Insertion of an intrauterine device

An intrauterine device (IUD) is one of the most effective methods of long-term contraception. An IUD is a small T-shaped device that is inserted into the uterine cavity by a physician. It may be hormonal or non-hormonal (containing copper, gold, or silver). The primary function of an IUD is to prevent pregnancy by altering conditions within the uterus, thereby inhibiting fertilization and implantation of a fertilized egg.

Types of intrauterine devices

1. Hormonal intrauterine devices. These IUDs release small doses of progestin (a hormone) that thickens cervical mucus, making it difficult for sperm to pass, and thins the endometrium (the uterine lining), thereby preventing implantation. The effectiveness of hormonal IUDs lasts up to 5 years.
2. Metal-containing intrauterine devices. This type of IUD does not contain hormones. Its contraceptive effect is achieved through the release of copper ions, which are toxic to sperm. Non-hormonal IUDs may remain effective for up to 10 years.

How does an intrauterine device work?

1. Inhibition of sperm passage. Copper ions (or hormonal components) alter the intrauterine environment, creating unfavorable conditions for sperm. Sperm motility is reduced, and their ability to fertilize an egg is impaired.
2. Prevention of implantation. The IUD alters the endometrium, making it unsuitable for implantation of a fertilized egg.
3. Thickening of cervical mucus (in hormonal IUDs). The hormone released by the device thickens cervical mucus, further hindering sperm penetration.

Indications for IUD insertion

1. Desire for long-term contraception. An IUD can be used for 5–10 years, depending on the type.
2. Contraindications to or unwillingness to use systemic hormonal contraceptives (in the case of metal-containing IUDs).
3. IUDs may also be used in nulliparous women; however, they are more commonly recommended for women who have given birth, as insertion may be more comfortable.
4. Treatment of endometrial hyperplasia. Hormonal IUDs may be used to manage certain uterine conditions, such as endometrial hyperplasia, and to reduce heavy menstrual bleeding.

Contraindications for IUD insertion

1. Pregnancy or suspected pregnancy.
2. Active pelvic inflammatory disease (e.g., active cervicitis or endometritis).
3. Uterine anomalies, such as a bicornuate uterus or other anatomical abnormalities.
4. Severe endometrial disease or endometrial cancer.
5. Abnormal uterine bleeding of unknown origin.
6. Allergy to copper (for copper IUDs) or progestins (for hormonal IUDs).
7. Severe cardiovascular disease in which hormonal methods are not recommended.

Advantages of an intrauterine device

1. IUDs are among the most effective contraceptive methods, with a pregnancy prevention rate exceeding 99%.
2. Long-term protection. Depending on the type, an IUD provides protection for 5 to 10 years.
3. Minimal need for ongoing monitoring. Unlike many other contraceptive methods, an IUD does not require daily user action.
4. Hormonal or non-hormonal options. Women may choose a copper IUD if they wish to avoid hormones, or a hormonal IUD for additional regulation of the menstrual cycle.
5. Reduction in menstrual bleeding. Hormonal IUDs can significantly reduce the volume and duration of menstruation and are beneficial in cases of heavy menstrual bleeding.

It is important to attend regular follow-up examinations with a physician to verify correct IUD positioning and monitor overall health. If pelvic pain, heavy bleeding, or signs of infection occur, immediate medical attention is required.

The choice between a hormonal and a metal-containing IUD depends on the individual needs of the patient. When used correctly, an IUD is one of the most reliable methods for preventing unintended pregnancy, with a low incidence of side effects.