IUD or IUS

(Intrauterine Device or System)

 

There are two main types of IUDs typically used in Canada (copper or hormonal).

An IUD is a small T-shaped object that fits in the uterus to prevent pregnancy. It is made with a plastic frame and added copper or progestin (levonorgestrel) to make it effective.

The hormonal device is often called an intrauterine system (IUS), because it is a system to deliver medication to your body.

One or two strings hang from the T shape device through the cervix so that the IUD can be removed easily.

 

Why would I choose an IUD / IUS?

Many individuals choose an IUD because it is one of the best ways to prevent pregnancy while still being easily reversible. It is very convenient because it prevents pregnancy without needing to think about doing something every time you have sex (diaphragm or condom) or taking medication regularly (pill, patch, ring or shot).

Some people are unable to take estrogen, so methods like the pill, patch and ring are not available to them. None of the IUDs contain estrogen and can therefore be a safe choice for these individuals. The levonorgestrel IUS makes periods much lighter and less painful, so many people choose an IUS for this reason.

Which IUD should I choose?

 

Copper IUDs are fully covered by MSP if you have valid coverage. If you don’t have coverage, they are less expensive than Mirena or Kyleena.

The IUDs we use are approved by Health Canada to remain in place for up to 5 years. Many people like them because they have no hormones.

Copper IUDs can make your periods slightly heavier and more painful, so they are not recommended for individuals who already have long, heavy, or painful periods. If you are not bothered by your periods and you want to avoid using hormones, this may be the right choice for you.

Levonorgestrel IUSs (Mirena or Kyleena) are fully covered by MSP if you have valid coverage. If you don’t have coverage, they cost about $400.

The Mirena and Kyleena are effective for 5 to 8 years and sometimes longer.

The Mirena or Kyleena IUS will make your period lighter, and often less painful. The Mirena IUS is more likely to make your period stop completely because it releases a higher dose of progestin. People who have heavy or painful periods, and those who cannot take estrogen, are great candidates for the IUS, as well as anyone who wants a very convenient and effective birth control method.

Other Questions

 

When is it inserted?

An IUD is inserted by one of our physicians at a short clinic visit. The best time is just at the end of your period, but anytime is fine, as long as there is no risk of pregnancy. If you are using the IUD for contraception, we recommend that you abstain from sex from your period until the insertion day, unless you are using another reliable form of birth control (pill, patch, ring, depo shot, or implant). The copper IUD is immediately effective, but the IUS will take 7 days to be effective unless it is inserted while you are on your period.

How is it inserted?

The doctor checks the size and position of your uterus. They put a speculum into your vagina to see the cervix, and may offer local anesthetic if you wish. They hold the cervix, checks that they can get through it, and then inserts the IUD to the top of your uterus, usually about 7 cm. The physician will then cut the string.

Depending on how the insertion went, we will often do an ultrasound during the same visit or during a visit a few weeks later. Ultrasounds aren’t necessary to have a successful insertion, but are a tool we can use to ensure the device is in the correct position. If you have any questions about having an ultrasound to confirm the position, please ask the physician doing the insertion.

Are there any risks?

No medical procedure is without risk. For IUD insertion, the risks are small, but include expulsion, pregnancy, infection and perforation. Expulsion is the most common, occurring 1 - 5 % of the time. Usually this happens within the first few months. Pregnancy is rare, about 1 in 100 for patients with a copper IUD, and about 8 in 1000 for patients with the Mirena IUS. Risks of infection are only high for 3 weeks following insertion, and are more common if you already have a vaginal infection or STI, so we recommend screening at the time of insertion. Rates of infection are less than 1 %. Perforation, or putting the IUD through the uterus instead of inside it, is uncommon, about 1 in 1000 insertions. This happens at the time of insertion and often noticed at the time. An ultrasound following the insertion can help us confirm the IUD is inside the uterus. If perforated, the IUD must be removed, sometimes requiring laparoscopic surgery.

With the Copper IUD, your first few periods will likely be a bit heavier and more painful. This tends to improve with time.

With the Levonorgestrel IUS, most people have unpredictable bleeding and spotting for the first 3 - 6 months. This is mostly light bleeding and not harmful. This usually stops by 6 months.

Does it hurt?

Sometimes. If you have not had a pregnancy with a vaginal delivery, your cervix might be tight and cause you to feel a strong cramp when the IUD is passed through the cervix into your uterus. Most people have a strong twinge but feel fine in a few minutes. Occasionally, some people might feel queasy or lightheaded. Taking ibuprofen before you come will help, and we recommend bringing someone to drive you home if you are concerned about pain.

We do offer local anesthetic (a cervical block) for insertions. If you want one, please ask your physician about local anesthetic.

Please click here for more information about other methods to reduce IUD insertion pain.

Are there other benefits to an IUD / IUS?

Because it has medication, the IUS is often used to control troubling period symptoms such as heavy bleeding and harsh cramping. For this reason, some people are not using the IUS for contraception, but for period control.

Copper IUD vs Hormonal IUS

  • Flexi-T/Liberte Copper IUD

    $ 80 + tax (if not covered by MSP)

    A plastic T shaped device that contains copper and sits inside the uterus

    0% Levonorgestrel

    99.2 - 99.4% effective

    1 in 100 get pregnant

    Does not contain estrogen

    In some cases decreases risk of endometrial cancer

    10 - 20% will have increase in menstrual bleeding and cramping

    Effective emergency contraception up to 7 days after unprotected sex

    5-10 years duration

  • Mirena Hormonal IUS

    $ 350 - 500 (if not covered by MSP)

    A plastic T shaped device that contains the hormone levonorgestrel and sits inside the uterus

    52 mg levonorgestrel

    99.9% effective

    8 in 1000 get pregnant

    Does not contain estrogen

    Decreases menstrual bleeding and cramping

    May decrease endometriosis and precancerous uterine cells

    Not effective for emergency contraception (preventing pregnancy after unprotected sex)

    8 years duration

  • Kyleena Hormonal IUS

    $ 350 - 500 (if not covered by MSP)

    A plastic T shaped device that contains the hormone levonorgestrel and sits inside the uterus

    19.5 mg levonorgestrel

    99.9% effective

    8 in 1000 get pregnant

    Does not contain estrogen

    Decreases menstrual bleeding and cramping

    May decrease endometriosis and precancerous uterine cells

    Not effective for emergency contraception (preventing pregnancy after unprotected sex)

    5 years duration

Rapid Access IUC and Implant Centres of Excellence

Vancouver Island Women's Clinic is a member of RAIICE

RAIICE is a network of clinics and health care providers across Canada who are experts in IUD insertion and care.

RAIICE clinics must meet the following criteria:

  1. have an expert insertion team;

  2. appointments for a contraception discussion and insertion made quickly;

  3. offer training in their communities to the public and/or to other health care providers;

  4. are committed to continuously improving the care they provide;

  5. must provide access to the copper IUD as emergency contraception.

Visit the website to find the nearest RAICE clinic near you.

Visit www.raiice.ca for more information

How to Book your IUD Appointment

 

If you want to talk to us first about whether an IUD/IUS is suitable for you, book a contraception consultation appointment with the clinic.

Preparations for the appointment include:

  • Abstain from intercourse for two weeks prior to insertion day

  • 1 hour prior to your appointment we recommend taking 800 mg of ibuprofen

  • Bring your Health Care Card, a pantyliner and your IUD

  • If possible, bring someone to drive you home in case you feel lightheaded or crampy after insertion

Post insertion:

You will be given an after-care information sheet for your Levonorgestrel IUS or Copper IUD.

We recommend you book a 6 week follow up appointment.

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