IUD insertion information for Clinicians

Information and resources for clinicians inserting IUDs

1) Indications and contraindications for IUD insertion.
– See this LINK for information

 2) Helping your patient choose an IUD.

For post-coital contraception, copper IUDs are 99.9% effective within 7 days; LNG-IUS (Mirena) are not effective.

For treating menorrhagia, LNG-IUS are more effective than oral contraceptives; copper IUDs increase bleeding.

For patients who have had hormonal side effects with oral contraceptives, such mood changes, decreased libido and weight gain, there is less chance that they will get these side effects from LNG-IUS. About 5% of patients have their LNG-IUSs removed for these reasons, but about 30% of people who had these side effects with other hormonal contraception also get them with LNG-IUSs.

Some people are eager to have their periods disappear and others find it disturbing and prefer to feel their natural cycles. With copper IUDS, one can expect 20-50% more bleeding and cramping.

Bayer sells two different levo-norgestrel releasing IUDs: Mirena and Kyleena. Mirena is licenced both for contraception and menorrhagia and about 70% of patients will lose their periods. Kyleena is smaller and has less hormones than Mirena. Mirena and Kyleena are licenced for 5 years.

A variety of Copper IUDs in different shapes and sizes

Average amount of hormone (levonorgestrel) released:
Mirena 14 mcg/day
Kyleena 9 mcg/day

There are 3 companies selling copper IUDs in Canada: TriMedic sells FlexiT 300, 300+ and 380+, MediSafe sells Liberté UT and TT short and regular and PACE sells MonaLisa 5, 10 and N.  FlexiT has 300 or 380 mg of copper, is licensed for 5 years, comes in two sizes, regular for nullips and plus for multips and costs about $90. Liberté UT380 has 380 mg of copper, is licensed for 5 years, comes in two sizes, short for nullips and standard for multips and costs about $75. Liberté TT380 has 380 mg of copper, comes in two sizes, the short for nullips is licensed for 5 years and the regular for multips is licensed for 10 years and costs about $75. MonaLisa 10 is licensed for 10 years, MonaLisa 5 for 5 years and MonaLisa N for 3 years.

The insertion techniques vary and you may find one easier than another.

3) Equipment for IUD insertions and where to order it :

LINK to 131101 IUD Equipment – PowerPoint presentation

4) Insertion techniques for
Liberté, FlexiT, NovaT, MonaLisa and Mirena IUDs :

Insertion of the Liberté UT 380PowerPoint presentation
YouTube Video – https://www.youtube.com/watch?v=T3A_haffn6c

Insertion of a Liberté TT 380PowerPoint presentation
YouTube Video – https://www.youtube.com/watch?v=aF9ezkkBPBY

Insertion of FlexiTPowerPoint presentation

Mirena Insertion – PowerPoint presentation

Insertion of MonaLisa 5PowerPoint presentation

Insertion of MonaLisa 10PowerPoint presentation

Insertion of MonaLisa NPowerPoint presentation

151011 Insertion of SMBPowerPoint presentation

5) Technique d’insertion DIU (French) :

Insertion of Liberte TT-380FRENCH

Insertion of Liberte UT-380FRENCH

6) Tips for managing difficult IUD insertions in nulliparous patients, acutely retroflexed uteri, obese or anxious patients.

Difficult Insertions

7) Local anesthesia

Local anesthesia

8) What about strings ?

What about strings ?

9) Managing Complications

Managing Complications

10) Additional Resources

IUC Expert – Teaching App

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MEDICAL DIRECTOR: DR ELLEN WIEBE