What is an intrauterine device (IUD) and when is it fitted?
An intrauterine device, or IUD, is a small contraceptive device that is placed inside the womb to help prevent pregnancy. Modern IUDs are usually T-shaped, cannot be felt in everyday life and can remain effective for several years, depending on the type of device.
An IUD can be fitted following a consultation with a gynaecologist, an examination and the ruling out of any contraindications. This method of contraception is often chosen if a woman: It is important to remember: an IUD protects against unwanted pregnancy, but does not protect against sexually transmitted infections. If there is a risk of STIs, the doctor may also recommend barrier contraception.
- wants long-term protection against pregnancy;
- is not planning a pregnancy in the next few years;
- does not want to take the contraceptive pill every day;
- has contraindications or restrictions regarding certain other methods of contraception;
- is considering a hormonal method for medical reasons;
- wants to have a Mirena IUD fitted following a doctor’s recommendation.
Which intrauterine devices (IUDs) can be fitted
The type of intrauterine device is selected by a gynaecologist. The doctor takes into account the woman’s age, obstetric history, menstrual cycle patterns, the condition of the uterus, the presence of any chronic conditions, reproductive plans and the purpose of the insertion.
Main types of IUDs: Insertion of the Mirena IUD requires the same careful preparation as the insertion of other IUDs. Before the procedure, it is necessary to ensure that there is no pregnancy, inflammation, changes to the uterine cavity or other risk factors.
non-hormonal intrauterine devices – these usually contain copper, silver or other metals, creating conditions that are unfavourable for fertilisation and implantation;
hormonal intrauterine systems – these release a small amount of hormone into the uterine cavity, thicken the cervical mucus and affect the endometrium;
Mirena – a hormonal intrauterine system containing levonorgestrel, which is used for long-term contraception and may be prescribed for heavy periods, certain forms of endometrial hyperplasia, endometriosis and other conditions at the doctor’s discretion.
Contraindications to IUD insertion
An IUD is inserted only after an assessment of the woman’s health. In some cases, the procedure must be postponed or an alternative method of contraception chosen.
Main contraindications: If the contraindications are temporary, the gynaecologist will first prescribe treatment or further diagnostic tests. Following a reassessment, the question of IUD insertion can be reconsidered.
- pregnancy or suspected pregnancy;
- acute inflammatory conditions of the pelvic organs;
- active infections of the vagina, cervix or uterus;
- sexually transmitted infections, until treatment is complete;
- uterine bleeding of unknown origin;
- marked deformation of the uterine cavity;
- certain tumours of the uterus or cervix;
- individual intolerance to the components of a specific IUD;
- a previously inserted intrauterine device, if it needs to be removed first;
- contraindications to hormonal contraception, if the Mirena is planned.
Preparing for the procedure
Before an IUD is inserted, a consultation with a gynaecologist is required. During the consultation, the doctor will discuss your symptoms, medical history, the date of your last period, cycle patterns, previous pregnancies, births, operations, inflammatory conditions and your current method of contraception.
The doctor will determine what is required for IUD insertion on a case-by-case basis. Usually, preparation may include: The optimal day of the cycle depends on the individual situation. The IUD is often inserted during the final days of menstruation or immediately afterwards, when the cervix is slightly open and pregnancy is unlikely. However, in some cases, IUD insertion is possible on other days of the cycle if the doctor is certain that you are not pregnant.
- a gynaecological examination;
- an ultrasound scan of the pelvic organs;
- a vaginal swab test;
- a PAP test or cervical smear, if one has not been carried out for some time;
- tests for infections – where indicated;
- a pregnancy test or hCG test, if there are any doubts;
- selection of the type of IUD and discussion of its duration of effectiveness.
Before the procedure, it is advisable to check with your gynaecologist whether you need to temporarily abstain from sexual intercourse, which medicines you can take, whether pain relief is required, and when to attend a follow-up examination.
How is an IUD fitted?
An IUD is fitted in a gynaecological consultation room. The woman is positioned in a gynaecological chair; the doctor carries out an examination, inserts a speculum, prepares the cervix and carefully inserts the intrauterine device through the cervical canal into the uterine cavity.
The procedure usually follows this sequence: How long does it take to have an IUD fitted? This depends on anatomical factors and the type of IUD. The insertion itself usually takes a few minutes, but the entire clinic visit takes longer due to the examination, preparation and post-procedure advice.
- The gynaecologist carries out an examination and checks that you are ready for the procedure.
- The cervix is cleaned with an antiseptic solution.
- The doctor assesses the position of the uterus and the depth of its cavity.
- The IUD is inserted via a special guide wire.
- Once the IUD is in place, the doctor trims the control threads to the required length.
- If necessary, the position of the IUD is checked using an ultrasound scan.
During insertion, the woman may experience a pulling sensation in her lower abdomen, a brief spasm or discomfort similar to period pain. If the patient is sensitive to pain or has previously undergone complex gynaecological procedures, it is best to discuss pain management options in advance.
Post-insertion recommendations
After the IUD has been inserted, a woman can usually return home on the same day. In the first few hours and days, she may experience a pulling sensation in the lower abdomen, slight spotting and mild cramping. These reactions are often linked to the uterus adapting to the IUD.
In the first few days after the procedure, your doctor may recommend: You should seek medical attention immediately if you experience severe pain, heavy bleeding, a fever, a foul-smelling discharge, marked weakness or a feeling that the IUD has moved out of place.
- avoid sexual intercourse;
- do not use tampons;
- do not douche;
- do not take hot baths;
- temporarily limit strenuous physical activity;
- monitor your discharge and how you feel;
- attend a follow-up examination or ultrasound scan on the scheduled date.
The IUD’s control threads help the doctor assess the position of the coil during an examination. You must not pull on them yourself. If the threads have become longer, have disappeared or are causing discomfort, you should book an appointment with your gynaecologist. In such cases, an examination, an ultrasound scan or removal of the intrauterine device may be necessary.
