The insertion of the Intrauterine Device (IUD) is done very simply by a general practitioner or gynaecologist, takes only a few minutes, and is usually pain free. Through a speculum (a collapsible metal tube) the doctor will examine the entrance to the womb (the cervix) and check the shape and size of the uterus. Then, while holding the cervix carefully with a special pair of forceps, the IUD is slowly pushed through the cervix canal into the uterus. It is only 3 mm. in diameter when inserted, but once inside the uterus it springs open to its T shape and is held in position by the arms of the device pushing on the uterine walls. It is normal to insert the IUD immediately after a menstrual period, but may be inserted at other times if the woman wants immediate protection.
Once in place, the woman is not aware of its presence. Most women with a Mirena type IUD will have no menstrual periods, but may experience occasional breakthrough bleeds.
After insertion, the woman should regularly feel for the fine thread, which will normally hang into the vagina. This is used to remove the IUD at a later time.
A Mirena device can remain in place for five years before its needs to be changed, but a doctor should check it and perform a routine Pap smear test every two years.
The IUD has one great advantage – you cannot forget to take it or use it. Once in place it can be relied upon to give 97% protection against pregnancy. When you want to become pregnant, or no longer require contraception, the device is easily removed. Your doctor will merely pull on the short thread left outside the uterus (but inside the vagina), and the IUD will fold up on itself, enabling it to be gently withdrawn.
Not all women are suited to the use of IUDs. Only about 60% of women still have them in place a year after insertion. Sometimes they can fall out, they may cause irregular periods, or rarely they may cause infections of the uterus resulting in permanent infertility.
During insertion, it very rarely may penetrate the uterus to cause serious peritonitis.
The devices are normally used, and have fewer side effects, in women who have had a pregnancy, but they can also be used in women who have had no children.