THIS PAGE CONTAINS INFORMATION ON BOTH INTRAUTERINE CONTRACEPTIVE DEVICES (IUD) AND INTRAUTERINE CONTRACEPTIVE SYSTEMS (IUS)

• It works as soon as it is inserted. (but an additional form of contraception is usually recommend for the first 7 days)
• It usually protects you from pregnancy for at least 5 years.
• It does not interfere with sex.
• You only have to think about it once a month (When you check the strings to see if it's still in place)

• Some women report that their periods become heavier, longer or more painful. They usually seetle down after a couple of months.
• If you are not in a monogamous relationship (i.e If you or your partner has other sexual partners) you are at risk of developing Pelvic Inflamatory Disease (P.I.D)
• It does not protect you from sexually transmitted diseases (STD's)
• It is possible that your womb could push out the IUCD. This is more likely in the first months so it is important to remember to check the IUCD is still in place.

What is an intrauterine system?

An IUS is a non copper IUD with the addition of slow releasing progesterone (levonorgestrel). The most common types in the USA and most of Europe are Progestasert and Mirena (LNG-IUD 20). Both are T shaped IUD's that contain either progesterone in their vertical arms. The hormone is slowly released into the uterine cavity over a period of one year or three years.

How does it work?

The IUD releases small amounts of progesterone each day over a period of one year (Progestasert). Mirena, was initially licensed in the UK for three years and is available in Scandinavia for five years use. These IUD's bring about subtle changes in the ebdrometrial environment that impair implantation of the egg. In addition, it is believed that the hormone alters the cervical mucus so that sperm are unable to penetrate it.

What are the advantages?

• It works as soon as it is inserted. (but an additional form of contraception is usually recommend for the first 14 days)
• Pregnancy and explusion rates are lower then for non-hormonal IUD's
• Hormonal IUD's are more effective that other IUD's in relieving uterine cramps
• Less tissue and blood is shed at menstruation, more suitable for women with heavy periods

What are the disadvantages and common side-effects?

• Progestasert must be replaced every year
• The diameter of the inserter is greater than of other IUD's and can be more painful at insertion for women with a small cervical opening
• Risk of extrauterine pregnancies (Pregnancies occuring outside the womb, usually within the Fallopian tube) with Progestasert due to lower daily progesterone dosage
• Later in the use of Mirena, amenorrhoea (Periods ceasing) is very commonly reported (can be regarded as an advantage for some women)
• Many of the same side effects as the progesterone only pill (POP)
• Period can be irregular for the first 3 months.
• Some women have reported breast tenderness and acne but again this usually settles down.

How reliable is it?

The Intrauterine System is over 99% effective at preventing pregnancy.

Where can I get an IUS fitted?

Only a specially trained Doctor or Nurse can fit an IUCD. You can get them fitted at Family Planning Clinics, Planned Parenthood (US), Gynecologists and some Doctors also fit IUCD's

Q. I had one (IUD) inserted as an emergency about 3 months ago and I have felt anxious about it ever since. I initially thought it was a great idea as I hated taking pills and don't feel confident relying on anything else. I'm embarrassed to admit since I had it inserted I have noticed a different smell during and after intercourse especially. There isn't necessarily a large amount of discharge but I am so conscious of this smell I am constantly having to freshen up. Sometimes it is worse than others. I probably notice it more but my boyfriend (as loving as he is) has also mentioned it a couple of times. I don't know what to do, is it normal?
My other problem is I can't seem to find the threads, my boyfriend said it's there as he has felt it but maybe to far up for me to feel! My biggest worry is the horror stories I have heard ?. I had a miscarriage 18 months ago and am really scared of becoming infertile or having future problems due to the I.U.D.
A. There are two possible causes of the unpleasant odour your experiencing. Firstly and most likely your natural vaginal flora (good bacteria) is out of control because the pH level in your vagina has been altered by your IUD. You can try two things here. If you douche then try a 1:10 ratio white vinegar to water douche daily for 7 days. This usually restores the natural pH level and the odour goes .. Second you COULD have an infection which is causing the bad odour. If the vinegar douche does not solve the problem then I would go to an obgyn (or planned parenthood if your in the USA) and ask for a vaginal culture and high swab to be taken and tested for infection.(JW)

Q. I had the mirena fitted nearly four months ago. I had severe pain for 24 hours after fitting and only one day of slight bleeding (3 weeks later). I haven't bled since and I have had no other problems up until 2 weeks ago when my breasts have become really sore and feel heavy and swollen. I am just wondering if this is a usual side effect after a few months or could it be nothing to do with the coil
A. From the signs and symptoms you describe it 'maybe' related to your Mirena, but I very much doubt it. I would suggest you take a quick trip to your Dr and get a checkup. (JW)

Q. How long does an IUD last?
A. This depends on the type fitted, usually between 1 and 10 years

Q. Will it fall out?
A. Your IUD cannot fall out as it is sits high in your uterus, but in a small percentage of women with IUD's fitted the body expels the IUD, this is why you need to check the strings once a month to make sure the IUD is still in place

Q. What is the difference between an IUD and an IUS?
A. Intrauterine Systems (IUS) contain hormones and release these over a period of time into the womb. Intrauterine Contraceptive Devices (IUCD) do not contain hormones

Q. I've heard that IUD's/IUS's can sometimes perforate the womb. Is this true?
A. Yes it does happen but only in a very very small percentage of users

Q. What do you do if you think you're pregnant whilst using an IUCD/IUS?
A. Although it is rare to become pregnant whilst using IUCD/IUS you should contact your doctor or clinic immediately if you suspect you may be pregnant or have any sudden or unusual pain in the lower abdomen. If you are pregnant, there is a small risk the pregnancy will be ectopic, that is where the foetus is developing outside the womb, usually within the fallopian tube. This is a serious condition which needs urgent attention.

Q. Who can use IUCD/IUS?
A. An IUCD/IUS is not suitable for all women. They are not suitable for women who have had unexplained irregular or heavy vaginal bleeding, have had a previous ectopic pregnancy or suspect they may be pregnant, suffer painful and/or heavy periods, have an untreated genital infection or where they or their partners have other sexual partners. The doctor or nurse will ask you questions to see if the IUCD/IUS is suitable for you.
They are more suitable for women who are in long-term, monogamous relationships.

Q. How do I know if it's still in place?
A. When you have your IUCD/IUS fitted, the doctor or nurse will show you how to feel for the threads. You should do this a few times a months in the first couple of months then once a month, after a period thereafter.

Q. Can I use tampons whilst using an IUCD/IUS?
A. Yes, you can use tampons or towels

Q. Can you get poisoned off copper coils?
A. Cases have been reported although these are extremely rare. Copper has been used in IUCD's for many years now by millions of women with very few cases of copper allergy or poisoning.

Q. I've just had a baby and I'm thinking of an IUD. Some people I know told me horror stories about them. Are they really all that bad?
A. Don't be put off by the horror stories, some of these were true for older technology IUD back in your mothers day and some are exaggerated and some are just incorrect. IUD technology has come a long way. There are pro's and con's as with any other method.

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