Intrauterine Contraceptive Devices – Is It for You?

Intra-uterine Contraceptive Devices, or IUCDs, are a means of contraception generally used by women who, for medical reasons, are unable to use hormonal contraception methods (eg. oral contraceptives), or in those who not motivated or prefer not to use such methods.

IUCDs are small devices that are inserted by your doctor into your uterus. They work by preventing implantation.

There are numerous type that have been developed over the years, the more common ones being:

• Multi-load Copper 250
• Copper T
• Nova T
• Lippes Loop
• Mirena Intrauterine System

The Mirena intrauterine system is a hormone impregnated IUCD. It acts locally by making the mucous of the cervix much thicker, thus preventing the sperms from getting through. It also makes the lining of the endometrium thinner, thereby preventing implantation.

General failure rates of common contraceptive methods (Failure rate of women using the method for 1 year):

• Mirena Intrauterine system: 1 per 1000
• Normal IUCD: 10 per 1000
• Ligation: 4 per 1000
• Oral contraceptive pills: 20 per 1000
• Depo injections: 10-15 per 1000

Are You Suitable To Use IUCDs?

Whilst the IUCD might appear to be a very convenient and hassle-free method of contraception, it is not without its side effects, and not all women are suitable for using it.

1. Absolute Contraindications (those who absolutely should not use IUCDs):

• Known or suspected pregnancy
• Active pelvic infection (including known or suspected gonorrhoea or chlamydia infections)
• Genital bleed which has yet to be diagnosed
• Genital cancers

2. Relative Contraindications (those who should preferably not use IUCDs):

• Those at increased risk of STDs (eg. those with multiple sex partners, or those whose partner has multiple sex partners)
• Recent or recurrent pelvic infections
• Single pelvic infection, in women who wish to get pregnant subsequently
• Lowered immunity, such as due to diabetes, AIDS etc.
• Menstrual bleeding of unknown cause
• History of ectopic pregnancy
• Presence of conditions which predispose to ectopic pregnancy
• Endometriosis
• Endometrial polyps
• Uterine fibroids
• Anaemia

What Are The Possible Complications?

Women using IUCDs may experience some side effects and potential complications. These are some which you should be aware of:

• Increased menstrual bleeding: many women experience slightly longer and heavier menstruation.

• Painful periods: menstrual pain is usually increased in the first few cycles, then subsequently improves.

• Intermenstrual spotting: light spotting between periods is fairly common with IUCDs, regardless of type.

• Pelvic infections: IUCDs increase the risk of pelvic infections, especially in the first few months. See your doctor immediately if you develop any signs of pelvic infection (increased vaginal discharge, lower abdominal pain, together with a fever).

• Pregnancy: as with all contraceptive methods, there is a failure rate. If you have an IUCD in place, and become pregnant, see your doctor to have the IUCD removed immediately (there is about a 20% risk of abortion by removing the IUCD, but if not removed, the risk of abortion is about 50%).

• Ectopic pregnancy

• Expulsion of the IUCD

• Serious complications immediately following IUCD insertion: vasovagal reaction and perforation of the uterus.