Information for Intrauterine Device Users

(Content revised 02/2019)

1. Intrauterine Device (IUD)

  • IUD is a small device which can be used as a regular contraceptive method. It is very effective and the failure rate is about 1 % in the first year
  • According to research findings, the fertility rate between IUD non-users and ex-users are similar
  • It is inserted into the uterus by the doctor. Before insertion, the doctor will review your medical history and perform pelvic examination to assess your suitability for an IUD. After insertion, you need to attend regular check-ups
  • Two types of IUDs are used in the Maternal & Child Health Centres (MCHCs): "T" type and "Umbrella" type; both bear a thread at their base for self-checking or examination by the doctor, and for the future removal of the device
  • The "T" type needs to be changed every 5 to 10 years depending on the models, whereas the "Umbrella" type needs to be changed every 5 years

2. How IUD works

Copper IUD can change the environment of uterus, interfere with sperm motility and decrease the chance of fertilisation. Moreover, the change in the environment of uterus can affect the fertilised egg from attaching to the walls of uterus and thus preventing pregnancy

3. Who are not suitable for using IUDs

Majority of the women can use IUDs. Seek advice from your doctor if you have any of the following conditions:

  • Heavy periods or dysmenorrhea or abnormal vaginal bleeding
  • Severe anaemia
  • Known copper allergy (IUDs used in MCHCs contain copper)
  • Known distorted uterine anatomy (e.g. double uterus, uterine septum)
  • History of gynaecological diseases (e.g. uterine or pelvic infection, tumour, ectopic pregnancy, sexually transmitted infections)
  • Have multiple sexual partners (there is a higher chance of contracting pelvic infection)
  • Known heart problems, e.g. valvular heart disease

4. Possible risks and complications

It is by no means an exhaustive list of risks or complications associated with the use of IUD (including during the insertion and removal procedures). Complications may happen even with proper procedures in IUD insertion and removal. Whenever complications occur, the woman may need to be referred to Accident & Emergency Department (A&E) or Specialist Out-patient Clinic (SOPC) for further assessment and management. Surgical procedure may be necessary for some of the complications.

4.1 During insertion procedure

  • Fainting or syncope (Vasovagal syncope)
    • During the insertion procedure, minority of the women may experience fainting or syncope due to pain or anxiety
    • It is an uncommon condition and is usually mild
  • Perforation of uterus
    • About one to two out of every 1,000 insertions
    • The risk of perforation was independently increased in the following women:
      • Who are breastfeeding at the time of insertion
      • Insertion within 36 weeks after giving birth

4.2 While using

  • Effect on menstrual periods
    • May have heavy, longer or painful menstrual period
  • Pelvic infection
    • Though not common, the risk of pelvic inflammatory disease is increased in the first 3 weeks following insertion when compared with woman without using the device
  • Expulsion of the IUD
    • About 5% of users
    • During a period and most commonly in the first 3 months after fitting the IUD
  • Cannot feel the IUD thread, this can mean that:
    • The thread has come off
    • The device has displaced in its position
    • The device has come out
    • The device has perforated the uterus and moved into the abdominal cavity
  • Ectopic pregnancy
    • The risk for a woman using an IUD is lower than those without using any form of birth control
    • For IUD users, it is important to seek advice from health care provider promptly to rule out ectopic pregnancy if suspected pregnancy. The reason is that the device is very effective at preventing intrauterine pregnancy but less effective at preventing ectopic pregnancy
  • The following risks and complications may occur without any known reason while using IUD:
    • Breakage of IUD thread
    • Breakage of the IUD device
    • Partial or complete perforation of uterus or cervix

4.3 During the removal procedure

  • The IUD is removed by grasping the attached thread by the doctor. The following risks or complications may occur during the removal procedure:
    • Breakage of the IUD thread
    • Breakage of the IUD device
    • Perforation of uterus or cervix
    • The woman may need to be referred to A & E or SOPC for further assessment and management. Surgical procedure may be necessary for some of the complications.
  • There may be mild abdominal pain and vaginal bleeding within a few days after the removal of the device

5. Insertion Procedure

  • Before the insertion, health professional will explain the insertion procedures and possible risks and complications. Then, you need to sign a consent form for the procedure
  • Doctor will do a pelvic examination and will pass a small instrument into your uterus to check the size of the uterine cavity for suitability of insertion (too big or too small uterine cavity is not suitable for insertion of an IUD device). If the size of the uterine cavity is suitable, the doctor will insert the device into the uterus by using an insertion tube
  • The thread at the base of the IUD device will be cut to leave 2 to 3 cm outside the cervix. It can be used for self-checking or examination by the doctor and for the future removal

6. Points to note after insertion

  • You have to abstain from sexual intercourse or use condoms in the first week after insertion to decrease the possibility of pelvic infection
  • The device may pass out during menstruation; therefore you are advised to check whether the IUD thread is still in place after menstruation by putting your fingers into the vagina. If you cannot feel the IUD thread, please seek advice from health care provider for assessment promptly. At the same time, you have to abstain from sexual intercourse or use an extra contraceptive method such as condoms
  • You need to attend check-ups including pelvic examination at 6 weeks, 6 months and then yearly after the insertion to ensure the IUD is not displaced or expelled
  • The IUD must be removed within 1 to 2 years after menopause

7. Return to MCHC or seek advice from health care providers promptly if you have the following conditions

  • Delayed menses, scanty or heavier menses, persistent vaginal bleeding or vaginal bleeding between periods (intermenstrual bleeding)
  • Suspected or confirmed pregnancy
  • Abnormal or severe abdominal pain
  • Foul smelling or pus like vaginal discharge
  • Cannot feel the IUD thread
  • Suspected displacement or expulsion of the IUD
  • You or your partner feel the IUD during sexual intercourse