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Articles/Pros and Cons of IUDs

Pros and Cons of IUDs

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Dr Len Kliman Associate Professor
6 minutes mins read September 13th 2021
What is an intrauterine device?

An intrauterine device is a T shaped flexible plastic device that fits within the uterine cavity and acts as a form of birth control. It has two thin plastic strings that pass out through the cervix and sit in the vagina. The strings are usually about 2cm past the opening of the cervix and you may or may not be able to feel them. The actual device itself is about 2.5cm in length and width.

Besides its use as a method of birth control hormone releasing IUDs can be used to treat heavy and painful periods and have also been used as the progesterone part of hormone replacement therapy and in the management of pain in such conditions as endometriosis.

Types of IUDs

There are two main types of IUDs available in Australia.

  1. Non-hormonal copper-containing devices. This is a small IUD that is inserted usually as an office procedure. It is primarily used for contraception and all IUDs have a failure rate of less than 1:100 in the first 12 months after insertion. The commonest side effect of non-hormonal IUDs is a worsening of the symptoms of your period, particularly the amount of bleeding can be heavier and the amount of period pain can be heightened. Non- hormonal IUD’s last for five years and then should be replaced. They are a rare cause of infection but there is a small risk of pelvic inflammatory disease associated with any intrauterine device and they should not be inserted in a woman who has had a past history of pelvic inflammatory disease.
  2. Progesterone releasing IUDs There are two common progesterone hormone-releasing IUDs available in Australia. They both continuously release progesterone hormone, the slightly smaller version releases a smaller dose of progesterone than the alternative. They can be inserted in as an office procedure with some exceptions. By continually releasing progesterone and thinning the lining of the uterus they tend to result in your periods being lighter and often less painful. In a significant percentage of women periods disappear altogether because the endometrium, or lining of the uterus, is so thin there is nothing to be shed at the time of your period. This is totally safe and is welcomed by most women.
Pros and Cons of IUDs

The pros of using an IUD are:

  • They are a simple and effective form of contraception that lasts for five years.
  • Women don’t have to try and remember to take a tablet or consciously remember to use another form of contraception.
  • In the case of progesterone hormone-releasing IUDs, they can be used as a way of controlling heavy or painful periods. The larger IUD that releases more progesterone hormone is better at period control.
  • In the case of women requiring hormone replacement therapy, this usually involves taking both an oestrogen and progesterone. In this case a progesterone releasing IUD can be used to provide the progesterone component.
  • Also, if you decide that you would like to conceive it is usually simple for your doctor to remove.

The disadvantages of using an IUD are:

  • They do not, unlike condoms, prevent sexually transmitted diseases.
  • They do have a small failure rate of less than 1%.
  • Especially in the case of the non-progesterone releasing IUDs they may make your periods more painful and uncomfortable.
  • It is not always possible to put an IUD in as an office procedure in the rooms. If you have had a previous caesarean section and have a potential weak point in the uterus, because an office procedure is a blind procedure, it is safer to insert the IUD under general anaesthetic as we are able to put a telescope into the uterus and see where the IUD is inserted. Similarly some women find IUD insertion particularly uncomfortable, or they may have a narrowing of their cervix and in this case it is also preferable to have the IUD inserted under a general anaesthetic.
  • IUDs are rarely expelled from the uterus but this has occurred. At the time of your period you may experience menstrual cramps and this can actually eject the IUD. For this reason we check all IUDs to make sure that they are appropriately positioned six weeks after insertion and Len will perform a simple ultrasound to ensure that is the case.
  • Progesterone releasing IUD’s can be associated with breast soreness, bloating and prolonged spotting. These symptoms usually resolve after three months.