Gynaecological procedures and examinations

An intrauterine contraceptive device or IUD is a T-shaped device with a 3-5 year effect that is inserted into the uterus to prevent pregnancy. There are two types of IUD:

• Metal-containing intrauterine device – prevents conception because it affects the mobility of sperm cells and eggs. It also reduces the sperm cell’s ability to fertilise an egg.
• The hormone-containing IUD contains progestin, which causes the structure of the cervical mucus to become thick, preventing sperm cells from passing through the cervix. The growth of the lining of the uterus and partly the occurrence of ovulation are also inhibited by the hormone. In addition to contraceptive protection, the hormonal spiral has some other favourable properties – it is well suited for women with heavy menstrual bleeding and has a protective effect on the uterine mucosa during certain treatment courses as well as an alleviating effect on menstrual pains.

Whom is the IUD suitable for?

• For women who for some reason cannot or do not want to use other contraceptives
• For women who want to avoid pregnancy for a longer period of time
• Hormonal IUD is suitable for women with heavy menstrual bleeding
• For women who are breastfeeding
• For women who have not given birth

Placing an intrauterine device

The device is placed during a gynaecologist appointment. The procedure is preceded by a doctor’s consultation, a PAP test (if one has not been done in the last three years) and an STD test and the chance of pregnancy must be ruled out.

IUD insertion is usually painless and can be done at any time, but the best time to do it is during or immediately after menstruation. After childbirth, the device can be placed when the uterus has returned to its former dimensions, usually around two months after childbirth. After an abortion, an IUD can be inserted immediately, provided that the presence of an infection has been ruled out.

After placement

The intrauterine device provides protection against pregnancy immediately after insertion, but it is recommended to refrain from sexual intercourse within 24 hours after IUD insertion. After the procedure, you may experience lower abdominal pain. You can relieve the pain with over-the-counter pain medications. After the placement of a copper IUD, the patient should take into consideration that they might have heavier and longer-lasting menstruations from now on. With the hormonal IUD, many women experience spotting and light bleeding in addition to normal periods during the first 3-6 months after device insertion.  During the use of the IUD, you must visit a gynaecologist regularly, preferably once a year.

Contraindications for intrauterine contraception

• Known or suspected pregnancy
• Acute or chronic inflammation of the pelvic organs
• Infection of the lower genital tract
• Uterine bleeding of unknown origin
• Abnormalities of the uterus or cervix, including uterine fibroids, if they deform the shape of the uterine cavity
• Cancer of the uterus or cervix
• Blood clotting disorders
• Wilson’s disease (copper metabolism disorder)

How the IUD is inserted

Depending on the specialist performing the procedure, the details of the procedure may vary slightly. A speculum (mirror) is inserted into the vagina. The cervix is cleaned with an antiseptic. The IUD is inserted into the uterus using a thin, flexible plastic tube or inserter. If necessary, local anaesthesia can be applied to the cervix before the device is inserted. As a rule, the position of the IUD in the uterus is checked immediately after insertion.

Possible complications

• Inflammation of the pelvic organs. See your doctor if you experience persistent lower abdominal pain, pain during intercourse, unusual bleeding, or foul-smelling vaginal discharge.
• Perforation (puncture) of the uterus. IUD can penetrate or pass through the muscular layer of the uterus. This is a very rare complication and most often occurs during the insertion. Depending on the extent of the perforation, it may be necessary to intervene with the administration of drugs that contract the uterus or surgery to remove the IUD from the uterine wall or the abdominal cavity.
• IUD falls out. Uterine contractions during menstruation can dislodge or push out the IUD. If the position of the IUD changes, it may no longer function as intended, increasing the risk of pregnancy. The main symptoms of an IUD falling out are pain and bleeding.
• Pregnancy with IUD. If you are pregnant and want to continue the pregnancy, it is recommended to remove the IUD. If the device is not removed, the risk of spontaneous abortion and premature birth are increased. The relative risk of ectopic pregnancy is increased in the case of pregnancy with a hormonal IUD.
• Anaemia. Copper IUD may increase the amount of menstrual bleeding and thus the risk of developing anaemia.