The intrauterine device (IUD) insertion and removal is a common gynecological procedure primarily used for long-term contraception or specific medical needs. This treatment involves placing the contraceptive device into the uterine cavity to provide reversible contraception or, in certain cases, removing it to restore fertility. The procedure is typically performed on an outpatient basis, taking about 5 to 15 minutes, but must be carried out by a qualified physician after assessing the patient's health condition.
The main purpose of an IUD is to offer an effective and long-term contraceptive method, with advantages including a success rate of up to 99%, a duration of 3 to 10 years, and rapid return of fertility after removal. Additionally, certain hormonal IUDs can be used to treat menorrhagia or endometriosis.
IUDs are divided into copper and hormonal types. Copper IUDs (such as Paragard) inhibit sperm activity and embryo implantation through copper ion release, while hormonal IUDs (such as Mirena, Kyleena) release progestin-like substances, thinning the endometrial lining and thickening cervical mucus to prevent sperm penetration.
Their mechanism mainly involves altering the uterine environment to prevent fertilization or implantation, with immediate effect (copper IUDs require a 5-day waiting period to ensure proper placement). Hormonal IUDs can also reduce menstrual bleeding and provide various medical benefits.
Suitable for women with stable partners and no congenital uterine abnormalities or infection risks. Some hormonal IUDs are also approved for symptom relief in endometriosis.
Prior to insertion, uterine size measurement and infection screening are necessary. The physician will dilate the cervix and place the IUD at the uterine fundus. The choice of device depends on the patient's age, uterine condition, and health history; for example, women over 35 who do not smoke may opt for hormonal types, and those with multiple pregnancies should choose appropriately sized devices.
The removal procedure is usually performed on an outpatient basis, using special forceps to grasp the tail string of the IUD. It is recommended to perform removal during menstruation or when the cervix is more relaxed to reduce the risk of uterine perforation.
Compared to other contraceptive methods, IUDs reduce the hassle of daily medication and do not contain estrogen, making them suitable for breastfeeding women or those with hypertension. Hormonal IUDs can also improve irregular menstrual cycles.
Common short-term discomforts include lower abdominal cramping and spotting between periods, which usually resolve after a few months. It is important to note that serious infections, uterine perforation, or device displacement are rare but can lead to severe complications.
Hormonal IUDs may cause intermenstrual bleeding or breast tenderness, while copper IUDs may worsen menstrual flow and dysmenorrhea. Immediate medical attention should be sought if severe abdominal pain or fever occurs.
Pre-insertion screening includes Pap smear, screening for uterine infections (such as STDs), and uterine position assessment. If pregnancy is suspected or there is a history of severe thrombosis, alternative contraceptive methods may be recommended.
Copper IUDs combined with anticoagulants may increase bleeding risk, while hormonal IUDs with antiepileptic drugs (such as carbamazepine) may reduce efficacy. Concurrent use of IUDs with oral contraceptives does not enhance effectiveness and may increase thrombosis risk.
Patients undergoing radiation therapy or immunosuppressive treatment should discuss risks and alternatives with their healthcare provider.
Clinical studies show that the failure rate of copper IUDs is less than 0.8% annually, and hormonal IUDs can reduce menstrual flow by up to 90%. Long-term follow-up indicates that over 95% of patients regain normal ovulation within six months after removal.
The World Health Organization (WHO) classifies IUDs as a first-line contraceptive method, with efficacy and safety confirmed through multiple meta-analyses. The benefits of hormonal IUDs in improving menstrual-related symptoms have been published in top journals such as The New England Journal of Medicine.
Oral contraceptives or barrier methods (such as condoms) are options but lack the long-term stability of IUDs. Implants are convenient but require replacement every three years, while tubal ligation is a permanent option.
The physician will compare the effectiveness and side effect risks of each method based on the patient's age, reproductive plans, and health status, providing personalized recommendations.
What examinations or preparations are needed before placing an IUD?
Before IUD insertion, it is recommended to perform a Pap smear, screening for uterine infections (such as STDs), and uterine position assessment. The doctor may advise avoiding the procedure during menstruation and recommend fasting for 4 hours prior if anesthesia is needed. Additionally, inform the doctor of any history of uterine surgery or allergies to evaluate suitability.
What should I do if I experience severe abdominal pain or heavy bleeding after IUD placement?
If severe abdominal pain, fever over 38°C, or bleeding exceeding normal menstrual volume occurs within 24 hours after placement, seek medical attention immediately. It could be uterine perforation or infection requiring urgent treatment. Mild discomfort can be managed with prescribed painkillers and symptom monitoring.
Should I avoid lifting heavy objects or vigorous exercise after IUD placement?
It is advisable to avoid lifting objects over 5 kg and strenuous activities within 24 to 48 hours post-procedure to reduce the risk of uterine bleeding or device displacement. Normal walking and light activities can generally continue, but specific restrictions should be adjusted based on individual recovery and medical advice.
Is there a high risk of IUD displacement or expulsion after placement? How can I detect abnormalities?
Initial use of IUD has a 3-5% chance of displacement or expulsion within the first year, most commonly within three months post-procedure. If irregular menstrual intervals, feeling the tail end during intercourse, or persistent lower abdominal discomfort are observed, an ultrasound should be performed promptly to confirm position. Regular follow-up can reduce risks.
If IUD removal is planned and I want to conceive, how long should I wait before trying?
Fertility can be attempted immediately after IUD removal, with no waiting period. However, if a progestin-containing device (such as a hormonal IUD) was used, some women may need a few weeks to restore normal ovulation cycles. Discuss reproductive plans with your doctor before attempting pregnancy and ensure no residual device remains in the uterus.
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