Family Planning of Clallam County
Client Information for Informed Consent
INTRAUTERINE CONTRACEPTIVES (IUCs)
IUCs are intrauterine devices (IUDs) and intrauterine systems (IUSs). Before using an IUC, you need to know the advantages, disadvantages, potential risks, and warning signs to watch for. We have listed them here for you. Be sure to read the manufacturer’s information, too. We are happy to answer your questions.
Other methods of birth control are available. We will offer you information about their use, effectiveness, advantages, disadvantages, risks, and warning signs. You should read these materials as well. Let us know if you have any questions about them.
You may notice some differences between the information the manufacturer provides and the information we provide. Please consult your clinician if you have questions about any difference you find.
IUCs are small, T-shaped pieces of plastic. They are put in the uterus. There are two types. The Paragard® contains copper. The Mirena® contains a hormone like the progesterone a woman’s body makes. IUCs prevent sperm from joining with an egg. In theory, they could prevent implantation of a fertilized egg. This has not been proven. For every 100 women who use the IUC, fewer than one will become pregnant during the first year.
IUCs are inserted after a pelvic exam. Some clinicians may offer medicine to soften your cervix beforehand. You may also be given a local anesthetic (to numb the cervix, the opening to the uterus.) Your vagina will be held open with a speculum. Your clinician will steady your cervix with a grasping instrument. The IUC will be inserted through the opening in your cervix into the uterus. You may feel cramping during the procedure. A short length of plastic “string” will hang down into your vagina. You can check the string to make sure that the IUC is still in place. Your clinician can also use it to remove the IUC.
The IUC does not protect against sexually transmitted infections (STIs). Condoms are the best way for sexually active people to reduce the risk of infection. Always use a condom if you or your partner has other sex partners.
Advantages of IUCs
• most effective reversible birth control
• nothing to do right before sex to make it work
• economical
• ability to become pregnant should return quickly when removed.
• can be used while breastfeeding
• works immediately upon insertion
• Mirena (Levonorgestrel IUS) • Paragard (T-380A Copper IUD)
• fewer menstrual cramps • no hormones
• lighter periods/less blood loss — • good for 12 years
periods often stop after a few months.
• less iron deficiency anemia
• good for five years
Both IUCs may be used for emergency contraception
Disadvantages of the IUC
Possible side-effects that usually clear up in the first several weeks or months:
• heavier, longer periods
• cramping or backache
• irregular periods or spotting between periods
Other disadvantages of the IUC
• requires visits to a healthcare provider — must be inserted and removed by a clinician
• mild to moderate discomfort with insertion
• substantial up-front cost
• using Paragard may lead to heavier periods and worse menstrual cramps
Client Information for Informed Consent continued
INTRAUTRINE CONTRACEPTIVES (IUCs)
Risks of using the IUC
• Perforation — Very rarely, the IUC is pushed into and through the wall of the uterus during insertion.This is called perforation. It could damage your internal organs. Sometimes surgery is needed to remove the IUC.
• Expulsion — Occasionally, the IUC will partly or completely slip out of the uterus. This is called expulsion. You can become pregnant if it happens. The IUC must be removed if it is partly expelled. A new IUC can be inserted, if desired.
• Pregnancy — The chance that a pregnancy will happen is very small. When it does, there is an increased risk of serious — potentially life-threatening — problems. They include ectopic (tubal) pregnancy, infection, miscarriage, and early labor and delivery. We recommend immediate evaluation and removal of the IUC if this happens.
• Infection — PID (pelvic inflammatory disease) associated with using an IUC is rare. PID may lead to sterility. It is caused by bacteria getting into the uterus during insertion. Most PID happens within three weeks of insertion. Infection after three weeks is very rare. But it is possible that STIs, such as chlamydia or gonorrhea, can cause PID after insertion. This is why the best candidate for an IUC is a woman at low-risk for STIs.
The IUC cannot be used by women who
• have a current pelvic infection or had a pelvic infection following either childbirth or an abortion in the past three months
• have or may have an STI
• are, or think they are, pregnant
• have cervical cancer that hasn’t been treated
• have cancer of the uterus
• have certain abnormalities of the uterus
• have abnormal vaginal bleeding that has not been evaluated
• have pelvic tuberculosis
• have, or may have, an allergy to copper or have Wilson’s Disease
(Paragard only)
• have severe liver disease (Mirena only)
• have, or may have, breast cancer (Mirena only)
Tell your clinician if you have any of these risk factors or conditions or any other past or current medical problems or concerns. Your clinician will examine you and evaluate your risks — including your risk for STIs — and will help you decide if the IUC is right for you. Sometimes special tests or follow up may be needed.
Warning Signs — call the clinic right away if you
• notice any change in the length of the string or can feel part of the IUC
• have pain or bleeding with intercourse
• think you are pregnant
• have no period after having a period every month
• have been, or might have been, exposed to an STI
• have unusual pelvic pain, cramping, or soreness in your abdomen
• have unusual vaginal discharge
• have unexplained fever or chills
• have unusually heavy bleeding from the vagina
Regular physical examinations for routine health care and for STIs and cancer screening are strongly recommended. Your health is important to us. If you have any questions or concerns please contact us at 360-452-2954. We are happy to help you.