Unintended pregnancy remains a social, economic, and psychological issue. According to the World Health Organization (WHO), unwanted pregnancies negatively affect the health of the mother and the foetus. There is an estimated rate of 70.1 unwanted pregnancies per 1000 women in the age group of 15 -49 years.
An intrauterine contraceptive device (IUCD) is used to prevent pregnancy. It comes in the category of long-acting reversible contraception (LARC). It is “T” shaped and placed inside the uterus. IUCD is safe and effective and is available in different sizes and types.
In India, the IUCD was introduced in 1965. Despite the second most prevalent contraceptive methods (the first being female sterilization), the use of IUCD in India reduced from 2% (in 1992-93) to 1.5% (in 2015-16). Thus, there is a need to provide adequate information about this contraceptive method to the general public.
There are two types of IUCD. Both types of devices are effective in avoiding pregnancy. The classification of IUCD is done based on the types of material and the presence and absence of hormone. Following are the types of IUCD:
Hormonal IUCD: Hormonal IUCD is made of plastic. This IUCD contains hormones and is inserted into the uterus.
Copper IUCD: The copper IUCD is made of copper and plastic. This IUCD does not contain hormones.
Healthy women are eligible for using an IUCD. It is important to note that these contraceptive devices do not protect against sexually transmitted diseases (STDs). IUCD is contraindicated in women in case of the following conditions
Pregnant or trying to get pregnant
Suffering from STD
Vaginal bleeding without any known reason
Diagnosed case of cervical or uterine cancer
Copper allergy or Wilson disease
Hormonal IUCD is contraindicated in liver disease and high risk of breast cancer
IUCD offers various advantages to the user. Some of the benefits of IUCD are:
Safe and effective: IUCD is highly effective in preventing pregnancy. They are safe and can be used while breastfeeding.
Long-lasting: IUCD is a long-lasting method for contraception. Based on the type of IUCD, it lasts for about 3 to 10 years.
Hassle-free: It provides a hassle-free experience. Once inserted, the woman and her partner need not worry about it.
Cost-effective: IUCD, in the long run, is cost-effective as compared to other methods of contraception.
Easy Reversal: The doctor can easily remove the IUCD if the woman is planning to get pregnant.
The functioning of IUCD depends on its type, i.e., whether it is hormonal or copper IUCD. Hormonal IUCD releases progestin hormonal, which provide contraceptive action through various mechanisms. Hormonal IUCD increases the viscosity or thickness of cervical mucus, which blocks the route of sperms to the egg. It also thins the uterine wall. Hormonal IUCD also suppresses the release of the egg from the ovary (a process known as ovulation).
Copper IUCD also works through various mechanisms. Copper act as a foreign object inside the uterus. This initiates the inflammatory process, and leucocytes and other immune cells infiltrate the uterus. These cells destroy the sperms. The copper IUCD also interferes with sperm mobility. The copper IUCD is toxic to sperms. It damages the sperm to such an extent that even if the sperm reaches the egg, the fertilization does not lead to a viable embryo.
IUCD insertion is an outpatient procedure. You can opt for IUCD insertion at any point of your cycle. However, it is more comfortable if you decide to undergo this procedure at the end of your cycle as your cervix is most wide during this time.
The doctor will analyse the size and position of the uterus. The doctor opens the vagina with the help of a speculum. The doctor keeps the IUCD in a tube and inserts it in the uterus through the vagina. The doctor then pushes the IUCD from the tube into the uterus and take the tube out. The upper ends of the "T" shaped IUCD attach to the uterine wall while the lower end is hanged into the vagina.
The woman may experience pain and bleeding for a few days after the procedure. The doctor may prescribe analgesic medications before and after the procedure.
The initiation of action of IUCD depends upon its type and timing of the insertion. Copper IUCD immediately starts functioning irrespective of the timing. If the insertion of the hormonal IUCD is done during the menstrual cycle, it will start functioning immediately. In other cases, the hormonal IUCD requires a minimum of 7 days for starting its function.
Most women do not experience any problem with IUCD. However, in some cases, IUCD may have the following side effects:
Longer, heavier, and painful periods
Less effective prevention of ectopic pregnancy as compared to normal (uterine) pregnancy
Worsening of an already existing infection
Losing or not felting the IUCD thread due to various reasons such as falling or displacement of the device
IUCD is a reversible method to prevent contraception. The procedure of IUCD removal is more comfortable as compared to its insertion. The doctor will take the IUCD out with the help of forceps. You may experience mild pain and bleeding, which will disappear within 1-2 days after the removal procedure.
It is important to note that if you need to remove IUCD and don't want to get pregnant, you must use other contraceptive methods at least 7 days before the IUCD removal procedure. The sperm stays in the womb for 7 days and may fertilize the egg once the IUCD is removed.
IUCD affects the menstrual cycle. With the hormonal IUCD, the women experience less cramping. With this IUCD, most women experience spotting in the first few months, and later, they experience slight bleeding or no periods at all. Copper IUCD worsens cramping and make the periods heavier.
You should contact your doctor in the following cases:
If you think that your IUCD has fallen out
You experience vaginal discharge
One-sided abdominal pain along with delayed periods
Severe persistent pain after IUCD insertion
In most cases, the IUCD holds its place until its removal. However, in a few cases, the IUCD may fall out. If this happens, immediately contact your doctor. Your risk IUCD falling increases if:
You are below 20 years of age
You do not have children
You are suffering from uterine fibroids
The IUCD does not precisely fit in your uterus
The primary use of IUCD is routine contraception. The other uses of IUCD are anaemia, emergency contraception, heavy bleeding, and painful menstruation.
IUCD is a highly effective form of contraception. The chances of getting pregnant while using IUCD is less than 1%. The hormonal, as well as copper IUCD, have a similar failure rate.
IUCD can also be used as a method of emergency contraception. You may use this method within 5 days after unprotected sexual intercourse. However, its insertion is done by a trained doctor, and you might not get the doctor in your area well in time. Thus, you should arrange beforehand if you are looking for IUCD as an emergency contraceptive option.
The length of working of an IUCD depends on its types. While hormonal IUCD lasts for around 3 to 5 years, the copper IUCD works for about 10 years.
HOD And Consultant - Obstetrics & Gynaecology
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