how to insert iud?
Intrauterine device insertion is an outpatient procedure that should be performed by trained healthcare professionals. Intrauterine devices (IUDs) are an effective and increasingly popular form of reversible contraception. The increase in popularity has been attributed to their efficacy, ease of reversibility, and patient satisfaction, with minimal effort required for long-term use. IUDs are equivalent to tubal sterilization at preventing pregnancy; in addition to vasectomy, they are the most cost-effective method of long-term contraception available in the United States. The IUDs currently available in the United States include the copper T380A IUD (Paraguard) and 2 levonorgestrel-releasing intrauterine systems (Mirena and Skyla).
The World Health Organization and the Centers for Disease Control and Prevention (CDC) have developed guidelines for practitioners regarding IUD use in a variety of clinical circumstances. IUDs are considered appropriate for the majority of women, including nulliparous women and adolescents. Both immediate postpartum insertion (within 10 minutes of placental delivery) and delayed postpartum insertion (within 4 weeks of placental delivery) are acceptable. Similarly, postabortion (spontaneous or elective) insertion is acceptable.
IUD use is safe in women with the following conditions:
Also, women with a history of sexually transmitted infections or a history of pelvic inflammatory disease may safely use an IUD, provided they have been treated and a test of cure has been obtained. .
Absolute contraindications for IUD use include the following:
Ongoing pelvic infections (eg, pelvic inflammatory disease, untreated cervicitis, puerperal sepsis, immediate postabortion or postpartum infection, endomyometritis, pelvic tuberculosis) are also absolute contraindications for IUD placement. In women with these infections, placement should be deferred for 3 months after treatment and a physical examination should be performed prior to insertion to exclude any evidence of persistent infection.
In general, women with a new diagnosis of cervical cancer should not receive IUDs. Although the World Health Organization and the CDC do not recommend the use of IUDs in women with a new diagnosis of endometrial cancer, there are observational studies and case reports suggesting that the 52 mg levonorgestrel-releasing intrauterine system (Mirena) may be an acceptable alternative for treatment in women who strongly desire fertility.
The levonorgestrel-releasing intrauterine systems are contraindicated in women with a history of breast cancer or in women with a benign or malignant liver tumor.
The copper T380A IUD is contraindicated in women with a known copper allergy or in women with Wilson disease.
Complications from IUD placement are relatively rare. The most common complication is IUD expulsion, which occurs in approximately 2-10% of cases. Patients should be encouraged to feel for their IUD strings on a regular basis at home to ensure correct placement. Placement in the immediate postpartum period is associated with a higher expulsion rate than delayed postpartum insertion. Similarly, insertion immediately following first and second trimester spontaneous or elective abortion is also associated with a higher expulsion rate than delayed insertion. There are, however, numerous advantages to postprocedural and postpartum insertion, which may outweigh the risk of expulsion (see Timing of Insertion).
Method failure is an exceedingly uncommon complication of IUD use. The 52-mg levonorgestrel-releasing intrauterine system (Mirena) has a failure rate of 0.2% in the first year of use. The 13.5-mg levonorgestrel-releasing intrauterine system (Skyla) has a failure rate of 0.4% in the first year of use. The copper T380A IUD has a 1-year failure rate of 0.8%. When pregnancy does occur following IUD placement, the pregnancy is more likely to be ectopic. The World Health Organization and the U.S. Food and Drug Administration both recommend IUD removal if pregnancy occurs. Pregnancies that persist with an IUD in place are associated with high risk of complications, including spontaneous abortion and septic abortion.
Your healthcare professional will examine your vagina to check the size and position of your womb. They will then insert a speculum (the same instrument used for a smear test) into your vagina. Your healthcare professional will place the IUD inside your womb.
Before getting an IUD, a person can speak to their doctor about which type is best for them. IUDs come in two forms:
Progestin can prevent ovulation, which means there is no egg for the sperm to fertilize. It also thickens cervical mucus, making it more difficult for sperm to travel to the egg if the body does ovulate.
Hormonal IUDs may help with some premenstrual and hormonal symptoms, such as heavy bleeding or period cramps.
Copper IUDs do not offer any benefit other than contraception, so doctors do not usually recommend them for people who already experience heavy bleeding or severe cramps during menstruation.
IUDs are safe for most people to use. However, those who are allergic to copper should not use a copper IUD.
An IUD can prevent unwanted pregnancy but cannot protect against sexually transmitted infections (STIs).
People should not use an IUD if they have had any of the following:
Women who are pregnant or want to become pregnant should not get an IUD, although it is safe to get an IUD soon after childbirth.
In some people, progestin increases the risk of blood clots in the leg or high blood pressure, so it is vital to tell the doctor about any cardiovascular or other health problems.
Many people worry about pain during an IUD insertion. However, a 2015 study found that women’s self-reported pain, following IUD insertion, was significantly lower than the pain they expected to experience.
Some research suggests that anxiety before the procedure can make insertion feel more painful. Working with an empathetic doctor or nurse, who is willing to take time to discuss the procedure and offer reassurance, may help.
A person may wish to consider asking a doctor what previous experience they have of inserting IUDs. Similarly, they can tell the doctor if they are feeling nervous about what is going to happen.
Some people report that taking over-the-counter (OTC) pain medication, such as ibuprofen, before the procedure helps reduce pain afterward.
First, your nurse or doctor will ask you some questions about your medical history. Then they’ll check your vagina, cervix, and uterus, and they may test you for STDs. You may be offered medicine to help open and/or numb your cervix before the IUD is put in.
To put the IUD in, the nurse or doctor will put a speculum into your vagina and then use a special inserter to put the IUD in through the opening of your cervix and into your uterus. The process usually takes less than five minutes.
IUDs can be put in at any point in your menstrual cycle, and you can usually get one put in right after giving birth or having an abortion.
People usually feel some cramping or pain when they're getting their IUD placed. The pain can be worse for some, but luckily it only lasts for a minute or two.
Some doctors tell you to take pain medicine before you get the IUD to help prevent cramps. They also might inject a local numbing medicine around your cervix to make it more comfortable.
Some people feel dizzy during or right after the IUD is put in, and there's a small chance of fainting. You might want to ask someone to come with you to the appointment so you don't have to drive or go home alone, and to give yourself some time to relax afterward.
Many people feel perfectly fine right after they get an IUD, while others need to take it easy for a while. There can be some cramping and backaches, so plan on chilling at home after your appointment — it’s a great excuse to curl up on the couch with your favorite book or movie. Heating pads and over-the-counter pain meds can help ease cramps too.
You may have cramping and spotting after getting an IUD, but this almost always goes away within 3-6 months. Hormonal IUDs eventually make periods lighter and less crampy, and you might stop getting a period at all. On the flip side, copper IUDs may make periods heavier and cramps worse. For some people, this goes away over time. If your IUD is causing you pain, discomfort, or side effects you don’t like, call your doctor.
Once you get the IUD, a string about 1 or 2 inches long will come out of your cervix and into the top of your vagina; don’t worry, you won’t notice it. The string is there so a nurse or doctor can remove the IUD later. You can feel the string by putting your fingers in your vagina and reaching up toward your cervix. But DON’T tug on the string, because you could move your IUD out of place or pull it out.
There's a very small chance that your IUD could slip out of place. It can happen any time, but it's more common during the first 3 months. IUDs are most likely to come out during your period. Check your pads, tampons, or cups to see if it fell out. You can also check your string to make sure it’s still there. If your IUD falls out, you’re NOT protected from pregnancy, so make sure to go see your doctor, and use condoms or another kind of birth control in the meantime.
Remember when you got your IUD (or write it down somewhere), so you’ll know when it needs to be replaced. The Paragard IUD should be replaced after 12 years. Mirena should be replaced after 8 years. Kyleena should be replaced after 5 years. Liletta should be replaced after 8 years. Skyla should be replaced after 3 years.
You can have sex as soon as you want after getting an IUD.
You might need to use a backup method of birth control (like condoms) until the IUD starts to work — whether you're protected against pregnancy right away depends on what type of IUD you get and when it’s put in your uterus.
Paragard (copper), Mirena, and Liletta IUDs start working to prevent pregnancy as soon as they're in place.
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