As a family planning doctor, I am in the privileged position to educate others about the different forms of birth control that are available.
In today’s story I discuss two different types of Long-Acting Reversible Contraceptives that are available in Australia, these are Intra-Uterine Devices (IUD) which can either be hormonal or non-hormonal. To understand this better, we need to understand a few principles in biology.
What are Hormones?
Hormones are chemical substances that are found in our body that regulate physiology and behaviour, of which we have many. It’s the control of these hormones that allows us to have effective contraception.
Hormonal IUDs
In Australia, currently there are two hormonal IUDs that have been approved for use by the Therapeutic Goods Administration, these are the Mirena and Kyleena, both manufactured by the pharmaceutical company Bayer.
Both of these devices are comprised of a small flexible plastic T. shaped device that fits inside the womb of a lady. The body of the IUD contains the hormone Levonorgestrel which has similar effects to the hormone found naturally in our body known as progesterone. This hormone is released steadily over a period of 5 years. The main difference between the Mirena and Kyleena is the dose of the hormone. The Mirena has approximately two and half times more hormone than Kyleena and is slightly larger in size. Both work as contraception, however, the Mirena, has an added advantage that it can also be used to treat heavy menstrual bleeding after investigations by a doctor and it can also be used with oestrogen replacement therapy during menopause.
How Do They Work?
The hormonal IUDs work in a number of ways, firstly, they thin the lining of the womb helping to prevent implantation of a fertilised egg. They also change the mucus of the cervix (neck of the womb) which makes it tricky for sperm to pass through. In some women, ovulation (release of an egg) is also suspended. The higher hormonal content of the Mirena makes it more likely that periods will be lighter and less painful. As Kyleena has a lower hormonal content, it is more likely to experience more bleeding and spotting in comparison.
Worldwide, there are other brands of hormonal IUD available and these include Skyla, Jaydess and Liletta.
Non Hormonal IUD or Copper IUD
The Copper IUD is similar to the hormonal IUDs in its shape, however, rather than a synthetic hormone at its body, it has a thin copper coil wrapped around it. Some models also have coil wrapped around the arms of the IUD. There are two main types of Copper IUD available in Australia, the Multiload and Copper T, one is licensed for 5 years and the other is 10 years. Depending on where you are in your family planning, your doctor will discuss with you which may be more suitable.
How Do They Work?
As there is no hormone, this particular IUD relies on the effect of Copper. Copper is a natural spermicide which means it will prevent sperm from fertilising an egg.
Side Effects
The hormonal IUDs can cause adverse side-effects such as cysts on the ovaries, headaches, acne and breast tenderness, this can reduce over the first few months depending on your body. The Copper Coil works without hormones so there are less side-effects, however it does often lead to heavier and painful periods especially for the first few months. As such, it may not be suitable for those with exisiting heavy and painful periods.
The Procedure
It is vital that if you are considering such a treatment that you seek an accredited medical practitioner as this is not a routine procedure. This procedure carries risks and doctors must be specially trained to perform it. Usually, they will have additional certification if they are a General Practitioner. For example, I myself have a diploma from the Faculty of Sexual and Reproductive Health which means that I have sat exams and have been assessed for the insertion and removal of contraceptive devices. If you are uncertain about your practitioner’s qualifications, you have every right to ask them. Specialist Nurses with additional training and accreditation can also perform the treatment. Aside from this you may wish to see a Gynaecologist who is a specialist doctor that has spent many years and sat several exams within the specialty of women’s health. Often, if a General Practitioner has some difficulties with insertion or removal, they may refer patients to a Gynaecologist.
The treatment time takes between 10–20 minutes, it can be uncomfortable. So it is very important to take pain relief such as paracetamol and an anti-inflammatory 30 minutes to an hour beforehand.
As with all invasive treatments, there are risks involved, your practitioner will go through this with you prior to insertion but they include:
- One in 1,000 insertions can perforate the womb, which can cause pain in the lower abdomen or at worst a trip to the hospital for surgery.
- One in 200 times the device may fall out, most likely to happen soon after it’s fitted.
- There is a small risk of getting an infection.
- As it is not 100% effective against pregnancy, there is a small chance this can occur which may lead to an ectopic pregnancy (pregnancy outside of the womb) or a miscarriage. These are considered to be serious and you must seek medical advice without delay should this occur.
- The IUDs do not protect you against sexually transmitted diseases, so it is important to always practice safe sex.
It’s always a good idea to have someone on standby to drive you home as you may still experience some cramps after insertion which typically can settle 4–5 days after the procedure. Your practitioner will go through your aftercare instructions after the insertion and it is important that you adhere to these to prevent any complications.
I hope that you have found this article helpful.
Take care and stay healthy,
Dr Nora x
Please note that the contents of this article are not intended to be a substitute for professional medical advice and should not be relied on as health or personal advice. Always seek the guidance of your doctor or other qualified health professional with any questions you may have regarding your health or medical condition.
