Services

 

  • IUD Counselling and insertion
  • Contraception
  • Family planning, fertlity counselling and work ups
  • HPV Counselling, management
  • STI screening

Self Referral IUD clinic

General Information: IUDs

IUDs (or IUCD’s  or IUS’s) are Intrauterine Contraceptive Devices. In Canada, the only form of Long Acting Reversable Contraception (LARC) are IUDs. There are 2 catagories of IUDs: Copper (non hormonal) and Progesterone releasing (hormonal). All types of IUDs are hightly effective forms of contraception.  IUDs are reversable contraception and do not impact future fertilty.

The insertion: A urine pregnancy test will be done at the time of the appointment for the insertion. The best time to insert an IUD is at the time of menstruation. It is vital to ensure you are not pregnant at the time of insertion* (ways to improve accuracy of a pregnancy test and our knowledge: not having intercourse for 2 weeks prior to insertion, staying on your current contraception until advised to stop post insertion).  Some women experience cramping during the insertion and this can be discussed in advance with the physician. There may be medications used in advance of the procedure which will be discussed at your initial consultation.

*copper IUDs can be used for emergency contraception within 7days of last intercourse see:

https://sogc.org/wp-content/uploads/2013/01/131E-CPG-August2003.pdf

Risks with the procedure are the same with all IUDs and they include:

  • Perforation: <1.6/1000
  • Infection: < 1/ 200 (usually related to untreated STI’s)
  • Expulsion: 5% over 5 years use cumulative
  • Short term irregular bleeding (0-6mo)

Copper: These IUDs induce a foreign body reaction within the uterus (endometrium) and inhibit sperm motility. These are 3-10 year devices. Copper IUDs can be used for emergency contraception within 1 week of unprotected intercourse. Copper IUDs may result in heavier, crampier, longer periods.

Progesterone Releasing IUS (IntraUterine System): These polyethylene devices slowly release low dose levonorgestrel into the uterus (endometrium). The device produces a foreign body reaction and endometrial decidualization and glandular atrophy. Cervical mucous may be thickened (inhibiting sperm) and ovulation may be suppressed in some women. There are 2 IntraUterine Systems in Canada:

  • Mirena: 52mcg (20mcg per day) levonorgestrel, lasting 5-7 years, highly effective at controlling heavy menstrual bleeding, approx 40% of women will be amenorrheic (no bleeding, still ovulating) , Pearl Index 0.09 (per 100 women years of use)
  • Kyleena 19.5 (12mcg per day) Leveonorgestrel lasting 5 years, periods are usually lightened and approx 20% of women will be amenorrheic (not bleeding, still ovulating). Kyleena is a smaller device designed, in part, for women who have not carried a pregnancy.
  • Jaydess: 13.5 mcg (8 mcg per day) levonorgestrel, lasting 3 years, periods are usually lightened, approx 12% of women will be amenorrheic, Jaydess is a smaller device designed, in part, for women who have not carried a pregnancy.

The amount of hormone in the IUS’s is less than 1% of the low dose oral contraceptives available in Canada. 

Special populations: There are times when estrogen is not recommended and often an IUD or IUS is an appropriate and effective form of contraception.  Copper and Progesterone releasing IUDs can be used in breastfeeding mothers. At the initial consult a full history including a review of past experiences with contraception, medical issues and family histories will be obtained. This consult is to ensure the most appropriate form of contraception, that you are most comfortable with is what you end up using.

References and Further Reading:

http://www.sexualityandu.ca/health-care-professionals/contraceptive-methods/intrauterine-contraceptive-device

http://www.sexualityandu.ca/health-care-professionals/contraceptive-methods/intrauterine-system-ius

https://sogc.org/wp-content/uploads/2014/03/gui305CPG1303E.pdf

https://sogc.org/wp-content/uploads/2015/11/gui329Pt1CPG1510.pdf

http://www.jogc.com/article/S1701-2163(15)00024-9/pdf