IUDs prevent pregnancy by releasing either copper or synthetic hormones into the female reproductive tract. Once in place, these devices protect from pregnancy for between 3 and 10 years, with fewer than 1 in 100 women with an IUD getting pregnant each year.
An IUD is a reliable method of contraception.
There are two forms of IUD in use. One contains copper, and one is impregnated with the female hormone, levonorgestrel.
The copper IUD is a plastic device with a copper coil on the stem and the arms. It continuously releases copper into the uterus to cause an inflammatory reaction which is toxic to sperm.
Hormonal intrauterine devices are also formed from plastic. They release the hormone levonorgestrel. This thickens the cervical mucus, and it stops sperm from fertilizing the egg.
Levonorgestrel may also thin the uterine lining, and this can partly prevent ovulation.
When should an IUD be removed?
IUDs can be removed at any time, but some situations make removal necessary.
As an IUD is a form of contraception, it should be taken out if the patient wants to become pregnant. In addition, an IUD has a limited lifespan. Copper-based IUDs prevent pregnancy for up to 10 years after insertion. They should be removed from the uterus after this time.
Hormonal-based IUDs have varying lifespans, depending on the brand. Some brands can prevent pregnancy for up to 3 years, while others work for up to 5 years.
After this, the device should be taken out.
A doctor may also recommend removing the IUD if the patient experiences:
- An increase in blood pressure
- A pelvic infection
- Endometritis, which is an inflammatory condition of the lining of the uterus
- Endometrial or cervical cancer
If other side effects or discomfort occur, these can prompt removal of the IUD.
Removal of an IUD usually takes place at a clinician's office. It should only be carried out by a qualified healthcare professional. A device can be taken out at any time during the menstrual cycle.
Removal of an IUD must be carried out by a qualified professional.
According to Planned Parenthood, removal is relatively quick and simple, and there are not many aftereffects.
IUD removal may involve the following steps:
- The patient lies on an exam table on her back with her feet apart, or in stirrups.
- A speculum is inserted to separate the vaginal walls, in order to locate the IUD.
- Forceps are used to pull gently on a string attached to the device.
- The arms of the IUD will fold upward as it moves slowly out of the uterus. Once the procedure is complete, the speculum will be removed.
Some light bleeding or cramping is common during, or just following, the process. Some doctors may suggest some women take a painkiller before removal, to reduce these feelings of discomfort.
If the IUD is removed due to infection, antibiotics or other treatments may be prescribed.
As long as there are no complications or infections, a new hormonal or copper IUD can be inserted immediately after removing the old device. This can be done during the same office visit.
Possible risks or complications of removal
In some cases, complications may arise during removal of an IUD.
Planned Parenthood advise that there is a small chance of the IUD not coming out easily. This may happen if the doctor is unable to locate the IUD strings, possibly because the strings were cut too short.
In this situation, the doctor may use an ultrasound to find the strings. Other medical instruments besides forceps may be used to help remove the IUD from the uterus. Tools commonly used to locate and grasp the strings include a cytobrush or an IUD hook.
Very rarely, the device migrates through the uterine wall. In this case, hysteroscopic surgery may be necessary, under anesthesia.
Alternatively, recent research suggests a removal guided by ultrasound can be an effective way to deal with these cases. It is less invasive than surgery, and it is more cost effective.
Another complication of IUD removal is unplanned pregnancy arising from sex in the days before removal.
Discussing alternative forms of birth control with a healthcare professional prior to removal is recommended to avoid this occurrence.
When to have sex before and after removal
Female fertility may return to normal as soon as the IUD is removed.
It is safe to have sexual intercourse in the days before and after removal of the IUD.
However, it should be noted that female fertility may return to normal immediately after the IUD is removed, and sperm can survive in the female reproductive tract for up to 5 days after intercourse.
This means that pregnancy is possible if sex occurs in the days prior to removal, depending on when ovulation takes place. Sex following removal of the device can also result in pregnancy.
New Zealand Family Planning recommend avoiding sexual intercourse for at least 7 days before the removal if patients do not wish to conceive.
Alternatively, other methods of contraception can be used.
After removal, if switching from an IUD to oral contraceptives, another form of protection should be used for 7 days until the oral contraceptive takes effect.
Alternative forms of contraception
Apart from the IUD, other forms of contraception are available to prevent pregnancy.
Mechanical barriers physically prevent the sperm from reaching the egg. They may be combined with spermicide to kill the sperm chemically. Forms of barrier contraception include male and female condoms, contraceptive sponges, diaphragms, cervical caps, and Lea contraceptives.
These release synthetic hormones such as estrogen and progestin into the female body. They include vaginal rings, implants, and contraceptive pills, patches, or injections.
Sterilization is a permanent form of birth control. For women, this takes the form of a procedure where the fallopian tubes are cut or sealed. Men can undergo a vasectomy, which involves cutting or blocking the tubes through which sperm pass.
In some cases, sterilization procedures can be reversed, although there is no guarantee that fertility will return to normal.