Copper-bearing IUD

An intrauterine contraceptive device (IUD) is one of the long acting reversible contraceptive methods (LARCs). It is a small device which is fitted inside the uterus, where it can remain for lengthy periods to prevent pregnancy. Copper IUDs are made of plastic and copper. There are 2 types of copper IUDs currently available in Australia.

Once inserted, they are not felt by the woman or her partner. All IUDs available in Australia have fine nylon threads attached to the lower end of them so that when fitted, the threads extend through the cervix (neck of the womb) into the upper vagina. These threads allow the woman to check that the IUD is still in place and allow for easy removal by a doctor.

IUDs work by:

• changing the lining of the uterus making it unsuitable for a pregnancy
• thickening the mucus of the cervix, preventing sperm entering the uterus

The copper IUD is at least 99% effective. This means that, on average, if 100 women use an IUD for 1 year, it is possible that 1 of them could become pregnant.

• long acting: 5-10 years depending on type
• reversible with rapid return to usual fertility when removed – within a month of removal
• highly effective: the most reliable form of contraception apart from permanent sterilisation
• relatively inexpensive – initially upfront cost. Over 5 years this is the most cost-effective form of contraception
• Copper IUD offers a non-hormonal option

• insertion and removal of the device can only be performed by a trained doctor
• insertion into the uterus requires a procedure which some women may find quite uncomfortable
• possible changes in periods/bleeding patterns: initial light bleeding or spotting while the device settles in place, expect normal or heavier periods
• does not protect against sexually transmissible infections, so continue to use condoms for this

• Abdominal pain - Following insertion, some women notice abdominal cramping pain mostly for a day or two – occasionally longer.
• Perforation - This is a rare but serious complication where the IUD device passes through the wall of the uterus into the pelvic area, usually at the time of, or shortly after, insertion. This may occur in about 1 per 400 insertions. This requires surgery under a general anaesthetic to remove the IUD. Some studies have found that women who have recently given birth may have an increased risk of this complication, however all women may be at risk of this rare event occurring.
• Expulsion - Sometimes the IUD device may be partially or completely pushed out of the uterus. It occurs in about 5 per 100 insertions and is most common in the months following insertion. It is important to regularly check for the threads, to detect if this has occurred, as the IUD won't work effectively if not fully within the uterus.
• Pelvic inflammatory disease (PID) - This is a rare complication of IUD insertion, most likely to occur in the first few weeks following the insertion procedure from an existing infection. It occurs in less than 1 per 300 insertions. PID may in some cases lead to infertility.

Possible risks associated with ongoing use of an IUD:

• Miscarriage - If a pregnancy occurs in the uterus there is an increased risk of miscarriage. If the IUD is then left in place, there is an increased risk of miscarriage with infection in later stages of pregnancy or premature birth.
• Ectopic pregnancy - If a pregnancy does occur with an IUD in place there is a small chance the pregnancy will develop in the Fallopian tube. However, because the IUD prevents most pregnancies, it is an uncommon complication and less common than amongst women who are not using any contraception. Ectopic pregnancy is a serious condition and often requires surgical management.
• To reduce complications, in the rare event of a pregnancy occurring with an IUD in place, it is important to see a doctor as soon as possible if you have any reason to suspect you are pregnant, eg, if there is a change in your usual bleeding pattern; if a period is missed; is lighter than usual or you have unusual abdominal or pelvic pain.

Most women can safely use an IUD. Your doctor will review the suitability of the method with you prior to insertion.

In assessing your suitability, consideration is given to a number of important factors:

• current menstrual and bleeding patterns
• unexplained vaginal bleeding (this should be investigated before using an IUD)
• a recent history of a sexually transmitted infection or PID
• uterine or cervical abnormalities
• any history of breast, cervical or uterine cancer
• pregnancy history
• cervical screening history
• any allergies including copper allergy
• the timing of insertion and pain relief needs for the insertion procedure

Prior to insertion, an assessment of your medical history and suitability for this method will happen. This assessment enables you to ask any questions you may have and be certain that it is the most suitable method for you.

Insertion of an IUD involves a procedure. Some women find insertion uncomfortable. This can be managed with the use of local anaesthetic into the cervix. If there are reasons to anticipate difficulties then a woman may choose or be advised to have a sedative or general anaesthetic.

The device should be inserted by a medical practitioner trained in the procedure.

You will be given details of follow up at the time of the insertion. Generally, you are asked to attend for a follow up visit after insertion and/or any time concerns exist.

You should contact your doctor if:

• if you miss a period or you feel you may be pregnant
• you experience pelvic pain or tenderness, fever or chills, offensive discharge or deep pain with intercourse
• you cannot feel the string or feel the string has lengthened
• you (or your partner) can feel the hard stem of the IUD

The IUD needs to be replaced with a new device every 5 or 10 years depending on which device is inserted. However, if you have a copper IUD inserted after the age of 40, this expiry date can often be extended and the same device left in for a longer period of time. This is because you have a lower risk of falling pregnant in your late 40s and 50s. Please discuss further with your medical practitioner.

It is important to keep a record of the date that replacement is due or remember a landmark event to arrange for replacement no later than this date. The IUD can easily be removed at any time. As fertility can return immediately after removal, it is important to consider alternative methods of contraception, before the IUD is removed, if trying to avoid pregnancy.

In some circumstances a copper IUD can be inserted up to 5 days after unprotected sex to prevent pregnancy occurring. It can be left in place to provide ongoing contraception or removed after a normal period.