THE INTRAUTERINE DEVICE (IUD 1)
WHAT IS IT? HOW DOES IT WORK?
HOW IS INSTALLATION HAPPENED?
Dr. Claude Allouche, gynecologist
Ahuza Clinic, Raanana, Israel
058 726 02 64
WHAT IS IT? HOW DOES IT WORK?
An intrauterine device (IUD) is a contraceptive method inserted into the uterus by a healthcare professional. The IUD is commonly known as a "sterile," but this term is inaccurate as an IUD does not make one sterile. In English, it is called an Intra-Uterine Device (IUD), and in Hebrew, "hetken" התקן.
What is it? Mazé?
It is a contraceptive device, mostly shaped like a "T," which is approximately 3 cm long.
The doctor or midwife inserts it into the uterus. In Israel, only doctors are authorized to insert IUDs.
The IUD ends with a thread that the doctor cuts very short during insertion. It is long enough for the doctor or midwife to remove the IUD with small pliers. The visible thread during a speculum exam does not interfere with sexual intercourse.
In France and Israel, there are two types of IUDs:
Non-hormonal copper IUD
Hormonal progestin-releasing IUD
HOW DOES IT WORK?
1/ Copper IUD
It is made of plastic with one or several copper sleeves, presenting a copper surface > 250 mm2;
It triggers an inflammatory reaction in the endometrium, the inner layer of the uterus.
This "foreign body inflammatory reaction" prevents sperm from reaching the uterine tubes and implantation of an embryo in the uterine cavity.
Copper also has a probable "spermicidal" effect.
The copper IUD comes in two sizes: "short" and "standard." So, there is an IUD suitable for all uterus sizes. For example, a woman who has never been pregnant (with a smaller uterus) can have a "short" IUD inserted. The smallest ones are 2 cm wide and 2.8 cm long.
In France and Israel, there are several brands of copper IUD, most of them shaped like a T, such as NovaT200, NovaplusT380, Mona Lisa, UT380, Multiload, etc.
There is also a particular form of copper IUD recently marketed: the IUB BALLERINE IUD.
This IUD is made of a nitinol wire (a nickel and titanium alloy) on which mobile copper beads are threaded. This wire takes a spherical shape upon release from the insertion guide into the uterine cavity, measuring approximately 15 mm in diameter and weighing less than 1 g. It is no longer in a T-shape and may be useful for patients who have not tolerated a traditional IUD before.
The copper exposure surface after deployment of the device is 300 mm². Copper provides contraceptive activity, mainly by interfering with the motility of sperm and the fertilization of an egg and/or the possible prevention of implantation.
In France, the Ballerine IUD is not reimbursed by social security, while others are.
In Israel, this does not matter because no IUD is reimbursed by the koupot holim (health funds).
2/ Hormonal Intrauterine Device (IUD)
This hormonal IUD is also called "Intrauterine System" or IUS. It contains a progestin hormone (levonorgestrel) that it will release in small amounts inside the uterus and its diffusion will be mainly local. This hormone has several effects:
Contraceptive effect: it thickens the secretions of the cervix ("entrance") of the uterus, which will prevent sperm from passing through.
Effect on periods: the hormonal IUD can reduce the duration and volume of periods as well as the painful contractions that accompany them; some users do not have periods while they have a hormonal IUD. In these cases, not having periods is safe for health or fertility.
There are now 3 types of hormonal IUDs all manufactured by the same laboratory:
Mirena, the oldest, the most dosed in hormones 52 mg, the largest 32 * 32 * 4.8 mm, effective for 5 years.
Kyleena, more recent, a little thinner 28 * 30 * 1.55 mm and also effective for 5 years.
Janess (called Jaydess in France), thinner 28 * 30 * 3.8 mm, less dosed in hormones 13.5 mg but also effective for a shorter time, 3 years, ideal for nulliparous women.
The choice of the type of IUD will be decided with the gynecologist based on the patient's wishes after informed consent, personal history, and medical history.
THE IUD (IUD 2): HOW IS INSTALLATION HAPPENED?
How do you get an Intrauterine Device (IUD) inserted?
Whether copper or hormonal, the IUD can be inserted in France by a gynecologist, a midwife or a general practitioner, in Israel only by a gynecologist, in kupat holim or privately.
The installation of the IUD is called in Hebrew “hatkanat hetken התקנת התקן”
A consultation prior to insertion is necessary so that the patient receives the essential information on the advantages and disadvantages of the different IUDs in order to allow her to choose the type of IUD that will suit her best, but also on the risks and possible complications. .
On this occasion an information form is often given in kupat holim, a form which must be signed by the patient.
As the IUD is only issued on medical prescription, a prescription will be given so that the patient can purchase it in a pharmacy.
In France, the copper IUD is reimbursed at 30% by social security (except the Ballerina which is not reimbursed) while the hormonal IUD is reimbursed at 65%.
In Israel it is simpler: it is not reimbursed at all and even its kupat holim installation is chargeable….
Historically, the copper IUD was preferably inserted during or at the end of menstruation, in order to be certain of the absence of pregnancy and to make the procedure less painful (the passage of the IUD is easier through a half-open cervical uterine orifice) .
But currently more and more doctors agree to perform it outside the rules, for reasons of organizing appointments, and of the patient's discomfort at being examined during her period.
With modern means it is now easy to ensure the absence of pregnancy at the time of insertion, depending on the contraception used by the woman previously.
Thus, the copper IUD can be inserted at any time during the cycle.
For the hormonal IUD, it is recommended that the insertion takes place within a week following the period in order to reduce the risk of untimely bleeding caused by the occurrence of the period a few days after insertion.
The IUD is inserted during a gynecological consultation.
The doctor places the speculum.
It disinfects the cervix using a sterile compress and an antiseptic.
After measuring the size of the uterus with a hysterometer and Pozzi forceps (small forceps used to grasp the cervix), he sterilely inserts the IUD into the uterus (through the natural channels) then cuts the thread using using a pair of scissors.
An ultrasound is done immediately to check the correct positioning of the IUD.
This gesture of a few seconds is generally not very painful, even if it is not supposed to be pleasant either….
To be sure to avoid pain, it is possible to take painkillers two hours before the installation.
After insertion of an IUD, regular gynecological follow-up is necessary and in general the patient is asked to return once 4 to 6 weeks later to check that the IUD has not moved.
At a minimum, one check-up visit per year will ensure that the IUD is correctly placed and will allow us to assess its tolerance.
The frequency of these checks should be discussed with the healthcare professional, generally once
Other files on the same subject:
- The IUD (IUD 1): Mazé? How it works?
- The IUD (IUD 3): How effective?
- The IUD (IUD 4): When and how to remove it?
- The IUD (IUD 5): Which one to choose?
Advantages and disadvantages
- The IUD (IUD 6): What are the risks and complications?
- The IUD (IUD 7): What to do in the event of pregnancy on an IUD?
- The IUD (IUD): What monitoring?
- The IUD (IUD 9): What contraindications?