What is an Intra-Uterine Contraceptive Device?

Intra-Uterine Contraceptive Devices (IUCD/IUD) are small (<4cm), ‘T-shaped’, flexible, plastic items. These can be inserted into a woman’s uterus via the vagina for pregnancy prevention. IUCD are one type of long-acting reversible contraception (LARC). IUD do not protect against Human Immunocompromised Virus (HIV) or sexually transmitted infection (STI).

INSERTION PROCESS

  • The procedure is readily performed in a clinic setting with the woman fully awake. Sedation is not required.
  • A preferred time for insertion is within the first 7-10 days of a woman’s cycle when she may still be bleeding.
  • The insertion process often lasts as long as it takes to do a Pap Smear test i.e. 6-8 minutes.
  • Insertion may be uncomfortable but should not be painful.
  • A woman may experience period-like, pelvic cramps a few hours after insertion and perhaps for a couple of days afterwards. Pre-insertion, simple painkillers e.g. can be used with good effect.

 

STEP 1 RESEARCH Patient and partner do research from multiple sources e.g. conversations with other women who have used IUCD, online, family planning nurses, doctors.
STEP 2 CONSULTATION Consultation with a family planning nurse or doctor e.g. general practitioner or gynaecologist to discuss the benefits and risks for the specific patient and her family planning needs.
STEP 3 PAP SMEAR Updated Pap Smear examination. Recommendations require evidence of a healthy Pap Smear test result 3 years or less, before insertion of IUCD.
STEP 4 APPOINTMENT Schedule dates for insertion & follow-up checks.

 

TYPES OF IUCD

Currently there are two (2) types of IUCD/IUD available.

 

HORMONAL NON-HORMONAL
Active material Progesterone (LNG-IUS) Copper (Cu-IUD)
Mode of pregnancy prevention
  1. Thickening of cervical mucus which ‘traps’ sperm and prevents sperm from reaching and fertilising an egg
  2. Progesterone containing device which temporarily thins the inner lining of the uterus
  1. Device with coils of copper metal attached. Copper is toxic to sperm and thus kills the sperm within the uterus.
Duration of use 3-5 years 10 years
Complications
  • Unplanned pregnancy (risk 0.2%)
  • Infection risk: Operator dependent
  • Perforation of uterus (risk <0.001)
 · Unplanned pregnancy (risk 0.8%)

· Infection risk: Operator dependent

· Perforation of uterus (risk <0.001)
Effect on periods Lighter flow or shorter number of bleeding days May experience heavier flow or greater number of bleeding days
Suitable patients Tolerant to progesterone Can wear costume jewellery without reaction
Suitability after pregnancy & delivery Yes, six (6) weeks after delivery Yes, six (6) weeks after delivery
Availability
  • Gynaecology clinic Port-of-Spain General Hospital
  • Family Planning Association
  • Private specialists
  • Health Centre
  • Family Planning Association
  • Private specialists

 

REFERENCES:

American College of Obstetricians & Gynaecologists (ACOG):

https://www.acog.org/Womens-Health/Birth-Control-Contraception

National Institute for Health and Care Excellence (NICE): https://www.nice.org.uk/guidance/cg30

Faculty of Sexual and Reproductive Health of the Faculty of the Royal College of Obstetricians and Gynaecologists (FSRH): United Kingdom Medical Eligibility Criteria for Contraceptive Use (2016) http://ukmec.pagelizard.com/2016#sectionb/cover