non-physicians to provide IUDs safely and effectively could result in higher use of this method. Recent studies also have investigated the possibility that the increased menstrual bleeding and upper genital tract infections associated with IUDs may increase the risk of HIV among IUD users. IUDs generally are not recommended for women at risk of any STI, including HIV.
BASIC INFORMATION
DESCRIPTION
The goal of contraception (or birth control) is to prevent an unplanned pregnancy. The majority of methods of contraception enable sexually active couples to temporarily avoid pregnancy. Permanent birth control is accomplished through sterilization. Be sure you know and understand the different types of birth control available to you, the risks and benefits of each, and any side effects, so that you can make an informed choice.
MoonDragon's Contraception Methods Compared
An IUD is a tiny T-shaped plastic device about 3.5 cm long that is placed into the uterine cavity to prevent pregnancy. One or two plastic strings (filaments) attached to the IUD extend out through the cervical canal. These strings enable periodic checking for position and as an aid when the IUD is removed. Unlike IUDs that were used in the 1970s, present-day IUDs are small, safe, and highly effective. IUDs are visible on x-ray should one become "lost". Small amounts of copper or a hormone are released into the uterus, blocking sperm from entering the Fallopian tubes and thus preventing fertilization. If fertilization were to occur, the IUD would prevent the fertilized egg from successfully implanting in the lining of the uterus. IUDs begin working immediately upon insertion and stop affecting fertility immediately upon removal.
The FDA has approved three kinds of IUDs:
- The Copper T (Paragard® T380A IUD) contains copper and can be used for up to 8 to 12 years (resources vary in length of time, average is about 10 years). Copper wire is wound around the stem of the T-shaped IUD. The Copper T is the one most often used for emergency contraception. As a short-term type of emergency contraception, the copper IUD is more expensive than emergency contraception with hormone pills.
- The Progestin (Progestasert®) contains a progestin released over a one-year period. It is also shaped like a T. It is not wrapped in copper. Instead, this IUD contains the hormone progestin (progesterone), which is slowly released. This type of IUD must be replaced after 1 year of use. Other types of IUDs are being researched and may soon be available.
- The Mirena® IUD (Levonorgestrel [LNg] IUD) also contains a progesterone hormone and is good for about 5 years. Mirena is an older, frame Intrauterine Device (IUD). The newer IUDs, like FibroPlant, and GynePlant don't have a frame. Mirena, the hormonal IUD available in the U.S., is a small, plastic, T-shaped device that also contains a progestin hormone (52 mg levonorgestrel) in its frame. The Mirena-LNg IUD appears to be even more effective at preventing pregnancy than the copper IUD. Also, unlike other IUDs, it may decrease the risk of pelvic inflammatory disease (PID). Mirena is inserted into the uterus by a medical professional, in a matter of minutes. Once in place, it releases a very low dose of the hormone locally, for up to 5 years.
Using Mirena is considered very safe. It has been used in Europe for over 10 years, with no serious problems reported. For more information, please visit the Mirena site, maintained by the manufacturer, Berlex. See www.mirena-us.com.
The hormone progesterone, the same as the hormone produced by a woman's ovaries during each monthly cycle. The progesterone causes the cervical mucus to become thicker so sperm cannot reach the egg. It also changes the lining of the uterus so implantation of a fertilized egg cannot occur. The IUD can also be used as an effective method of emergency contraception (EC). While hormonal EC taken orally can be used for 72 hours after intercourse, an IUD can be inserted up to five days after unprotected intercourse for emergency pregnancy prevention.
After the recommended time, the IUD should be replaced. The IUDs have a the most effective reversible method of contraception currently available, IUDs are 99% effective at preventing accidental pregnancy (other sources state a 4 to 5 percent failure rate, but it is still highly successful at preventing pregnancy).
All types of IUDs prevent fertilization of the egg by damaging or killing sperm. The IUD also affects the uterine lining (where a fertilized egg would implant and grow). The Mirena-LNg IUD prevents fertilization by damaging or killing sperm and making the mucus in the cervix thick and sticky, so sperm can't get through to the uterus. It also keeps the lining of the uterus (endometrium) from growing very thick. This makes the lining a poor place for a fertilized egg to implant and grow. The hormones in the Mirena-LNg IUD also relieve dysfunctional uterine bleeding, reducing menstrual bleeding and cramps. Copper IUD uses copper because it is toxic to sperm. It makes the uterus and fallopian tubes produce fluid that kills sperm. This fluid contains white blood cells, copper ions, enzymes, and prostaglandins.
You might want to use an IUD if you have had at least one baby (pregnancy stretches the uterus and reduces the chance that your body will expel the device), you are in a mutually monogamous relationship or are otherwise not at risk of contracting sexually transmitted infections (STIs), you have no history of pelvic inflammatory disease (PID), or you cannot use hormonal contraceptives. You should not use an IUD if you have an STI; IUD use increases the possibility that an STI (such as gonorrhea or chlamydia) will lead to PID, which can cause infertility, increased risk of ectopic pregnancy, and even death, if it goes untreated. You also shouldn't use an IUD if you might be pregnant or if you have certain cervical and uterine abnormalities as defined by your health care provider.
IUD USE AND MEDICAL CONDITIONS
An IUD can be a safe birth control choice for women who:
- Have a history of ectopic pregnancy. Both the copper IUD and Mirena-LNg IUD are appropriate. Intrauterine devices reduce the risk of all pregnancies, including ectopic (tubal) pregnancy. However, if a pregnancy does occur while an IUD is in place, it is a little more likely that the pregnancy will be ectopic. Ectopic pregnancies require medication or surgery to remove the pregnancy. Sometimes the fallopian tube on that side must be removed as well.
- The IUD is most likely to work well for women who have been pregnant before. Women who have never been pregnant are more likely to expel the IUD or have more pain and cramping after insertion. However, they can still use the IUD.1
- Have a history of heavy menstrual bleeding and pain. The Mirena-LNg IUD may be appropriate for these women and women who have a bleeding disorder or those who take blood thinners (anticoagulants).
- Have a risk for bacterial endocarditis. Antibiotics would be used at the time of insertion and removal to prevent infection.
- Have diabetes.
- Are breast-feeding.
- Have a history of endometriosis. The Mirena-LNg IUD is a good choice for women who have endometriosis.
IUDs may not be a good choice if you:
- Have never been pregnant (you are more likely to have pain with an IUD, and are more likely to have the IUD come out after it is inserted).
- Have a sexually transmitted disease (STD) currently or within the past 3 months. Pelvic inflammatory disease (PID) concerns have been linked to the IUD for years. However, it is now known that the IUD itself does not cause PID. Instead, if you have a genital infection when an IUD is inserted, the infection can be carried into your uterus and fallopian tubes. This is why your health professional will test you for sexually transmitted diseases (STDs), and treat you if necessary, before you get an IUD.
- Are not willing to use condoms to protect yourself from sexually transmitted diseases.
- Have an active infection of your vagina or cervix.
- Have pelvic inflammatory disease or have a recent history of PID.
- Have a bleeding disorder or take blood-thinners (anticoagulants). Although you cannot use the copper IUD, you can use the Mirena-LNg IUD.
- Have a history of problems with IUDs.
- Have abnormalities of your uterus.
- Have a uterine infection after childbirth or a septic abortion.
- Have uterine bleeding of unknown origin.
- Have an allergy to copper, so the Copper T 380-A IUD would not be an option.
If you have one of the older, all-plastic IUDs, such as the Lippes Loop, ask your health professional at your next checkup about replacing this IUD with a more effective copper or hormonal one.
PREGNANCY WITH AN IUD
If you become pregnant with an IUD in place, your health professional may recommend that the IUD be removed. This is because the IUD can cause miscarriage or preterm birth (the IUD will not cause birth defects). Taking out an IUD early in a pregnancy lowers risks of miscarriage or preterm birth. However, IUD removal can also cause a miscarriage. As a pregnancy progresses, miscarriage risk is lower than if an IUD is left in place.
ADVANTAGES
Lovemaking does not need to be interrupted by the insertion of a birth control device or spermicide. Many women report that they are more spontaneous about having sex, because the risk of pregnancy is so low.
May prevent ectopic pregnancies, which are life-threatening pregnancies that occur in the Fallopian tubes in some women.
Cost effectiveness over time. No age limitations or restrictions on use for women age 20 and over. No restrictions for women who have already given birth.
Replacement is required just every 5 to 10 years, depending on the type.
The Mirena-LNg IUD may prevent endometrial hyperplasia or endometrial cancer and may decrease the risk of pelvic inflammatory disease (PID). The Mirena-LNg IUD may effectively relieve endometriosis, and is less likely to cause side effects than high-dose progestin contraceptives. It also reduces the risk of ectopic pregnancy.
Women do not have a harder time getting pregnant after removal of an IUD than they do after the use of other forms of birth control.
IUDs are quite effective for birth control (97-99%). Copper T IUD: Typical User: 0.8% - For a group of 1000 typical users, only 8 women may become pregnant when using the IUD in the first year. Perfect Use: 0.6% - If 1000 women are using the IUD perfectly, only 6 may become pregnant in the first year. Over 10 years of use, about 20 to 30 women per 1,000 become pregnant.
Mirena-LNg IUD: About 1 per 1,000 women becomes pregnant. Over 5 years of use, only about 7 women per 1,000 become pregnant. Most pregnancies that occur with IUD use happen because the IUD is pushed out of (expelled from) the uterus unnoticed. IUDs are most likely to come out in the first few months of IUD use, after being inserted just after childbirth, or in women who have not had a baby.
Progestasert IUD: Typical User: 2% - For a group of 100 typical users of the Progestasert IUD, 2 women out of that group of 100 may become pregnant when using it in the first year. Perfect Use: 1.5% - If 100 women use the Progestasert IUD perfectly, 1 to 2 women out of that group of 100 may become pregnant.
A woman using an IUD should check for the string as often as advised. The IUD also needs to be replaced in a timely fashion. The Copper T can last up to 10 years. The Mirena-LNg IUD needs to be replaced every 5 years. The Progestasert needs to be replaced yearly. A woman should also watch for warning signs of infection, especially during the first few months after insertion.
The device is easily fitted and tolerated by most women. Can be used by women who cannot use estrogen-containing birth control pills.
The IUD requires no daily routine.
Although they cannot be discontinued as easily as discontinuing a daily pill (oral contraceptives), they can be removed at any time by a trained health care provider.
With the progesterone containing IUD, there will probably be less bleeding during menstrual cycles. The Mirena-LNg IUD reduces menstrual bleeding and cramps and, in many women, eventually causes menstrual periods to stop altogether. In this case, not menstruating is not harmful. The Mirena-LNg IUD reduces dysfunctional uterine bleeding by an average of 90% after the first few months of use.
Fertility for a woman after removal of the IUD should probably be the same as it was before using the IUD.
The Mirena-LNg IUD does not cause weight gain.
DISADVANTAGES
Cramping and bleeding may occur the first few days after insertion.
Spontaneous expulsion of the IUD. Occurs more frequently within the first 3 months to one year. It is noted in most instances, but some women may not be aware of the device being expelled.
Occasional bleeding between menstrual periods and changes in amount of flow and increased pain with periods.
IUDs offer no protection against sexually transmitted diseases (STDs). A form of barrier protection needs to be used by those at risk.
IUD may perforate the uterus and travel into the abdomen. Lost or misplaced IUDs require special examinations such as an x-ray or ultrasound.
IUDs can increase the risk for pelvic infections such as pelvic inflammatory disease (PID) making the woman very sick which can impair future fertility or infertile.
If pregnancy occurs with an IUD in place, there is a 50% chance of miscarriage. The IUD should be removed.
IUDs may increase the risk of ectopic pregnancy in some women.
Not usually recommended for women who have a diagnosed gynecological problems or are pregnant, women who have not yet had a child and women with multiple sexual partners.
The Mirena-LNg IUD may cause non-cancerous (benign) growths called ovarian cysts, which usually go away on their own.
The Mirena-LNg IUD can cause hormonal side effects similar to those caused by oral contraceptives, such as breast tenderness, mood swings, headaches, and acne. This is rare. When side effects do happen, they usually go away after the first few months.
The high cost of insertion is also a disadvantage for some women. and the need to be removed by a health professional.
RISKS & CONSIDERATIONS
A number of problems could occur while you are using an IUD, some of which can be severe. These problems are listed below (the first two are the most common):
- Increased menstrual bleeding and cramps, mostly during the first few months of use. Menstrual problems. About 12% of women have the Copper T 380-A IUD removed because of increased menstrual bleeding or cramping. Women may also experience spotting between periods. However, after about 3 months of increased bleeding or spotting, the LNg IUD reduces menstrual cramps and bleeding by an average of 90%.
- Spotting between menstrual periods.
- Irritation of your partner's penis.
- Increased risk of pelvic inflammatory disease, which can lead to infertility.
- Unnoticed loss of the IUD from the uterus, which may result in unexpected pregnancy. Expulsion. About 2% to 10% of IUDs are pushed out (expelled) from the uterus into the vagina during the first year. This usually happens in the first few months of use. Expulsion is more likely when the IUD is inserted right after childbirth, or in a woman who has not carried a pregnancy. When an IUD has expelled, you are no longer protected against pregnancy. You will need to use another form of birth control, such as condoms.
- Embedding of the IUD in the uterine wall.
- Damage to the uterus by the IUD, with possible damage to other organs as well as internal bleeding. Perforation in 1 out of every 1,000 women, the IUD will get stuck in or puncture (perforate) the uterus. Although perforation is rare, it almost always occurs during insertion. The IUD should be removed if the uterus has been perforated.
- Potential problems if pregnancy occurs with an IUD in place, including ectopic (tubal) pregnancy. If you become pregnant with an IUD in place, it should be removed right away. It might increase your risk of miscarriage (loss of the baby), as well as the risk of infection in the uterus and preterm birth of the baby.
- Do not receive diathermy (deep heat) treatments if you have a copper IUD. Diathermy treatment increases the risk of injury to the tissues of the uterus.
- IUDs do not protect against sexually transmitted diseases, such as AIDS. Use latex or polyurethane condoms for protection against these infections.
- There has been no evidence of birth defects resulting from the use of an IUD.
You should not use an IUD if:
- You have cancer in the uterus or cervix.
- You have unexplained vaginal bleeding.
- You may be pregnant.
- You have had pelvic inflammatory disease.
- You have a severe infection of the cervix (cervicitis).
- You have fibroids or other problems with the structure of the uterus that make it hard to insert the IUD.
- You should not use a copper IUD if you are allergic to copper or metals.
The risk of pelvic inflammatory disease (PID) with IUD use is highest in those with multiple sex partners or with a history of previous PID. Therefore, the IUD is recommended primarily for women in mutually monogamous relationships.
In addition to PID, other complications include perforation of the uterus (usually at the time of insertion), septic abortion, or ectopic (tubal) pregnancy. Women may also experience some short term side effects -- cramping and dizziness at the time of insertion; bleeding, cramps and backache that may continue for a few days after the insertion; spotting between periods; and longer and heavier menstruation during the first few periods after insertion.
GENERAL MEASURES
INSTRUCTIONS FOR USE
You will have a full medical examination including a pelvic exam, Pap smear testing, breast exam, pregnancy test and tests for STDs along with your medical history before being given an IUD.
Your health care provider will insert the IUD into the uterus through the vagina and cervix (opening of the uterus). The IUD is usually inserted during a menstrual period, when the cervix is slightly open and you are least likely to be pregnant. Also, because the cervix is more open at this time, putting it in then may be more comfortable. The timing for the insertion can vary. It may be done during a menstrual period, between periods or 6 weeks after childbirth or abortion. However, it can be put in at any time during the menstrual cycle, as long as you are not pregnant. Others prefer to put it in during the middle of your cycle because this may lower the risk of infection. The cervix is also more open at the middle of the cycle, around the time of ovulation.
It takes only a few minutes to insert an IUD. You may feel some cramping pain when the IUD is being inserted. You may be given a local anesthetic or pain medicine before the IUD is inserted to help control this discomfort.
You may want to have someone drive you home after the insertion procedure. You may experience some mild cramping and light bleeding (spotting) for 1 or 2 days.
FOLLOW-UP
Your health professional may want to see you 4 to 6 weeks after the IUD insertion, to make sure it is place. One of the biggest advantages to the IUD is that there isn't much follow-up after the insertion.
Your health care provider may examine you after your next menstrual period to be sure the IUD is staying in the right place. During the first few months after insertion of an IUD, check often for the attached string to be sure that the IUD is still in the uterus. You should also check for the string after every menstrual period. You can do this by putting a finger inside the vagina and feeling for the string near the cervix. (Be careful no to pull on the string.) As long as you can feel the string, the IUD is in position and it is unlikely that you will become pregnant. If you feel the hard plastic of the IUD, it is no longer in the correct place and you will have to see your health care provider to change it.
Be sure to check the string of your IUD after every period. To do this, insert a finger into your vagina and feel for the cervix, which is at the top of the vagina and feels harder than the rest of your vagina (some say it feels like the tip of your nose). You should be able to feel the thin, plastic string coming out of the opening of your cervix. It may coil around the cervix, which can make it difficult to find. Call your health professional if you cannot feel the string or the rigid end of the IUD.
If you cannot feel the string, it doesn't necessarily mean that the IUD has been expelled. Sometimes the string is just difficult to feel or has been pulled up into the cervical canal (which will not harm you). An exam and sometimes an ultrasound will show whether the IUD is still in place. Use another form of birth control until your health professional makes sure that the IUD is still in place.
One of the potential side effects of the Copper T IUD is a longer menstrual period and more intense cramps so you may want to visit your doctor for additional medications to regulate your period.
If you have no problems, check the string after each period and return to your health professional once a year for a checkup.
TO INSERT:
- The IUD is straightened out in a plastic tube (like a straw) and the tube is inserted through the cervix and vagina into the uterus. The IUD is pushed through the tube and it springs back into shape in the uterus.
- The tube is removed and the IUD stays in the uterus with its string dangling into the vagina. You will be instructed on how to check for the string.
- There may be pain during the insertion and sometimes cramping for the rest of the day. Right after the IUD is put in, you may feel dizzy or have cramps. For the first few weeks, it is normal to have some spotting, heavier menstrual bleeding or cramps.
- Check for the strings often. Check for the strings before each time you have intercourse and after the periods ends. Also check once after each period and check any time you have abnormal cramps when menstruating. Use a clean finger to reach into your vagina and feel near the cervix for the strings. In the middle of your cycle, your cervix is higher so the strings may be harder to find. If the strings haven't changed, the IUD is in place. If you can't find the strings or you feel any plastic, the IUD may be out of place. If it is out of place, you may not be protected against pregnancy. Rarely, the IUD may be pushed out of the uterus without a woman knowing it. If you think the IUD is out of place or has been pushed out, its advisable not to have intercourse until you get checked. If you do have intercourse, use a back-up method of birth control.
TO REMOVE:
- Consult your health care provider about removing the IUD. It will need to be done by your health care provider.
Remove the IUD when it stops working.
a. The Copper T lasts for 10 years.
b. The Progestasert lasts for 1 year.
c. The Mirena (LNg) IUD lasts for 5 years.
If you think you might be pregnant or if you want to get pregnant.
If you want to stop using it for any reason.
See your health care provider if you experience any IUD warning signs. Side Effects vary for each type of IUD. Be familiar with the side effects for the type of IUD you choose to use.
COMPLICATIONS
Infection or Pelvic Inflammatory Disease (PID). This is most likely to occur during the first few weeks after insertion. It is often caused by STDs that were present when the IUD was put in. It requires quick and careful treatment. If not treated, a woman may lose her fertility. She can also become very sick and even die.
Tear or hole in the uterus or cervix. This is a rare complication of insertion.
Expulsion of the IUD. Signs of the IUD coming out include vaginal discharge, abdominal cramping or pain, spotting, change in the length of the string, and the feel of hard plastic at the cervix.
Miscarriage. If a woman does get pregnant while using an IUD, there is a 50% chance that she will have a miscarriage.
Ectopic Pregnancy. If a woman with an IUD gets pregnant, she is more likely to have an ectopic pregnancy than a woman without an IUD.
IUD WARNING SIGNS
- Period late, abnormal spotting or bleeding (could mean pregnancy or infection).
- Abdominal pain, pain with intercourse (could mean ectopic pregnancy infection).
- Infection exposure (any STD), abnormal discharge (possible infection).
- Not feeling well, fever, chills (possible infection).
- String missing, shorter or longer (IUD may be missing or dislodged).
MEDICATION
Ask your health care provider about the need for pain medication during and after the insertion procedure.
Ask your health care provider if there are any medications that are contraindicated with the use of your type of IUD.
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
You are interested in an intrauterine device (IUD) for contraception. There are some reasons why a health care provider may advise against the use of this method. Most are related to the risk of Pelvic Inflammatory Disease (PID) during the first months of use. These include current or past STDs, PID or other pelvic infections or a past tubal pregnancy. Risk factors for STDs, such as the number of sex partners, will also be assessed by the health care provider. If a woman wants to have children in the future, your health care provider may suggest a different method. This is because if PID occurs, there is a chance that a woman could become infertile. Also, if a woman has a history of abnormal vaginal bleeding, the cause needs to be known before the IUD is put in.
Following the insertion of an IUD, unexpected side effects develop including:
- Excessive, severe or irregular vaginal bleeding or abnormal spotting.
- Painful cramps in the lower abdomen. Severe, unexpected pain especially if it happens when you have intercourse.
- Vaginal discharge with a bad odor. Infection with or exposure to a sexually transmitted disease (STD).
- Signs of infection (fever, chills, muscle aches) with no apparent cause. Not feeling well or having fever of 100.4°F (38°C) or higher.
- Heavy bleeding for more than 1 menstrual period.
- You think you might be pregnant with the IUD still inside the uterus. If your period is late with a copper T IUD, contact your health care provider. If you have the LNg IUD. It is normal to miss a period or stop menstruating while you are using the LNg IUD, and this is not a cause for concern.
- You cannot find the string of the IUD when you search for it or you feel the hard plastic of the IUD. (Use condoms as backup birth control until your health professional has checked your IUD.)
- The IUD has been in place for the length of time recommended for the type you had inserted.
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