Family planning

IUD: What it is and how it works?

Intrauterine Device IUD insertion

An IUD is a highly effective, long-acting, and reversible method of contraception inserted into the uterus, with fertility returning after removal and no external physical effects or scars. The device offers protection for several years, ranging from 3 to 10 years, depending on the specific type.


“An IUD is a highly effective, long-term contraception
that can be inserted into the uterus by a healthcare provider
in approximately 10 minutes, offering reliable protection against pregnancy
for women who are not ready for children.”

Interesting information about IUD insertion

What is an IUD?

An Intrauterine Device (IUD) is a small device inserted into the uterus by a healthcare professional to prevent pregnancy. It’s a highly effective and long-acting, reversible form of birth control.

Types of IUDs

Types of IUDs

1. Non-medicated (Inert) IUD

Non-medicated or “inert” IUDs, like the Lippes Loop, are indeed made of plastic (polyethylene) with barium sulfate (BaSO4) for X-ray visibility, or stainless steel, and were designed for long-term use. However, these older, inert IUDs are no longer used in Thailand.

2. Medicated IUD

2.1. Copper IUDs (copper-coated intrauterine device) are a form of birth control that prevents pregnancy by releasing copper ions into the uterus, which stimulates an inflammatory response. This inflammatory reaction creates an environment that is toxic to sperm, affecting their movement and viability, and can also prevent the implantation of a fertilized egg. There are two main types of copper IUDs.

2.1.1. Copper T IUDs last for 5 years.

2.1.2. Multiload IUDs last for 3-5 years.

2.2. Hormone-releasing IUDs are long-acting reversible contraceptives that release levonorgestrel, a type of progestin, to prevent pregnancy for up to 5 years.

2.3. Frameless IUDs, such as the copper-coated GyneFix IUD, are an alternative to traditional framed IUDs. However, a potential disadvantage of these frameless devices is a higher expulsion rate compared to some framed devices, though this can be mitigated by proper, skilled insertion into the uterine muscle, which may require more technical skill than for standard devices.

How does an IUD work?

  • An IUD works by creating an inflammatory response in the uterus, which is toxic to sperm and can prevent a fertilized egg from implanting in the uterine wall. This inflammatory process, triggered by the device as a foreign object, creates an environment unsuitable for fertilization and implantation.

  • Progestin-releasing IUDs prevent pregnancy by releasing a synthetic progestin hormone that thickens cervical mucus, creating a barrier to sperm, and thinning the uterine lining, making it difficult for an embryo to implant.

Who are good candidates for an IUD?

Who are good candidates for an IUD?

  1. Women who desire highly effective birth control methods

  2. Women in a low-risk category for STIs

  3. Women who want a long-term birth control for at least one year

  4. Women who want a reversible birth control after IUD removal

  5. People who need to avoid estrogen-containing birth control methods

Important considerations when choosing between a copper and a hormonal IUD

Important considerations when choosing between a copper and a hormonal IUD

  1. Menstrual history, regularity, bleeding, and cramp
  2. Congenital diseases
  3. Users’ needs for menstrual cramp and bleeding relief
  4. Users’ perceptions and experiences with amenorrhea or spotting from IUD insertion
Advantages of IUDs
Advantages of IUDs

  • IUDs provide contraception for periods ranging from 3 to 10 years.

    They are estrogen-free, as copper-coated IUDs do not contain any hormones.

  • Fertility returns almost immediately once an IUD is removed, unlike contraceptive injections.

  • IUDs are a suitable and safe birth control option for a wide range of people, including breastfeeding mothers and overweight women.

  • If a woman experiences an IUD-related adverse event, the IUD can be removed immediately.

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Disadvantages of IUDs

  • IUDs must be inserted and removed by a doctor or other health care professional.

  • A pelvic examination is required before IUD insertion

    Period-like pain, mild cramping, and light bleeding (spotting) are common and normal side effects of both IUD insertion and removal.

  • Menstruation may be affected. Copper IUDs can cause heavier, longer periods, while hormonal IUDs typically lead to lighter periods, and some users may experience no periods at all.

  • IUDs carry a slight risk of pelvic infection and inflammation, especially in the first few weeks after insertion. A more serious, though rare, complication is uterine perforation.

  • The IUD’s strings can sometimes interfere with sexual intercourse in some cases.

IUD insertion procedure

  1. The patient must urinate before the procedure.

  2. The doctor performs a pelvic exam before an IUD insertion.

  3. A speculum is inserted into the vagina to hold the tissues open and provide a clear view of the cervix.

  4. A uterine probe is used to measure the uterine cavity’s depth before IUD insertion to ensure proper placement and prevent potential uterine perforation.

  5. The IUD is then inserted through the cervix to the measured depth.

  6. After IUD insertion, the patient is asked about these common symptoms.

Side effects of IUDs

  1. Copper-coated IUDs can result in heavier, longer, and more painful periods with increased cramping in the first few months after insertion.

  2. Hormonal IUDs can indeed cause a range of menstrual changes, including missed periods or amenorrhea and irregular spotting (light bleeding between periods).

  3. Some IUD users may experience increased vaginal discharge as the device can alter cervical mucus.

  4. IUDs are linked to an increase in the risk of pelvic inflammatory disease (PID).

Risks of IUD insertion

Risks of IUD insertion

  • IUD dislocation, or expulsion, is a known risk of IUD use, with the highest risk in the first few months after insertion and decreasing over time.

  • An IUD insertion malposition can reduce contraceptive effectiveness.

  • Missing IUD strings can make removal difficult.

  • An IUD rupture can lead to the dislodgement of fragments into the abdominal cavity, potentially causing complications like abdominal infection or infertility, though this is a rare occurrence.

  • Uterine perforation by an IUD is an uncommon but serious complication, occurring in roughly 1 in 1,000 insertions, and can happen immediately or even years later after IUD insertion. While symptoms may not always be immediate, severe, unusual abdominal pain warrants immediate medical attention.

Post-IUD insertion care

avoid sexual intercourse
  • It is generally recommended to avoid sexual intercourse for 24 hours after an IUD insertion as it could raise the risk of infection in the early stages after IUD insertion.
contact a doctor if your pain is unusually severe or worsens.
  • Experiencing mild bleeding and slight abdominal pain for a few days after IUD insertion is normal. However, you should contact a doctor if your pain is unusually severe or worsens.
see your doctor for a follow-up appointment to check IUD placement
  • You should see your doctor for a follow-up appointment to check IUD placement and for any signs of infection, and continue with annual checkups to maintain long-term IUD function.

Contraindications for IUD insertion

  1. Severe uterine distortion, often resulting from congenital structural issues like a bicornuate uterus, cervical stenosis, and abnormal shape or size of the uterine cavity.

  2. An active pelvic infection, in which the IUD should be inserted at least 3 months after the infection is successfully treated.

  3. Pregnancy or suspected pregnancy because IUD insertion significantly increases the risk of complications, including spontaneous abortion (miscarriage) and septic abortion.

  4. Copper allergy in cases where copper-coated IUDs are used

  5. Wilson’s disease because Wilson’s disease causes excessive copper accumulation in organs.

  6. Abnormal uterine bleeding of unknown origin because spotting and irregular vaginal bleeding after IUD insertion is a common side effect and it would mask or exacerbate symptoms.

  7. Other conditions: Levonorgestrel-containing IUDs are not recommended for people with current or a history of breast cancer

Frequently asked questions about IUD insertion

  • Does getting an IUD painful?

Getting an IUD can cause slight pain, as well as some pain during IUD removal.

  • Is there a risk of the IUD expulsion after insertion?

IUD expulsion, which occurs in about 3-10% of cases, is more common in the first year. Factors increasing this risk include heavy menstrual flow, sever cramps, and IUD insertion immediately after childbirth or miscarriage.

  • Can I have sex as soon as I place an IUD?

It is generally recommended to avoid sexual intercourse for 24 hours after an IUD insertion as it could raise the risk of infection in the early stages after IUD insertion.

An IUD can be inserted at various points in a woman’s menstrual cycle, with insertion during the first few days (or at least the initial 7-day window of the cycle)

being common and potentially beneficial because the cervix is softer, facilitating placement and reducing the risk of expulsion.

Prices of IUD insertion

  • Non-hormonal IUD insertion starts at 4,400 Baht
  • Hormonal IUD insertion starts at 12,800 Baht

Note: Prices may vary depending on the doctor’s diagnosis

References

  • Family planning and contraception, Usanee Sanmee, Faculty of Medicine, Chiang Mai University
  • Intrauterine devices: IUDs, Dhammapoj Jeerakornpassawat and Thawiwan Pantasri, Faculty of Medicine, Chiang Mai University
  • IUDs…for long-term contraception, Associate Professor Dr. Nonglak Sukwanichsin, Drug Information Center, Faculty of Pharmacy, Mahidol University

For more info and make appointment

Jittiwat Amnouypon ,M.D.
General Practitioner

Latest edit: 17/09/2025

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