Intrauterine Contraceptive Device - Pros and cons and side effects

How long will the intrauterine contraceptive device work for?

There are many different types of intrauterine contraceptive device (IUCD). Most copper IUCDs work well for at least five years, and many types now work for ten years. If you were over 40 years old when the device was fitted it can be assumed to last until your menopause.

What are the advantages of the intrauterine contraceptive device?

Once an IUCD is inserted you no longer need to use other contraception. So, unlike users of contraceptive pills, you don't need to think about contraception every day.

The IUCD does not interfere with sex (intercourse) or sex drive (libido). It is not a hormonal method so it has no side-effects on the rest of the body. This means that it will not affect your mood, weight or libido. This lack of side-effects is one of the reasons many women choose it.

Having an IUCD does not increase your risk of having any type of cancer in the future.

Because it does not contain hormones, if they wish to, most women can have an IUCD. There are a few situations where an IUCD is not recommended. Your doctor or nurse will make sure it is safe for you to use an IUCD, by asking questions about your health.

What are the disadvantages of the intrauterine contraceptive device?

Although the majority of women with an IUCD have no problems, the following may occasionally occur as side-effects or consequences.

Heavy, painful periods

Some women find that their periods become heavier, longer or more painful with an IUCD. This tends to be in the first few months after insertion and then often settles. This means that the IUCD may not be suitable if you already have heavy or painful periods. There is a special intrauterine contraceptive called the intrauterine system (IUS), which is like an IUCD but it also releases a hormone into the womb (uterus). This is an effective treatment for heavy periods as well as being a contraceptive. See separate leaflet called Intrauterine System.

If you have painful, heavy periods with an IUCD in place this can still be treated in the same way as in women who do not have an IUCD. For example, your doctor may prescribe anti-inflammatory painkillers or other medicines to take just before and during your periods.

Infection

There is a risk of worsening an existing infection of the womb (pelvic infection) when you have an IUCD inserted. A check for infection of the vagina or neck of the womb (cervix) may be advised by taking a sample (swab) before an IUCD is inserted. The doctor or nurse fitting the device may ask you some intimate questions about your sex life in order to determine whether it might be sensible to do a swab or urine tests. If there is thought to be a risk, you may be given antibiotics at the time the IUCD is fitted.

Ectopic pregnancy

The chance of becoming pregnant is very small if you use an IUCD. However, if you do become pregnant, your doctors will need to check this is not an ectopic pregnancy (a pregnancy in the Fallopian tube and not in the womb). This is because IUCD prevents ectopic pregnancy slightly less well than it prevents normal (uterine) pregnancy. However the risk of ectopic pregnancy is not increased by IUCD compared to no contraception - it is in fact decreased by it.

The IUCD does not cause ectopic pregnancy. However, whilst it is very effective at preventing intrauterine pregnancy, it is less effective at preventing ectopic pregnancy. This means that those pregnancies that do develop with an IUCD in the womb have a significant chance of being ectopic. See a doctor urgently if you miss a period (or your period is light and prolonged) and you develop lower, one-sided tummy (abdominal) pain.

Expulsion

Rarely, the IUCD may come out without you noticing. This may happen during a period, most commonly in the first three months after fitting. It is slightly more likely to happen if you have not had children or if the fitting was particularly uncomfortable.

It is a good idea to check you can feel the threads of the IUCD after your period. If you cannot feel them, you should use extra precautions such as a condom, until your doctor has checked the IUCD is still there.

If the IUCD has come out in the last few days you may need emergency contraception. If the IUCD could have come out more than a few days ago, and you are sexually active, the doctor will make sure you are not already pregnant before fitting another one or starting alternative contraception.

Lost threads

When the IUCD is inserted the threads dangle out of the neck of the womb (cervix). They will often come to lie against the cervix, in the cervical mucus, and you or your partner should not notice them unless you look for them. The threads allow you to check that the IUCD is still in place, and when the IUCD is removed they are used to pull it gently out.

Occasionally, though, the threads are lost. This can either mean that:

  • The threads have come off the device, and the device is still in place.
  • The device is in the right place but the threads have got tucked up behind it.
  • The device has moved further into the womb so that the threads can no longer be felt.
  • The device has come out.

If you cannot feel the threads it is important to use other forms of contraception (if you don't wish to become pregnant) until you can be checked to find out what has happened. You may also need emergency contraception.

An ultrasound exam will show whether the IUCD is where it should be. If it has come out then it can be replaced, as long as you are not pregnant. If it is still in place but has lost its threads then it can remain there. When the time comes to remove it, doctors experienced in removal of IUCDs with lost threads will advise you on whether this can be done in clinic, or whether you might need a short procedure under anaesthetic to take it out.

Damage to the womb

The fitting of an IUCD can, very rarely, make a small hole in the womb - this is called perforation. It protrudes through the wall of the womb and can escape into the pelvis. This happens in fewer than 2 women per 1,000, usually at the time of fitting. It can cause pain but this is not usually severe and often there is no pain. The main symptom is not being able to feel the threads.

You should tell your doctor or nurse if you can no longer feel the threads of your IUCD. This can mean perforation has occurred. However, more commonly it means either that the threads are tucked up inside the cervix or (less commonly) the threads have come off the device. An ultrasound scan will be carried out to find a lost IUCD. If ultrasound does not find the IUCD, an X-ray will be ordered.

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Author:
Dr Mary Lowth
Peer Reviewer:
Dr Jacqueline Payne
Document ID:
4285 (v42)
Last Checked:
08 July 2017
Next Review:
07 July 2020

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Patient Platform Limited has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.