The IUD and IUS (coil)
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They’re effective forms of contraception, yet the IUD and IUS remain a mystery to a lot of women. We take a look at what they are exactly, who they’re for, their advantages and disadvantages.
The IUD and IUS are most commonly T-shaped devices that are inserted into the uterus. They alter the uterus’ lining and the mucus that is secreted in your cervix to make it unlikely for a fertilised egg to be accepted. They can only be removed via the threads that hang a short way down into the vagina.
The different types of coil
• The IUD (Intra-uterine device)
Also known as the coil or loop, the IUD is made of copper and plastic and is about 3.5cm long. The bigger the copper surface, the more effective it is. It works by preventing sperm from getting through your uterus and into your Fallopian tubes, by altering secretions of mucus in your cervix and by affecting the lining of your uterus. There are several types of coil available in Britain, lasting from five to eight years (Flexi-T 300, Gynefix, Multi-Safe 375, Multi-Load Cu 375, Neo-Safe T380, Nova T 380 and T-Safe 380A). Make sure you know the name of the IUD you have fitted. In five years’ time, you might not remember which it is and might be left asking yourself whether it needs to be removed or not!
• The IUS (Intra-uterine system)
This is not made of copper. It continously releases the hormone progestogen (also called levonorgestrel or LNG) in the uterus for 5 years. It works by combining the action of an IUD with a progestative contraception, by thickening the cervix’s mucous secretions and making them impenetrable by sperm. The IUS also goes by the name Mirena.
Note that both the IUD and the IUS are around 98% effective. The IUD can produce heavier, longer and more painful periods whereas the IUS may actually help to reduce menstrual flow so periods become lighter, shorter and pain-free. Some women have no periods at all during the five years they have the IUS inserted, which is not harmful to fertility.
Who is this contraceptive method aimed at?
This question is still being debated in medical circles! On one side of the argument, specialists say that an IUD or IUS should only be fitted in women who have already had a child (who have an enlarged uterus). Others believe they can be fitted in any woman, regardless of whether she’s had children or not. You may find medical views vary from one GP to the next.
Nevertheless, you should be aware that there are certain conditions which make it ill-advised to have the coil fitted: unexplained vaginal bleeding, heart valve problems, pelvic infections, sexually transmitted infections and structural abnormalities of the womb or cervix. If there is any chance you could be pregnant you should not have the coil fitted before making sure you aren't. And you shouldn't have the IUD fitted if you are allergic to copper.
How is it fitted?
The IUD/IUS is fitted in just a few minutes by a GP or nurse, without anaesthetic. It’s usually fitted during or at the end of your period. Insertion usually isn’t painful, but if you’ve not yet had children, you might want to take an aspirin or paracetamol a couple of hours beforehand.
Make sure you contact your doctor straightaway if you can no longer feel the threads, if they become shorter or longer than normal, or if you can feel the IUD/IUS itself with your fingers. This may indicate that it has moved and might not be protecting you any more.
• Reliable and practical: you can pretty much forget about contraception for a few years! No more remembering to take the Pill...
• Normal return to fertility: as with the Pill, removal is easy and you quickly become fertile again. Another advantage of the IUD/IUS is that it can be fitted about a month after childbirth (whereas you need to wait for your first period before taking hormonal contraception).
• No health risks: there are no risks of cardiovascular illness or cancer, which isn’t the case with the Pill.
• Limited risk of infection: the risk of pelvic inflammatory disease is most common in the three weeks following fitting of the IUD/IUS.
• An effective form of emergency contraception: after unprotected sex, the IUD (but NOT the IUS) can be used as a form of emergency contraception, provided it’s not fitted more than 5 days after ovulation.
Like all methods of contraception, the IUD/IUS does come with some disadvantages. Some women experience them, while others don’t have any at all, or only slight forms.
• The IUD can make periods longer and heavier.
• Like other progestogen-based contraceptives, the IUS can cause lighter, shorter periods, weight gain and acne.
The IUD/IUS should be checked by a doctor or nurse six weeks after it has been fitted and then every year. You should check the threads yourself every month to make sure the device is still in place.
Remember that while IUDs and IUSs are very effective forms of contraception, they do nothing to protect you from sexually transmitted infections. Condoms are essential for protection from STIs!