Fitting of an Intrauterine System (IUS)
What is an IUS?
An IUS is a small T-shaped plastic device, which slowly releases a hormone (progestogen) that prevents pregnancy. A trained doctor will put the IUS into your uterus (womb). The IUS available in the UK is called Mirena. It works for up to five years. If you are aged 45 or older when the IUS is fitted and your periods stop, it can be left in until the menopause or until contraception is no longer needed.
How effective is an IUS?
The IUS is over 99 per cent effective. Fewer than one woman in every 100 women who use the IUS will get pregnant over five years.
When will the IUS start to work?
The IUS can be fitted any time in your menstrual cycle if it is certain that you are not pregnant. If it is fitted in the first seven days of your menstrual cycle you will be immediately protected against pregnancy. If it is fitted at any other time, you will need to use an extra contraceptive method for the first seven days. If you have a short menstrual cycle with your period coming every 23 days or less, you should always use an additional contraceptive method for the first seven days after fitting.
How does an IUS work?
What are the advantages of an IUS
It works for 5 years
It doesn’t interrupt sex
Your periods usually become lighter and shorter, and sometimes less painful. They may stop altogether after the first year of use. An IUS can be helpful if you have heavy, painful periods
It can safely be used if you are breastfeeding.
Your fertility will return to normal when the IUS is removed.
It is useful if you cannot use oestrogens (hormones) like those in the combined pill.
The IUS is not affected by other medicines.
What are the disadvantages of an IUS?
Your periods may change in a way that is not acceptable to you, for example irregular bleeding.
Some women report having acne, headaches and breast tenderness and occasionally mood changes. These hormone related side effects are usually mild and tend to settle in the first few months.
Some women develop small fluid-filled cysts on their ovaries. These are not dangerous and do not usually need to be treated. Often there are no symptoms, but some women may have pelvic pain. These cysts usually disappear without treatment.
An IUS doesn’t protect you against sexually acquired infections, so you may need to use condoms as well. If you get an infection when the IUS is in place this could lead to pelvic infection if this is not treated. By
tAre there any risks or complications?
IUS insertion is usually a straightforward procedure but there are risks, including:
Infection: There is a small risk of you getting an infection during the first 20 days after an IUS is put in. You may be advised to have a check for any possible existing infection before an IUD is fitted.
Expulsion: The IUS can be pushed out by your uterus (expulsion) or it can move (displacement). This occurs in around 1 in 20 fittings. This is more likely to happen soon after it has been put in and you may not know it has happened. This is why your doctor will teach you how to check your IUS threads each month.
Perforation: There is a small risk that an IUS might go through (perforate) your uterus or cervix when it is put in (occurs in up to 2 per 1000 insertions). This may cause pain but often there are no symptoms. If this happens the IUS may have to be removed by surgery. Risk of perforation is slightly higher in breastfeeding women.
Ectopic Pregnancy: If you do become pregnant while you are using the IUS there is a small risk of ectopic pregnancy. In an ectopic pregnancy the baby develops outside the womb, often in the fallopian tube that carries the egg from the ovary to the uterus. This can cause severe bleeding and can affect future chances of getting pregnant. Overall however the risk of ectopic pregnancy is less in women using an IUS than in women using no contraception.
How do I prepare for the procedure?
It is vital that you are not pregnant when the IUS is fitted. Please abstain from sexual intercourse from the start of your period until after the IUS is fitted, or use a reliable method of contraception. You may get period-type pain after the IUS is fitted. We recommend that you get a supply of whatever painkillers you find useful, taking one dose Immediately before the procedure. We usually recommend 400mg Ibuprofen and/or 1g paracetamol.
What does it involve?
The doctor will examine you internally to find the position and size of the uterus before they put in an IUS. An internal measurement is made of the length of the uterus and then the device is inserted. Fitting an IUS takes about 15-20 minutes. It can be uncomfortable and you may wish to take a tablet painkiller that is safe for you, half an hour or so before the procedure. If necessary local anaesthetic can be applied or injected around the neck of the womb, although for most women this is not necessary. Occasionally patients feel nauseous or faint afterwards and you may wish to consider bringing someone with you to accompany you home. You are likely to get some bleeding after the procedure so please bring a sanitary pad with you. Please be aware that we sometimes have trainees working alongside the clinic doctor. With adequate training and supervision, they may perform your procedure with your permission.
What happens afterwards?
If you feel unwell, have persistent or worsening pain in your lower belly, a high temperature or a smelly discharge please contact us for advice. This may be a sign of infection and you should have a follow-up check as soon as possible. Any period-type pain should steadily improve over the following few days. Frequent spotting is quite common after an IUS is fitted but should improve over the first couple of months and by six months your periods usually become much lighter. Unless the IUS is fitted in the first seven days of a regular 28 day cycle you will need to use additional contraception for the first seven days. Many patients find it reassuring to use condoms routinely in the first week.
What follow-up will I need?
We will offer you a follow-up appointment to have your IUS checked by a doctor or nurse approximately 6 weeks after it is put in. If all is well at this appointment then you do not need any further appointments until the IUS is due for removal. If you have any problems, questions or want the IUS removed you can go and see your doctor or nurse at any time. If you have any significant change in your medical history it is advised that you check with the clinic or your own doctor that the IUS is still suitable. Please seek medical assistance if you have pain (worse than period cramps), signs of infection (pain, abnormal discharge and fever), an unexpected change in your bleeding pattern or you cannot feel the device.
How do I check my IUS?
An IUS has two threads attached to the end that hand a little way down from your uterus into the top of your vagina. The doctor or nurse will teach you to feel for the threads to make sure the IUS is still in place, which you can do after each period or at regular intervals. If you cannot feel the threads or if you think you can feel the IUS itself you may not be protected against pregnancy. Use an extra contraceptive method, such as condoms and see your doctor or nurse straight away. If you have had sec recently you may need emergency contraception. A trained doctor or nurse can take out an IUS at any time. When having an IUS removed you should use extra contraception methods, such as condoms, for 7 days beforehand.
What if I think I am Pregnant?
Very few women become pregnant while using an IUS. If you think you might be pregnant or have sudden or unusual pain in your lower abdomen, seek medical advice as soon as possible. This might be the warning sign of an ectopic pregnancy. If you are pregnant the IUS should be removed as soon as possible. If you want to continue the pregnancy, removing the IUS can increase the risk of miscarriage. This risk is less than if the IUS remains in the womb.
Useful Phone numbers and further information
Narrowcliff Surgery 01637854433
The Sexual Health Hub01872 255044
Family Planning Association 0845 122 8690