Intrauterine Devices

Myths:
 
·         Abortion
·         Complications with Method
·         Effectiveness
·         Health Risks and Side Effects
·         Infections
·         Infertility
·         Menstrual Bleeding
·         Sexual Desire and Sexual Pleasure
·         Who Can Use the Method
 
Myth: Abortion
Some couples do not want to use the IUD because they incorrectly believe that the IUD prevents pregnancy by causing abortions.
 
Fact:
IUDs do not work by causing abortions. In the vast majority of cases, IUDs work by preventing fertilization. The copper-bearing IUD acts as a spermicide, killing or impairing sperm so they cannot reach the egg. IUDs that contain progestin cause the cervical mucus to thicken, which stops sperm from entering the uterus.Thus, the current evidence suggests that the main mechanisms of action of IUDs occur prior to fertilization. In very rare case, IUDs prevent implantation which is considered a contraceptive not an abortifacient effect.
 
Counseling Messages:
The IUD does not cause abortion, but prevents pregnancy by interfering with sperm movement. Its presence in the uterus also makes the environment unfavorable for implantation. (Lesotho)
 
The IUD is a non-abortifacient. Its primary action is by preventing the viability and transport of the sperm. Hence the action is by preventing fertilization. Further, in the rare case that fertilization does take place; the egg is not able to stick to the wall of the uterus. This means that the complete process that is necessary for a baby to start growing, which involves fertilization and attaching to the uterine wall, is not happening. So, action is before pregnancy and therefore is not an abortion. (India)
 
The main way the IUD acts as a contraceptive is by causing [changes] in the uterine cavity, which prevents the meeting of the sperm and ovum. So, their will not be a zygote to abort. (Iran)
 
The copper and Mirena IUDs both usually work by preventing the sperm from reaching the egg, so the egg is not fertilized. The copper IUD can also work by preventing a fertilized egg from settling into the womb. However, medically abortion means something that works after a fertilized egg has settled into the womb and the IUD does not work at that stage. If you are worried about something that could work after the egg is fertilized, you should consider another method of contraception such as the pill, which acts earlier. (New Zealand)
 
The IUD prevents fertilization by preventing the sperm from meeting the egg. This is not abortion. Some scientists say it prevents the fertilized egg from implanting in the walls of the uterus. This is not abortion either, since the medical profession considers a woman to be pregnant when the fertilized egg is implanted and starts to develop in the wall of the uterus. (Dominican Republic)
 
The IUD is a contraceptive method, which means it prevents pregnancy from occurring. There has been scientific research about these facts and there is no evidence that the IUD acts by causing abortion. It acts in different ways on the sperm and on the uterus which prevents the sperm and [egg] from meeting. (Argentina)
 
The IUD, for example, the Copper T, works by causing a chemical action hostile to sperm and the fertilization of a woman’s egg. (Trinidad and Tobago)
 
The IUD doesn't cause abortion exactly, but it causes [changes in] the endometrium so a fertilized ovum may not embed in the uterus. (Yemen)
 
In general, the IUD works by preventing fertilization. (Germany)
 
The IUD does not cause abortion. (Ghana)
 
This myth is propaganda used by enemies of women who do not believe in the reproductive rights of women or their use of effective contraception. Ignore these people. It is safer, however, to always visit the family planning staff to get well informed about any health matters. Encourage your friends to do the same. (Nigeria)
 
Pregnancy does not occur before nidation [implantation]and the IUD works by preventing fecundation [fertilization]. (Haiti)
 
I explain in detail how an IUD or IUS works. If the woman is still worried about the devise causing an abortion, I would offer her an alternative method of contraception. (Ireland)
 
It does not cause abortion, but other factors, such as infection, can cause [spontaneous] abortion and other factors. (Swaziland)
 
 
Myth: Complications with Method
Some women do not want to use the IUD because they incorrectly believe that the IUD can cause infection or that it can travel from the uterus to other parts of the body.
 
Fact:
Infection
Infection related to IUD insertion probably occurs because the instruments or IUD carry with them organisms from the lower genital tract. If the organisms are bacteria normally present in the genital tract, then it seems that some mechanism automatically eliminates this contamination from the uterus soon after the insertion process without infection occurring. Risk of infection can be further reduced by following routine infection-prevention procedures including the “no-touch” insertion technique (not letting the loaded IUD or uterine sounds touch any unsterile surfaces such as hands, speculum, vaginal wall, or table top).
 
Travel to distant parts of the body
The IUD never travels to the heart, brain, or any other part of the body outside the abdomen. The IUD normally stays within the uterus like a seed within a shell. Rarely, the IUD may come through (perforate) the wall of the uterus into the abdominal cavity. This is most often due to a mistake during insertion. Proper insertion technique can help prevent many problems, such as infection, expulsion, and perforation. If uterine perforation is suspected within 6 weeks after insertion or if it is suspected later and is causing symptoms, refer the client for evaluation to a clinician experienced at removing such IUDs. Usually, however, the out-of-place IUD causes no problems and should be left where it is. The woman will need another contraceptive method.
 
Counseling Messages:
The IUD is a very safe method. When inserted according to the correct aseptic method, the risk of infection is significantly minimized. It is a misconception that the IUD can travel from the uterus to the heart or cause death. (India)
 
There is a small risk of infection (about 1-2%) when the IUD is first put in because it has to go through the vagina and some of the ordinary bacteria in your vagina may go up into the womb at the same time. However, we have done tests to check that you do not have an infection, so there is little risk of that. After insertion, you have the same risk of infection with an IUD as someone not using an IUD. Very occasionally an IUD can perforate the womb, but that is very unlikely if an experienced person, such as us, puts it in. You can check that it is still in place by feeling for the string hanging down into the vagina. (New Zealand)
 
As we have discussed, there is a small chance of infection when the IUD is first put in, but the risk is very tiny--about 1-2%. Although you may get discharge, irregular bleeding or pain with an infection, infections can be silent. The IUD normally stays within the uterus. Very rarely the IUD may come through the wall of the uterus and rest in the abdomen. The IUD never travels to other parts of the body. (Malaysia)
 
The IUD is sterile or free of germs. It does not cause any illness or infection. If there is an infection before or after the IUD has been inserted, this infection can be treated. However, a person with an IUD must be careful not to expose oneself to multiple partners and thereby expose herself to greater risk of infection. With regard to the movement of the IUD, this is not possible because the IUD fits in a way that it cannot move. (Dominican Republic)
 
We have trained personnel who insert the IUD in an aseptic way. So, there is less chance of infection, and it cannot travel from the uterus to other parts of the body because it is placed within the uterus. Attend the clinic for a follow-up visit to ensure that your IUD is OK. (Bangladesh)
 
This phenomenon is very rare. It can occur only if the device gets misplaced from its normal position—the chance of this occurring is rare. Our body is like our home, there are many rooms and each has a door serving as an inlet or an outlet— some have both and some do not. The uterus is shaped like a balloon that is closed from above, thus the shape does not permit the IUD to go upward. The device is placed at the bottom of the balloon. (India)
 
It is not possible for the IUD to travel from the womb to the heart. Just look at this picture and you will understand. (Show a picture of the anatomy) (Ghana)
 
This is not correct. The IUD will remain at the insertion place and does not travel to other parts of the body.  Show the client a picture or model of the uterus with an IUD in it and tell her if the IUD wanted to travel to other parts of the body it would exit from the body through the cervix and the vagina). Regarding infection, there are groups of people who are prone to infection with IUD use and if you are in those groups the IUD is not a good contraceptive for you. (Iran)
 
These are rumors that you should not believe. If you want any information about any family planning method, ask health workers at the family planning clinic. However, you are advised to: always keep your clinic appointment, keep your body and vagina clean, and carry out self-examinations of your vagina as instructed in order to detect missing tags (if you have missing tags report to the family planning clinic promptly for assistance). Also, if you notice an unusual change in your menstrual pattern, report to the family planning clinic immediately. (Nigeria)
 
Based on the female anatomy, the IUD is confined within the uterus and it is unlikely that there will be consequences from its use. (Malaysia)
 
You should report any unusual vaginal discharge. If you do not feel the threads or you feel the hard part of the IUD, please report back to the clinic immediately. (Show the client a pelvic model and explain how the IUD fits in the womb.) (Trinidad and Tobago)
 
 
Myth: Effectiveness
Some women do not want to use the IUD because they incorrectly believe that the IUD is not effective in preventing pregnancy or that the IUD loses its contraceptive effect after only a few years from the time of insertion.
 
Fact:
Both the hormonal and copper-bearing IUDs are highly effective contraceptive methods. In fact, they are among the most effective reversible methods, with pregnancy rates similar to those for female sterilization. 
 
Hormonal levonorgestrel-releasing IUD (LNG-IUD):Less than 1 pregnancy per 100 women using the LNG-IUD over the first year (2 per 1,000 women). That means the LNG-IUD will prevent pregnancy in 998 of 1,000 women. A small risk of pregnancy remains beyond the first year of use and continues as long as the woman is using the LNG-IUD. Over 5 years of LNG-IUD use, about 1 per 100 women (5 to 8 per 1,000 women) will become pregnant. The LNG-IUD is approved for up to 5 years of use.
 
Copper-bearing IUDs:Less than 1 pregnancy per 100 women using an IUD over the first year (6 to 8 per 1,000 women). That means the IUD will prevent pregnancy for 992 to 994 of 1,000 women using IUDs will not become pregnant. A small risk of pregnancy remains beyond the first year of use and continues as long as the woman is using the IUD. Over 10 years of IUD use, about 2 per 100 women will become pregnant. The IUD is effective for up to 12 years.
 
Counseling Messages:
The IUD is 97% effective, which means for every 100 women who have the IUD inserted, 3 will become pregnant. The IUD does not lose its contraceptive effect after only a few years of use. (Malaysia)
 
The IUDs we are using have a failure rate of about 1% (Multiload Cu375), which means that only 1 couple out of 100 using the IUD will have an accidental pregnancy per year—this is better than the pill. [Copper-bearing IUDs are effective for up to 12 years.]  The failure rate for the Mirena [the LNG-IUD] is 1 in 100. These IUDs last for 5 years. [Editor’s Note: See Fact for more on pregnancy rates for copper-bearing IUDs and LNG-IUDs] (New Zealand)
 
Clients usually say that the IUD is an “old-fashioned method” and so it is less effective compared to “modern methods”. I explain that the IUD is a modern and effective method. (Lithuania)
 
Some women believe that the IUD is not effective because they know of a woman who has gotten pregnant when using the IUD. However, the IUD is an effective contraceptive device. [Editor’s Note: See Fact for pregnancy rates for copper-bearing IUDs and LNG-IUDs] (Yemen)
 
It is recommended that the IUD be used for three to five years, depending on the type of IUD. [Editor’s Note: Duration of use depends on manufacturers’ recommendation] (Germany)
 
The IUD is very effective for long-term use because it is well stationed in the uterus. (Swaziland)
 
 
Myth: Health Risks and Side Effects
Some women do not want to use the IUD because they incorrectly believe that IUD causes side effects or health risks such as cancer, sexually transmitted infections, or birth defects.
 
Fact:
Cancer
IUDs do not cause cancer in otherwise healthy women, but confirmed or suspected cancer of the genital tract is a contraindication to IUD use, because the increased risk of infection, perforation, and bleeding at insertion may make the condition worse. For the levonorgestrel-releasing IUD, breast cancer is also a contraindication.
 
Sexually Transmitted Infections (STIs)
IUDs do not increase the risk of contracting STIs, including HIV. However, usually women who have a very high risk of exposure togonorrheaor chlamydia should not have an IUD inserted. In special circumstances, when other, more appropriate methods are not available or acceptable to her, a qualified provider who can carefully assess a specific woman’s risk may decide that she can use an IUD.
 
Birth Defects
IUD use neither causes multiple pregnancies after removal nor increases the risk of birth defects, whether the pregnancy occurs with the IUD in place, or after removal.
 
In the rare event that a client becomes pregnant with an IUD in situ, it is important to explain the risks of leaving the IUD in the uterus during pregnancy. There is a higher risk of preterm delivery or miscarriage, including infected (septic) miscarriage during the first or second trimester, which can be life-threatening. Early removal of the IUD reduces these risks, although the removal procedure itself involves a small risk of miscarriage. There is no evidence of increased risk of fetalmalformations, however.
 
Counseling Messages:
There is absolutely no cancer risk associated with IUD use. There may be a risk of STIs if condoms are not used, but not with IUD use. The IUD won't cause any damage to the baby in the case of a pregnancy, nor will it cause birth defects or bodily harm. (Argentina)
 
Studies have shown no difference in rates of cancer among women who use an IUD. A woman has the same risk of catching an STI from someone with an infection whether or not she uses an IUD. We do not recommend using an IUD if you or your partner is at risk of getting an STI. If there is an accidental pregnancy, there is no increased risk of the baby being born abnormal. The IUD [is usually expelled with] the placenta (afterbirth), not embedded in the baby. (New Zealand)
 
The IUD does not cause cancer, sexually transmitted infections or birth defects. If a client becomes pregnant it is best to remove the IUD to avoid severe infections. [Editor’s Note: See Fact for consideration surrounding pregnancy and copper-bearing IUDs and LNG-IUDs] (Malaysia)
 
Yes, this is a problem in some cases [such as pelvic infection, septic miscarriage, and premature delivery]. But, the IUD is a safe method and it doesn’t cause any defects to the fetus. Of course, if anybody becomes pregnant with the IUD, she will need special care in the pregnancy period. (Iran)
 
A baby can not be born with an IUD embedded anywhere because, while in utero, the fetus is in its sac and the IUD is in the uterus outside the sac. (Swaziland)
 
Some clients believe that the IUD can cause a birth defect if they fall pregnant with the device. If you fall pregnant with the device, the device will be found between the membrane and the baby, not inside the baby. (South Africa)
 
Whether to insert an IUD is a personal choice and there is no medical proof that it can cause cancer. (Nigeria)
 
We have no knowledge of studies showing a connection between the IUD and cancer. Also, we do not advise women with multiple partners to use the IUD because of the increased risk of infection. (Barbados)
 
 
Myth: Infections
Some couples do not want to use the IUD because they incorrectly believe that the IUD causes PID, toxemia, or other infections to a woman’s reproductive organs.
 
Fact:
Pelvic Inflammatory Disease (PID)
Overall levels of PID in IUD users are low. A woman with chlamydia or gonorrhea at the time of IUD insertion, however, is at higher risk of PID in the first few weeks after insertion than she is later. After the first few weeks, an STI may be no more likely to progress to PID in an IUD user than for other women with STIs. To reduce the risk of infection during IUD insertion, providers can ensure appropriate insertion conditions, screening, and counseling, as well as regularly monitor and treat infection.
 
Antibiotics are usually not routinely given before IUD insertion. Most recent research done where STIs are not common suggests that PID risk is low with or without antibiotics. When appropriate questions to screen for STI risk are asked and IUD insertion is done with proper infection-prevention procedures (including the no-touch insertion technique), there is little risk of infection. Antibiotics may be considered, however, in areas where STIs are common and STI screening is limited.
 
If PID occurs or is suspected with an IUD in place, treatment should be started as soon as possible. There is no need to remove the IUD if a woman wants to continue using it. The PID should be treated and the IUD left in situ. If a woman wants it removed, it can be taken out after starting antibiotic treatment. An IUD should not be inserted in women who currently have a PID. It may be inserted as soon as she finishes treatment, if she is not at risk for reinfection before insertion.
 
Toxemia
The copper in copper-bearing IUDs is not released into the blood. Levels of serum copper in long-term users of copper IUDs are similar to that of the normal population.
 
Infection
Infection related to IUD insertion probably occurs because the instruments or IUD carry with them organisms from the lower genital tract. If the organisms are bacteria normally present in the genital tract, then it seems that some mechanism automatically eliminates this contamination from the uterus soon after the insertion process without infection occurring. Risk of infection can be further reduced by following routine infection-prevention procedures including the “no-touch” insertion technique (not letting the loaded IUD or uterine sounds touch any unsterile surfaces such as hands, speculum, vaginal wall, or table top).
 
Counseling Messages:
There is a small chance of infection when the IUD is first put in, but the risk is very tiny—about 1-2%. Although you may get discharge, irregular bleeding, or pain with an infection, infections can also be silent, so you may not know if you have one. (New Zealand)
 
The IUD won't cause genital infection by itself. The presence of infections, such as STIs and PID, are generally associated to the sexual behavior of people who frequently don’t use barrier methods (condoms) after the insertion of an IUD. Of course, you'll have efficient protection against undesired pregnancy, but none against STI using the IUD. (Argentina)
 
This is not true. Infection is caused by not keeping clean, having multiple sexual partners, using dirty paper or cotton wool to plug the vagina and by inserting dirty fingers into the vagina. If cleanliness of the body and vagina is maintained, infection cannot occur. However, a clinic appointment must be maintained. (Nigeria)
 
PID depends a lot upon the way insertion is done and the environment in which it is done. If the doctor follows aseptic methods and ensures that PID does not already exist before the insertion, the chances of infection are less. (India)
 
PID is an important point for information. Clients must have the information about risk factors while using an IUD (for example frequent changing of sex partners). (Germany)
 
When the loop is inserted in the uterus, it is sterile and therefore does not cause infection. But, when a symptomatic infection exists, it will show after IUCD insertion, therefore, the client needs to be treated. (Swaziland)
 
The IUD itself does not cause PID or infections, but in the case of PID infection, only the presence of an IUD may enhance the inflammatory process, as it is a foreign body. (Yemen)
 
The IUCD is inserted under sterile conditions and cannot be responsible for infection. (Barbados)
 
If you get back aches, abdominal pain, white discharge, or another problem difficult to handle, visit your doctor for syndromic management for infections and maintain good local hygiene. (India)
 
There may be an increase in vaginal discharge during the first few months after the IUCD is inserted–this does not lead to PID or other infections of the vagina, cervix and uterus. (Malaysia)
 
 
Myth: Infertility
Some couples do not want to use the IUD because they incorrectly believe that the IUD will cause infertility, ectopic pregnancy, or miscarriage.
 
Fact:
Infertility
Good studies find no increased risk of infertility among women who have used IUDs, including young women and women with no children. Whether or not a woman has an IUD, however, if she develops pelvic inflammatory disease (PID) and it is not treated, there is some chance that she will become infertile. PID can permanently damage the lining of the fallopian tubes and may partially or totally block one or both tubes enough to cause infertility.
 
Ectopic Pregnancy
Because any pregnancy among IUD users is rare, ectopic pregnancy among IUD users is even rarer. An IUD does not increase a woman’s overall risk of ectopic pregnancy. In fact, an IUD user’s risk of an ectopic pregnancy is much lower than the risk to a woman who is not using any method of contraception. In the unlikely event of pregnancy in an IUD user, 6 to 8 in every 100 of these pregnancies is ectopic. Thus, the great majority of pregnancies after IUD failure are not ectopic.Still, ectopic pregnancy can be life-threatening, so a provider should be aware that ectopic pregnancy is possible if an IUD fails.
 
Miscarriage
IUDs do not cause miscarriages after they have been removed. If correct insertion technique is used, the use of an IUD will not cause any difficulty in future pregnancies.
 
In the rare event that a client becomes pregnant with an IUD in situ, it is important to explain the risks of leaving the IUD in the uterus during pregnancy. There is a higher risk of preterm delivery or first- and second- trimester miscarriage, including infected (septic) miscarriage which can be life-threatening. Early removal of the IUD reduces these risks, although the removal procedure itself involves a small risk of miscarriage.
 
If the client does not want to continue the pregnancy and if therapeutic termination of pregnancy is legally available, inform her accordingly. If she wishes to continue the pregnancy andthe IUD strings are visible or can be retrieved safely from the cervical canal, gently remove the IUD or refer for removal. The client should return at once if she develops any signs of miscarriage or septic miscarriage (vaginal bleeding, cramping, pain, abnormal vaginal discharge, or fever).
 
However, if the IUD strings cannot be found in the cervical canal and the IUD cannot be safely retrieved, refer for ultrasound, if possible, to determine whether the IUD is still in the uterus. If the IUD is still in the uterus, if ultrasound is not available, or if the client chooses to keep the IUD, her pregnancy should be followed closely by a nurse or doctor. She should see a nurse or doctor at once if she develops any signs of septic miscarriage.
 
Counseling Messages:
Not necessarily. Just like any pregnancy, this will occur when God wants this to happen. The IUD should not be blamed for a delay in getting pregnant. Women have been known to get pregnant immediately after the removal of an IUD or within three months of removal. Infertility is another rumor to give the IUD a “bad name”. However, if you are worried, you can report to the clinic any time for a medical opinion. (Nigeria)
 
When the IUD is removed from uterus, normal fertility function is restored. (Yemen)
 
Fertility is immediately restored to the original level as soon as the IUD is removed. (India)
 
The loop [copper IUD] is not a hormonal method and therefore it does not enter the blood stream. Once it is removed or misplaced, a woman can get pregnant. (Swaziland)
 
The IUD usually cannot cause infertility. It only can cause infertility in the case of PID among the prone infection group, which is why it is better for them not to use the IUD. (Iran)
 
The vast majority of IUD users get pregnant just the same as the people who don't use the IUD. It is possible that if a fertilized egg got stuck in the tube, say after the tube had been damaged by an infection, a copper IUD wouldn't prevent that pregnancy from growing in the wrong place - the copper IUD works better in the womb than in the tube. The Mirena IUD is so effective at preventing pregnancy that the risk of an ectopic pregnancy is minute. (New Zealand)
 
The IUCD does not cause infertility or delay the return of fertility after it is removed. (Malaysia)
 
A pregnancy that occurs with an IUD in place is more likely to end in a miscarriage. (Ireland) [See Fact for information on miscarriage]
 
 
Myth: Menstrual Bleeding
Many couples do not want to use the IUD because they incorrectly believe that using the IUD will cause either no monthly bleeding (amenorrhea) or heavier, painful, and more frequent menstrual bleeding.
 
Fact:
Women can experience changes in bleeding patterns depending on the type of IUD. 
 
Women using copper-bearing IUDs may experience:
  • Heavy and prolonged monthly bleeding
  • Irregular bleeding
  • More cramps and pain during monthly bleeding
 
These bleeding changes are normal and usually are not signs of illness. They are most common in the first 3 to 6 months after insertion and usually lessen with time. A provider should evaluate for an underlying condition unrelated to method use if:
  • Cramping continues and occurs between monthly bleeding;
  • Heavy or prolonged bleeding continues, or if bleeding starts suddenly after several months of normal bleeding or long after the IUD was inserted, or;
  • Irregular bleeding persists after 6 months, or starts suddenly after several months of normal bleeding.
 
Severe anaemia requires careful consideration because if heavier menstrual periods are experienced, the additional monthly blood loss could worsen existing anaemia. The anaemia should be treated before an IUD is inserted. The LNG-IUD may actually help to reduce anaemia by reducing blood loss.
 
Women using the LNG-IUD may experience heavy, prolonged, or irregular bleeding in the first few months, but then experience
  • Lighter, regular, and predictable bleeding
  • Infrequent, light, or no monthly bleeding
 
These bleeding changes also are normal and usually are not signs of illness.
 
Copper-bearing IUDs rarely cause monthly bleeding to stop completely. However, women using an LNG-IUD may not experience monthly bleeding due to strong uniform suppression of the endometrium. If monthly bleeding does not occur while a woman is using a copper-bearing IUD, pregnancy should be excluded. If the woman is not pregnant, other causes of no monthly bleeding should be investigated.
 
Pain associated with menstruation may increase in some women, but usually this is only for the first month or two. The LNG-IUD may reduce the pain associated with menstruation. Non-steroidal anti-inflammatory drugs may also reduce discomfort.
 
Counseling Messages:
Just like anything that is new, it takes time for the body to get adjusted. It is true that for the first 3 months the IUD may affect the pattern of the menstrual flow and the quantity. But, immediately the body gets adjusted and things will come back to normal. However, if you are worried, report to the clinic. It is very important to observe the bad or carry out a vaginal examination to check that the IUD is not partially or fully expelled because of the heavy bleeding. Again, if there is partial expulsion, this could also cause heavy bleeding. Reporting to a clinic nurse is recommended. Any pain is temporary and taking a simple pain relieving drug, like aspirin or paracetamol, will relieve the pain. But, if pain persists or you are worried, report to the clinic staff immediately. (Nigeria)
 
During the first three months, there is a possibility of heavier bleeding and slight discomfort. However, in most cases, this subsides and the lady enjoys the benefits of the method. It has been found that of all reversible methods used, the IUD has one of the lowest discontinuation rates, expressing that the method is quite popular. (India)
 
Copper IUDs tend to make your period longer, more painful and heavier. We will check how you are getting on at your 6 week check. If you use the Mirena (LNG-releasing IUD),  initially we expect you may spot bleed for many days of the month, but after a few months we expect you will have light periods or maybe no periods at all. (New Zealand)
 
 
Moderate blood loss and frequent menstrual bleeding may happen for 2-3 months after insertion of the IUD. Later on it will be OK. If you feel pain you can take pain-relieving medicine. (Bangladesh)
 
You may experience a heavier flow of the menses after the insertion. However, this is normal and in subsequent months the menses should return to a normal flow. There is nothing to worry about if there is a little more flow in the first month after insertion. (Dominican Republic)
 
This may happen for some clients during the first months of use and it will be solved after that. For this problem you can use some simple drugs in the bleeding period that will help you be more comfortable. The IUD doesn't interfere with the hormonal regulation of menses. (Yemen)
 
Regarding amenorrhea, the use of the levonorgestrel IUD may be a cause of this, but many times this is the effect we are looking for when using it. Also, it is common to see heavier or painful bleeding during the first months of insertion, which generally stop after this period. (Argentina)
 
After a few days pain will subside. Bleeding may be heavier for the first few months, but will later stabilize. (Swaziland)
 
This is a common complaint when the IUD is inserted. You should wait for 3 months and your menstrual cycles should become regular. (India)
 
Inter-menstrual spotting may occur in the first month after insertion. Heavier menstruation may occur for the first 3 months after insertion. (Malaysia)
 
Copper coils can cause heavier periods. The Mirena IUS can make periods lighter or can cause them to stop. This is normal. (Ireland)
 
You may experience heavier bleeding initially, but it will settle. (Barbados)
 
It is standard information that bleeding might increase while using the IUD (look at information from the World Health Organization and the International Planned Parenthood Federation). Also, it is important to inform clients about possible amenorrhea while using the hormonal IUD. (Germany)
 
The first menstrual period that you may have following the insertion of the IUD is usually heavier than usual, as the IUD is a foreign body and the womb has to adjust to it. If your period continues to be heavy or you experience any other discomfort please report to your clinic as soon as possible. (Trinidad and Tobago)
 
Yes, in some women the IUD causes heavy menstrual bleeding. (Fiji)
 
One of the side effects of the IUD is that the menstrual bleeding can be extended for a while. (Georgia)
 
 
Myth: Sexual Desire and Sexual Pleasure
Some couples do not want to use the IUD because they incorrectly believe that the IUD will cause inconvenience during sex, pain for the male partner because the strings will hurt the penis, or that using the IUD causes discomfort and pain for the woman during sex.
 
Fact:
There is no reason why an IUD should negatively affect sexual pleasure. On the contrary, being free from fear of pregnancy may allow both partners, especially the woman, to enjoy their sexual life.
 
There is no reason why an IUD should cause discomfort or pain during sexual intercourse unless the woman is already having cramps, which sometimes occur during the first few weeks after insertion. Sexual intercourse cannot displace an IUD.
 
Sometimes a man can feel the strings if they are too long. If this bothers him, cutting the strings shorter should solve the problem. Sometimes a man can also feel discomfort if the strings are cut too short. To remedy the problem, the provider can cut them even shorter so they are not coming out of the cervical canal. The woman should be told beforehand, however, that this will mean she may not be able to feel the strings to check her IUD, and removing her IUD may be more difficult.Alternatively, she can have the IUD replaced with a new one and the strings cut to the correct length.The strings should be cut so that 3 centimeters hang out of the cervix. A man may feel discomfort during sex if the IUD has started to come out through the cervix. If a woman suspects this, she should see a doctor or nurse immediately. Proper counselling of the male partner may be appropriate.
 
Counseling Messages:
The strings will not cause inconvenience during sex because the strings are cut short after insertion of the IUD, leaving only a small portion of the strings outside the cervix. So, the IUD will not hamper your or your partner’s sexual pleasure. (Bangladesh)
 
The nylon string is soft and won’t cause any obstruction during sex unless the string is too short or too long or the IUCD has been partially expelled. The IUCD will not cause pain for the male partner during sex. If your husband feels discomfort during sex, there is a possibility that the IUCD has started to come out through the cervix. You must see a doctor or nurse immediately. (Malaysia)
 
Neither you nor your partner should notice any difference with sexual intercourse while using an IUD. Occasionally, your partner may notice the string but it is usually enough to put a finger in the vagina and curl it out of the way. If the string is cut too short, it can prick your partner. If this is a problem, return and we will trim it further. If you have discomfort with intercourse, you should return to check that nothing has gone wrong. (New Zealand)
 
The threads are quite fine. However, if your partner complains that the threads are causing him discomfort, please return and we will shorten them. (Trinidad and Tobago)
 
For a man, the loop does not cause pain except when the strings have been cut too short. Otherwise, it does not prick and cause pain. (Swaziland)
 
This can occur if the thread of the IUD is long. A well placed IUD does not hinder the pleasure obtained during sex. I have success stories from many of my clients. (India)
 
With correct insertion of the IUD and its string your partner will not have any inconvenience during intercourse. Women do not have any problem with IUD use and pain during sex. (Iran)
 
If the tag [strings] of the IUD are cut too short and cause discomfort, the client should report to the clinic to have the IUD removed and a new one inserted so that the tag will be reduced to a size that does not cause discomfort. If a short tag is not the case, she is instructed on how to push the tag to the vaginal fornices so that it is tucked away. Vaginal cleanliness must be maintained. Always wash your hands before examining the tag. It is recommended that examination of the tag be done during your bath to be sure that your hands are clean during the examination. (Nigeria)
 
If your partner complains of pain during sex because of the device, this means that the device has been misplaced (partially extruded). Remove the device and reinsert it or use another method. If the woman complains of discomfort or pain find the cause and treat accordingly. (South Africa)
 
The string of the IUD is made of a soft material (either HDPE or Nylon). Furthermore, the string is cut by the doctor very close to the cervix. Most of the time, the penis does not reach or touch the string at all. There have been test instances where the couple returned complaining that the string was hurting the male organ and they wanted removal of the IUD. The doctor did not remove the IUD, but informed them that it had been done. The couple did not return with any complaints. This proves that it was more of a psychological issue than the issue of the string. (India)
 
Most times a man complains only if he is aware that his partner has an IUD inserted. Therefore, it may just be in his mind. If a man does not know of the presence of the IUD or its string, he does not complain. Even if his penis may feel the end of the string, there is not likely to be any danger for him or for you as the string is very thin and flexible and unlikely to cause any inconvenience. (Dominican Republic)
 
This is incorrect. (Show the client an IUCD with the uterus model and show her where it is placed and how the strings are cut short.) (Barbados)
 
If you have pain and discomfort nothing will happen because the uterus is strong and thick and the IUD inside is very small. (Yemen)
 
Few women told me that the IUD strings give inconvenience to their partners, but sometimes it is just that the men don't support their partner in using this kind of contraception. (Malaysia)
 
Sexual activity takes place in the vaginal canal, not in the uterus where an IUD is placed. [Editor’s Note: The IUD is in the uterus but the strings lie in the cervical canal and can be felt by a sexual partner if they are too short or too long.] The strings are cut so that they become short. (Lesotho)
 
 
Myth: Who Can Use the Method
Many women do not want to use the IUD because they incorrectly believe that the IUD should not be used by women who are young or who have not had children.
 
Fact:
There is no minimum or maximum age requirement for using the IUD. An IUD should be removed after menopause has occurred—at least 12 months after her last monthly bleeding. There is also no requirement that a woman must have children to use the IUD. A history of pelvic infection or multiple sex partners (one indication that a woman is at high risk for STIs) make the choice of an IUD inappropriate for such women.
 
The myth that young women and women without children cannot use IUDs stems from fears about a higher risk of expulsion in these women and fears about a higher risk of infection in these women.
 
Expulsion is more likely in certain circumstances, such as young age at insertion (under 20 or 25 years old). Some studies also have found a higher rate of expulsion among women who have no children. The additional risk of expulsion, however, is not sufficient to deny IUDs to women in these circumstances, because the advantages of the IUD outweigh the risks of expulsion.
 
Women with current gonorrheal or chlamydial infection should not have an IUD inserted. Since laboratory STI tests usually are not available, World Health Organization guidance considers STI risk assessment and physical examination essential to safe use of IUDs, but not laboratory tests. Providers should not determine a woman’s STI risk based on her age or whether she has had children. Rather, the provider can discuss risky behaviors or situations in their communities that they think are most likely to expose women to STIs, for example having more than one sexual partner in the last three months without always using condoms. The client can think about whether such situations occurred recently (in the past 3 months or so).
 
Counseling Messages:
Young women and women who have not had children may use the IUD. If you do not like injectables or oral contraceptives, or if they cause some inconvenience, you may use the IUD. While it is true that older women use it, young women may use it quite comfortably and effectively. Inserting the IUD will not prevent you from having a baby when you want to. When that time comes, the IUD is removed and you can try to have a baby. (Dominican Republic)
 
According to a clinical study that was done, it has been proved that the IUD is also an effective method for use among nulliparous women (women without a first child or an abortion). A few doctors believe and recommend that the IUD should only be inserted after a first child, but studies prove otherwise. (India)
 
Young women incorrectly believe that they should not use the IUD, as it can alter their interior environment. This is not true. Each acceptor of the IUD behaves differently, but the primary purpose of the IUD as a contraceptive has served many women and it is reported to be safe even in young women. (India)
 
Any women of childbearing age, who for some reason cannot use hormonal methods, can use an [copper] IUD if they choose. (Lesotho)
 
It doesn't matter whether you are married with kids or not, this is just a psychological barrier. (Nigeria)
 
The IUD can be used by all women except those with contraindications. (Swaziland)
 
The IUD also can be used by younger women and girls. A smaller IUD (only with copper) is available in Denmark for women who haven’t given birth and for girls who are not fully grown. (Denmark)
 
The IUD is most suitable for people in long-term relationships where there is little or no risk of getting an infection. Although we recommend that young women who have not had any children consider using something such as the pill instead, it is OK for you to use an IUD if you have considered all the pros and cons. [Editor’s Note: Current evidence from well conducted clinical trials indicates that it is generally safe for women with no children to use IUD.] (New Zealand)
 
As per instruction of the government contraceptive manual, we can provide the IUD only to those women who have at least one child. [Editor’s note: This is a local precaution and not a World Health Organization recommendation.] (Bangladesh)
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