An IUD is a small contraceptive device that is placed inside the uterus.

It is a really reliable form of long-acting reversible contraception (LARC), that is cost effective and suitable for women of all ages.  

The copper IUD does not have any hormonal content and is suitable for women who prefer to use non hormonal based contraception.

The Mirena IUD has a low dose of Levonorgestrel (a progesterone) that acts to increase the cervical mucous, thereby preventing the sperm from meeting up with the egg for fertilisation. It has the added benefit of thinning the lining of the uterus (known as the endometrium) that builds up each month. This is the lining that sheds if you do not fall pregnant and is known as your period.  

The Mirena IUD has the beneficial side effect of reducing the amount of menstrual bleeding, helping to improve period pain, and decrease pain related to endometriosis. It is so effective at thinning the lining, that 20% of women with a Mirena report no periods at all.

The Mirena IUD can now provide reliable contraception for up to 8 years but is typically changed at the 5 year mark in regard to helping with period and/or endometriosis management.  

There is also a newer progesterone-based IUD available, called the Kyleena. Some people refer to it as the baby Mirena. It is slightly smaller in size and contains an even lower dose of the Levonorgestrel hormone. It is very reliable for contraception like the Mirena but is less likely to suppress the menstrual flow and help with pain due to the lower hormone content.

Once an IUD is removed, usual fertility returns readily, making it a great choice if you are planning a pregnancy in the future.

This is why we often recommend it, and why the use of hormone IUD use is growing globally.

However, sometimes an IUD gets a bad rap. 

If you have googled ‘Mirena’ it is likely that google has offered up stories of people having a bad experience with insertion, or it not suiting them post insertion.  

It is suitable for many patients but like all things in healthcare, it is not a ‘one solution suits all’ situation and the decision to go ahead should involve a discussion with your practitioner. 

Something we can definitely improve on is the comfort for patients during insertion.

The experience is improved for women by:

• Firstly, selecting the right patient. Not everyone is suitable for an in rooms procedure and some may need to have their IUD inserted as a day procedure under sedation. Under most circumstances, anyone who has been sexually active is suitable for an in rooms procedure by a gynaecologist at Ballarat Women’s Clinic (BWC).
• Having the patient correctly positioned. The most comfortable position for insertion is for the patient to be seated in a colposcopy/gynaecology chair, not a flat examination bed. This enables the pelvis to be optimally positioned and the practitioner to also be positioned correctly.
• A quick, steady insertion. The whole appointment may take 30 minutes, but an experienced practitioner can perform the insertion within a couple of minutes. 
• A speculum is required to hold open the walls of the vagina, like when a cervical screening test (formally known as the PAP smear) is done.
• Some patients feel about the same, or a little bit more discomfort as a cervical screening test. Other patients will feel some cramping pain with insertion similar to bad period pain if you have ever experienced period cramps before. The cramps begin to subside once the insertion process is complete. Much rarer is a feeling of dizziness with insertion, but this is also short lived and passes quickly once the insertion process is complete.  
• An in rooms ultrasound. After insertion, ultrasound offers reassurance to both patient and practitioner that placement of the IUD is correct and there has been no perforation of the uterine wall, a rare complication.
• Taking anti-inflammatory medication such as ibuprofen 1 or 2 hours before the procedure can help reduce cramping pain.

There is “Internet Talk” that you are better to be at a particular time in your menstrual cycle for insertion. This doesn’t seem to matter. However, if you have your Mirena inserted more than 7 days after the start of your period, you will need backup contraception for one week.

At the insertion the practitioner will trim the IUD strings so that they don’t protrude too far into the vagina. You can check yourself that the IUD is still in place by feeling if the strings are still near your cervix. If you are unsure if it is still in place, we can check at BWC using an ultrasound scan.

What if it doesn’t suit you?

If after 3-6 months post insertion you are not happy with your IUD are still having issues, it can be removed, and another treatment plan made. It can be removed earlier if requested, but the irregular spotting that can occur post the hormonal IUD insertion often resolves by this time and is why we encourage giving it a go for a few months. Removal is easy and patients report either no pain or brief discomfort with possible light bleeding that settles down quickly.

If you have further questions, please talk with your GP, or make an appointment to see a BWC gynaecologist on (03) 5332 9940.

Written by Obstetrician and Gynaecologist Dr Kate Stewart