When it comes to intrauterine devices, also known as IUDs, many women think of them as a "memory of the one-child policy era" belonging to their mothers' generation.
Some people have heard from their elders that IUD insertion can cause increased menstrual flow, abdominal pain, and that the IUD can "grow into the flesh" when it is removed, so they avoid IUD insertion altogether.
In addition to these well-known side effects, a recent study also found that copper intrauterine devices can increase the virulence of some Candida albicans (commonly known as yeast) in the vagina and increase resistance to antibiotics.
Fortunately, these Candida species with increased virulence are not the main cause of yeast infections. Furthermore, there are currently no extensive studies finding similar results. Therefore, the list of side effects of intrauterine devices does not currently include "increasing the risk of yeast infections."
So, is the intrauterine device (IUD) an outdated method of contraception, as many people think?
Sheung Wan is not what it used to be.
First of all, the intrauterine devices (IUDs) available today are no longer just simple copper rings as before. They come in two main categories: copper rings (some of which also release indomethacin) and T-shaped IUDs that release progestin (Mirena).
In fact, they are highly effective and safe, easy to use, and inexpensive (copper rings), and have long been the most commonly used long-acting reversible contraceptive methods worldwide.
Between 2002 and 2012, the rate of intrauterine device (IUD) use among women in the United States who used contraception rose from 2% to nearly 12%.
Intrauterine devices (IUDs) have a very high success rate for contraception, with both copper rings and Mirena achieving over 99%. Moreover, unlike short-acting birth control pills, they don't require daily medication.
In addition, a copper ring can be placed for 10-12 years, which is almost a permanent solution for people who have given birth in their 30s. The effective period for Mirena is 5 years.
Copper rings primarily cause an inflammatory response in the endometrium through copper ions, while Mirena achieves contraception by locally releasing progestin into the endometrium, making the endometrium unsuitable for conception.
So who is a suitable candidate for IUD insertion?
In fact, this method is suitable for most people who want long-term contraception, including breastfeeding women and women with various medical complications who cannot use hormonal contraception.
However, it is not recommended for patients with uterine cavity deformities, excessively large uterine cavities (such as uterine fibroids, adenomyosis, uterine malformations), abnormal uterine bleeding, or those in the acute phase of pelvic inflammatory disease. It is also not recommended for patients with breast cancer.
Is there a specific time for IUD insertion?
As long as pregnancy can be ruled out, an IUD can be inserted at any time during the menstrual cycle. However, since many people's contraceptive methods are not guaranteed to be effective, it is generally recommended to insert it within 2 weeks before the menstrual cycle.
In addition, IUDs can be inserted immediately after a miscarriage.
One important difference between intrauterine devices (IUDs), subdermal implants, and oral contraceptives is the procedure of insertion and removal. This places a significant psychological burden on many women considering IUD insertion.
In fact, although IUD insertion usually only involves local anesthesia, the actual discomfort only lasts for about 5 minutes. The pain varies from person to person, and it is mostly a spasmodic pain.
If an IUD with a tail string is inserted, removal only requires pulling on the tail string, unlike in my mother's generation where instruments were needed to be inserted into the uterine cavity to hook it out.
Many women with a history of cesarean section are afraid that IUD insertion will cause uterine perforation. In fact, the chance of uterine damage caused by IUD insertion is only about 1 in 1000.
The most common side effects after IUD insertion are spasmodic abdominal pain and bleeding. For patients using copper IUDs, about 60% experience spasmodic abdominal pain within 3 months after the procedure, and 70% experience heavier menstrual bleeding than before.
Among patients using Mirena, 15% experienced abdominal pain and 32% experienced menstrual abnormalities, which may manifest as prolonged menstrual bleeding or spotting.
However, Mirena has a hidden benefit: a higher rate of amenorrhea. It's important to note that this amenorrhea is healthy and doesn't indicate a problem with your endocrine system; it usually resolves quickly after the IUD is removed.
Other common side effects related to progesterone include acne, weight changes, hirsutism, headaches, nausea, and mood changes. However, because Mirena acts only locally in the uterine cavity and has a very low blood concentration, most people do not experience these side effects.
In addition, the incidence of intrauterine device displacement and expulsion is approximately 10%-20%.
There are some misconceptions among people, such as the belief that IUD insertion will lead to ectopic pregnancy or that the IUD will grow together with the uterine lining over time.
There is currently insufficient evidence to suggest that IUDs increase the risk of ectopic pregnancy, but the incidence of ectopic pregnancy may increase when IUD contraception fails.
The ring doesn't grow together with the flesh.
Are there any additional benefits to intrauterine devices (IUDs)?
For copper rings, insertion within 5 days (120 hours) after unprotected sex can also serve as a very effective method of emergency contraception.
Mirena can relieve menstrual cramps and reduce menstrual flow, and it also has a therapeutic effect on endometriosis and endometrial proliferative diseases.
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