Before

Before inserting an intrauterine device (IUD), your gynecologist will ask you questions about your fertility goals. Assuming you do not want to conceive in the next 1-5 years, you may be a potential candidate. There are two types of IUDs; one with progesterone and one without any hormones. The progesterone containing IUD is very good for women who have heavy periods and cramps because the hormone makes the lining thin and less likely to release a lot of blood. It must be replaced every year because the hormone wears off. The second type of IUD is made of copper and lasts five years.

IUDs are an option for the majority of women, including those who have never been pregnant, never had a baby, and for adolescents.

Immediate insertion can be done after delivery of the baby and within 10 minutes of the delivery of the placenta. It can also be inserted up to 4 weeks after the baby’s delivery. Similarly, post- miscarriage or abortion insertion is acceptable.

IUD insertion should not be done within 3 months of treatment for pelvic inflammatory disease, postpartum uterine infection, or a miscarriage that resulted in an infection.

A negative urine pregnancy test is mandatory prior to placement of an IUD due the increased rate of complications if a pregnancy occurs with an IUD in place. Practitioners usually schedule the insertion within the first 5-7 days of the menstrual flow because the chance of pregnancy is low during that time.

How do IUDs Work?

IUDs work as a spermicide and by preventing fertilization and  implantation of the egg due to the inflammation and the affect on on the lining of the uterus that is unfavorable for egg implantation. In the case of the progesterone-containing IUD, the cervical mucus gets thick which also kills sperm.

Technique for IUD Insertion

Intrauterine device insertion is done in the office and should only be performed by trained healthcare professionals. Insertion of both types of IUDs begins with a pelvic exam to assess for uterine size, position, and lack of tenderness

Next, a speculum is placed in the vagina to see the cervix. Tests for sexually transmitted diseases are collected in many cases. The cervix (opening to the uterus) and the vagina are cleaned with a medical grade soap or disinfectant. The healthcare professional puts on sterile gloves at this point because the device needs to remain sterile during the insertion. Sometimes, a local anesthetic is given to numb the cervix.

The cervix is grasped with a device to hold it steady for the insertion. The uterine cavity is measured with a narrow probe. Slight tugging on the cervix helps align the cavity. The length of the cavity needs to fall within 6 to 10 centimeters. Otherwise, the procedure should be stopped

The IUDs are sterile in their packaging which is opened by an assistant. A marker or knob is placed to prevent the device from being inserting to deeply into the cavity. The arms of the IUDs must be in the horizontal position. Then the arms are pulled inside of the insertion tube. Second picture.

The tube with the IUD is gently inserted into the cervix until the knob of the tube meets the cervix. Then the arms are released to rest at the top of the uterus. The tube is removed. The IUD has a sting attached to the end that is cut short so that it can be removed at a later date. It is also needed so that the woman can check for its presence each month.

After each menstrual period, the woman is instructed to place her finger in her vagina to find the string. This reassures her that the IUD did not fall out. Expulsion of the IUD is the biggest complication or risk.

The first month after insertion is the highest risk for the IUD. Infections or expulsions are possibilities. You are immediately protected from pregnancy with the copper IUD insertion and after 7 days with the progesterone-containing IUD.

Guest Author:  Dr Kim Langdon Cull

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