Intra Uterine Contraception

Intra Uterine Contraceptive Devices (IUCDs) have been used since the first half of the 20th Century. There have been three types of device. Inert, generally made of plastic, (before 1960), containing a metal such as copper (after 1960) and containing a hormone similar to progesterone (after 1980). It is unclear how they work but in principle they create a hostile intra uterine environment not favourable to the sperm fertilising the egg. All are highly effective for contraception and the progesterone containing device is also used to treat gynaecological problems such as heavy periods. The reliability of IUCDs in preventing conception depend on several factors which include the age of the woman, frequency of intercourse, correct placement of the device and, possibly, how long it has been in the womb. They are highly effective, more so than oral contraceptive pills. Devices can be left in place for 5-10 years and longer if the woman was 40 years old or more when it was placed. A device is more difficult to place if there are uterine fibroids and may be less reliable in these circumstances. Certain gynaecological conditions such as pelvic infection is a contra indication to their use.

Insertion

It is important that this should be done in the first half of the menstrual cycle when the woman is certain she is not pregnant. A detailed history should be taken from the woman to exclude any contra indications to insertion and to establish whether it may be easy or difficult with subsequent discomfort if it is difficult. If insertion is to take place without prior consultation, then a telephone consultation is useful to discuss these issues in advance. The woman may obtain the device from the General Practitioner and bring it for insertion. The advantage is that the device is prescribed free of charge by the NHS but is paid for privately.

If the woman has never been pregnant or has never delivered a baby vaginally then the insertion may be more difficult and painful. Nevertheless, we see many young women who have never had a birth who have a successful and relatively painless insertion. It is useful to take 1milligram (2 tablets of Paracetamol) 1-2 hour before the scheduled insertion. It is important to determine the position in which the woman is lying before insertion determine the angle of insertion. We do this using transabdominal ultrasound in every case. We use a local anaesthetic jelly during insertion. There are three discomfort points for a few seconds during the insertion. The first is when the cervix is grasped in an instrument to steady the position of the womb. The second is when a small instrument is passed through the cervix to verify the position of the womb. The third is when the device is inserted. After insertion the threads on the end of the device are trimmed. Usually the woman rests on the couch for five or ten minutes after the insertion. As a minimum we use ultrasound to check the position of the device just after insertion. She can then usually go home and expect menstrual discomfort for a day or two. She is warned that there may be a little extra vaginal bleeding, usually with a period, for a few months after an insertion. This may be a little more painful than normal, but it is worth seeing how it goes before opting for removal. After six weeks the woman should attend for an ultrasound scan to verify the position is correct. The woman can also be taught to check the threads by self-examination.

It is important to remember that an IUCD may not protect against an ectopic pregnancy although we have never seen such a case.

Removal Of IUCD

We undertake routine removals of IUCD. This should not require ultrasound guidance. Women often come to see us when they or their doctor/nurse is unable to locate the IUCD threads. This may be in circumstances when they want to have the IUCD removed. We can usually see it on ultrasound scan and can use a special instrument to remove it. We use anaesthetic jelly for pain relief. Ultrasound scan guidance is very important. We may succeed where others have failed. Anaesthesia in hospital should not be necessary.

Post Coital IUCD

An insertion of an IUCD is very effective in preventing an ongoing pregnancy when inserted within 36 hours of unprotected sexual intercourse.
 

Booking An Appointment 

 Dr Gibb is available on Thursdays. Please contact our reception team to book an appointment. 

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