About IUDs
There are two kinds of IUDs in Canada – copper and progesterone. They all last for years and are put into the uterus by the doctor.
IUDs work well and couples like them because they prevent pregnancy without the user needing to do something every time they have sex (like condoms) or having to take a pill everyday. They are excellent for people who cannot take hormones because of side effects or because they have a high risk of blood clots.
Your appointment: The appointment will be about an hour. You will come in to the office, fill out some forms and sign a consent form. We will get a urine sample from you and get any payments if necessary. You then may have a short wait before being taken in to see the doctor.
Insertion: The doctor checks the size and position of your uterus. She will then put a speculum into your vagina so she can see your cervix and do swabs to check you for infection. She usually uses freezing with a local anesthetic. Most patients feel a pinching feeling and then a sharp cramping pain which lasts a few minutes when the IUD is inserted. Taking ibuprofen an hour before helps the cramps. The best time to put in an IUD is during or just after a period but they can be put in any time as long as we know you are not pregnant. We can provide you with a prescription.
Risks: There are no increased risks of infection except in the first few weeks after IUD insertion; That is why we check for infection and give antibiotics to anyone who is high risk for infection (for example, a woman with many sexual partners). There are no long term effects on fertility. There is about 5% chance per year of the IUD being rejected or falling out. This is why it is a good idea to check for the string by putting your finger inside your vagina or by getting a doctor to check. There is about a 1/1000 chance of the IUD perforating the uterus or getting into the wrong place and needing minor surgery to remove it. Perforations heal and do not cause any problems later with having babies.
Which IUD should you choose?
Mirena– $400 (5-7 years) – Most health benefit plans will pay for the Mirena so it may be the cheapest choice. Mirenas work better; only 1/1000 patients per year will get pregnant and the periods will be lighter and easier. The amount of hormone in a Mirena is much less than birth control pills, patches or shots so there are very few hormone side effects. About 10% of people will get the IUD removed for hormone side effects such as weight gain, mood changes or acne. Most people get some spotting in the first month or two after their Mirena has been inserted.
Kyleena – $400 (5 years) – These are smaller and have less hormone than Mirena. They are a good choice for people who just want contraception and do not have very heavy painful periods.
Copper IUD – $75 (5 or 10 years) Many patients choose copper IUDs because they are less expensive and have no hormones. They are very effective with about 1 in 100 people getting pregnant in a year. They usually make periods heavier, longer and more painful by about 20-50%. There are no effects from a copper IUD outside the uterus: no weight gain, mood changes, nausea, sore breasts, etc. A person with heavy, painful periods should choose a hormone IUD, if she can afford it. The copper IUD is also very effective as emergency contraception.
Average amount of hormone (levonorgestrel) released:
— Mirena 14 mcg/day
— Kyleena 9 mcg/day
IUDs for Emergency Contraception
For more information check: www.mirena.ca, http://www.cmaj.ca/cgi/content/full/169/6/585
Also visit RAICE for more information:
RAICE – Rapid Access IUC Centres of Excellence
(IUD insertion centres across Canada)
COMPARING EMERGENCY COPPER IUDS AND EMERGENCY PILLS
Plan B (Morning After Pill)
How effective is it?
About 60%. If 100 patients have unprotected sex once during their cycle, 5 would become pregnant. After taking Plan B within 5 days, only 2 patients would become pregnant. Less effective if a person weighs over 175 pounds (>80 kg, BMI >30)
How does it work?
It prevents or postpones ovulation.
Is it safe?
Yes. There is no harm to the patient who takes it, nor does it cause birth defects if it does not work or the patient is already pregnant.
How do I take it?
Take both pills as soon as possible. They must be taken within 5 days of the unprotected sex to have any effect but work best if taken as soon as possible.
What are the side effects?
You may get some nausea. You may take Gravol (dimenhydrinate) for this. Your period may be irregular for a month afterward.
And afterwards?
You are likely to ovulate soon after taking the Plan B so make sure you are using good contraception!
What is the cost?
Plan B costs $25-40 at a pharmacy and it is less expensive or free at youth clinics and OPT clinics.
HOW LIKELY ARE YOU TO
GET PREGNANT ?
1st two days of period = 0
Two days before ovulation = 15-20%
Any day = 5%
Leung VWY, Soon JA, Levine M. Emergency Contraception Update: A Canadian Perspective. Clin Pharmacol Ther.
2008 : 83 (1 ): 178-181.
Copper IUD
How effective is it?
Over 99%. In studies of 7034 patients who received emergency IUDS, 6 people (0.09%) became pregnant. — We would have expected 352. There is no difference with weight or BMI.
How does it work?
It interferes with sperm and egg activity and prevents fertilization and implantation.
Is it safe?
Yes. There is less than 1/1000 chance that a hole could be made in your uterus when the IUD is inserted (perforation). These holes heal within weeks. There is a slightly increased risk of infection in the first few weeks. You will be checked and treated for this if it happens.
How do I get it?
You can call Willow Clinic at 604-709-5611 for an appointment. Make sure you say it is for an Emergency IUD and when you had unprotected sex so you will be given an appointment within 7 days of that event. A doctor will insert it into your uterus.
What are the side effects?
Most patients feel crampy pain when the IUD is inserted, but this is quickly gone. Most patients feel like they are having a period afterwards with light bleeding and maybe some cramps. Periods are heavier and longer for most people afterwards, but improve after the first 3 months.
And afterwards?
If you want to leave the IUD in, you will have good contraception for 5 years. You can have it taken out any time after your next period.
What is the cost?
The copper IUD is $75.00 at our clinic. If you do not have BC Medical Coverage there will be a charge of $160.00 for insertion.
WHERE CAN I GET AN EMERGENCY IUD?
Many clinics and doctors who insert IUDs are not able to get you an appointment in time. Here is a list of clinics which are able to insert IUDs within a few days so that it will be within 7 days from unprotected sex.
In Vancouver:
Willow Clinic
#1013 – 750 West Broadway
604-709-5611
In Victoria:
Vancouver Island Women’s Clinic
#104 – 284 Helmcken
250-480-7338
FAQs about IUDs
1. What is the difference between the types of IUD’s?
Please read the section above, “Which IUD should you choose?”
2. What do they cost?
If you do not have extended medical coverage the cost in our office is: Mirena – $400.00, Kyleena – $400, Copper – $75.00
3. What will it cost to insert if I don’t have BC Care Card?
There will be a charge of $160.00 for anyone who does not have a BC Care Card. If you have medical coverage from another province we can give you a receipt to send in and you may get a full refund, or a portion of the fee from them.
4. Will the insertion hurt?
You will likely feel a strong cramp at the time of the insertion. We use a local anesthetic on your cervix and recommend that you take ibuprofen 1 hour before your appointment to help with the cramping. Most patients feel fine after resting for a few minutes. Some people do find that the cramps remain strong and may be given a stronger pain killer if needed.
5. How long does the IUD take to start working?
IUDs work immediately. Make sure you use condoms if there is risk of sexually transmitted diseases.
6. How often should I get it checked?
After your first period or in about one month, check to see if you can feel the string by putting your finger inside, to the top of your vagina. If you can’t feel the string or if you feel any hard plastic, check with a doctor. If you don’t want to do the string check yourself, book an appointment with your regular doctor or with us. After the first month, you only need to get checked if you notice something wrong. Note: Bayer will replace your IUD (Mirena or Kyleena) free if it comes out in the first 6 weeks AND you see a doctor about it.
7. What should I do if I am bleeding heavier than my normal period?
Expect that copper IUDs will make your first periods quite heavy and that they will get better after three months. If they remain very heavy, make sure you eat well or take iron supplements so that you do not become anemic.
8. What should I do if I have really bad cramps?
Ibuprofen 400-800 mg is the best for cramps. Heat (hot water bottle, heating pad, etc) and anything that helps you relax will help.
9. What should I do if I have a positive pregnancy test?
If you get pregnant with an IUD, check with a doctor to make sure it is a normal pregnancy.
10. Can I go to work after the insertion?
Most patients feel well enough to continue their normal activities that day and are able to control any cramps with ibuprofen. Some people do have very strong cramps and need to rest. Unfortunately we cannot tell how it will be for you. Don’t plan any major physical activity that day (running a marathon, moving house).
11. How long will my appointment be?
You will be here at our office for approximately 1 hour. You will fill out forms when you come in and do a urine sample. You will then see the doctor for the insertion. After the insertion we will ask you to rest for about 10 minutes for us to make sure you are feeling OK.
12. Will the IUD affect future pregnancies?
Within one month after the IUD has been removed, your fertility will be back to normal.
13. Do you do ultrasounds?
The doctor will do a vaginal ultrasound before the insertion to check your uterus and then again after the insertion to make sure the IUD is in correct position.
14. Will I bleed after the insertion?
You may have some bleeding at the time of and after the insertion so we ask you to bring a pad with you. The bleeding may last for a few days or even weeks depending on how your body adjusts to the IUD. You may have spotting on and off or a day or two of heavy bleeding. This is normal and should settle down within 3 months.
15. Do I have to make an appointment?
Yes, you do need to call us at 604-709-5611. We do not take walk in patients.
16. How long does it take to get an appointment?
There is often a 3 – 4 week wait for an appointment.
17. Is it OK to have an MRI or an X-ray with an IUD in place?
Yes – The IUD will not interfere with the tests.
18. How long should I wait to book the IUD insertion after my baby is born?
At least six weeks.
19. Can I use tampons? What about menstrual cups?
Yes. When using your cup, just make sure you break the suction before removing it.
20. Will I feel an IUD during sex? Will he feel it?
Occasionally, you may feel a twinge, but it shouldn’t hurt. About 5% of men (1 out of 20) say they can feel the strings, but it usually doesn’t bother them. If it does bother your partner, we can shorten or tuck the string up out of his way.
21. Is there anything I should be watching for?
Yes, if you get a fever, steady pain and/or a smelly discharge, you might have an infection that needs to be treated.
22. How soon can I have sex?
The IUD works right away, but you might feel some pain during sex in the first few days after insertion.
23. What should I do if the string feels longer?
Don’t panic. Your cervix moves naturally during your cycle and when it moves down the string will feel closer to the outside of your vagina. A long string could mean that the IUD is coming out. If it stays longer, get a doctor to check.
24. What should I do if I can’t feel the string?
Don’t panic. Many people will never feel the strings. You might ask your partner to try. If you are worried that it has come out without you seeing it, you can get a doctor to check.
25. REMOVAL: When can I have the IUD removed? / Can I have the IUD removed at your clinic?
You can have an IUD removed at any time. / If you decide you would like to get pregnant, or decide you no longer want the IUD, you may call the office at 604-709-5611 and book an appointment to have it removed at our clinic.
26. Can I have a new IUD inserted at the same appointment as getting an IUD removed?
Yes – it is best not to take a break between IUDs, because if you do, you will have to go through the same adjustment reaction (cramps and bleeding) as the first time. If you get it done at the same appointment, you will only have a day or two of bleeding.
27. How long after removal do I have to wait before I try and get pregnant?
It is not dangerous to get pregnant right away, but it is better if you wait for one period cycle.
Fun Facts About IUDs
The first intrauterine devices (IUDs) were used by the Arabs. They would put pebbles in their camel’s uterus to prevent her from getting pregnant on long trips across the desert or to market.
EARLY IUDs:
In 1909, Richter used silkworm gut. In the same year, Grafenberg used silkworm gut and silver wire. IUDs used in the 1960’s had names like the Lippes Loop, the Margulies Spiral, of the Saf-T-Coil.
TODAYS IUDs:
The style of IUD we use today has been common in North America for about 50 years.
The tail-less steel ring is used in China by about 45 million women.
Worldwide, there are nearly 160 million IUD users, most of them (over 100 million) in China. IUD use varies in developed countries, from as low as 1% in the Netherlands and the USA to about 30% in Scandinavia.
WHO INVENTED THE MODERN IUD?
Ernst Grafenberg invented and marketed the first IUD in 1928. He was a Jewish German opthalmologist-turned-OBGYN. When the Nazis assumed power in Germany, Grafenburg, was forced to resign from his hospital. He refused to leave Germany, believing that since his practice included wives of high Nazi officials, he would be safe. He was wrong. He was arrested in 1937. Three years later, Margaret Sanger (an early advocate of birth control) ransomed him from Nazi prison. He went to the U.S. and opened a practice in New York City.
DID YOU KNOW…
Grafenberg was also famous for his studies of the G-Spot (Grafenberg Spot), a pleasure zone inside the vagina.
WHY PATIENTS CHOOSE THE IUD
Actual comments from Willow Clinic patients:
“Because of family history, I don’t want to take any estrogens.”
“I just want to feel secure about everything and not have to think about it.”
“It was better than having to take a pill or inserting something and having to take it out.”
“Less hassle.”
“…I never felt like I had any other options because all the other, like the patch and depo provera, all have these crazy side-effects that I was terrified of, and I know condoms always break.”
“I wish everybody knew about it, because they’re [IUDs] so wonderful.”
MEDICAL DIRECTOR: DR ELLEN WIEBE