Inserting a Contraceptive Device? What’s that?

So this post was inspired the readers/followers on social media. This past week, there has been an Instagram post making the rounds online about the unfortunate case of a young woman who has suffered quite severe side effects from an Intrauterine device.

I don’t have all the details of the case but I noticed that the post generated a lot of comments from women who were either glad they were not on any sort of hormonal or device contraception or women who vowed to stick to the withdrawal method for contraception. I conducted a survey of 100 Nigerian women mostly in Nigeria and I found that about 21% of women were using a contraceptive device (3% - Implant and 18% for the coil or IUD). A lot of their decision was based either on the fear of hormones or the fear of a foreign device being.

Whilst I’m all for autonomy and women having the right to decide what works for them, I am also passionate about women making well informed  medical decisions based on facts/evidence but not fear. 

As previously discussed on the blog here. Contraception methods are vast but this post will further explore contraceptive devices ie the Implant and Coil.

 The Implant 

The implant is a very small plastic rod(about the size of matchstick) that is inserted using local anesthetic to the upper arm. It releases the hormone progesterone into the blood stream and lasts for 3 years.Progesterone works mainly by stopping ovulation but also by thickening cervical mucus which makes it difficult for sperm to travel through the cervix.  It is more than 99% effective and is not dependent on a woman remembering to do anything so its convenient. It is particularly useful for women who cannot use contraception with oestrogen. It can be taken out at any time and fertility is restored quickly.

You can have the Implant fitted anytime by a trained nurse or doctor provided you are not already pregnant  or have any mdical conditions that contradict its use ( A pregnancy test should be done prior to fitting an implant!). If fitted with the first 5 days of your menstrual cycle, you are immediately protected against becoming pregnancy, at any other time , you will need to use a condom for the first 7 days.

Implant

NB:An implant may not  be suitable for you if you have or have had breast cancer in the last 5 years,have unexplained bleeding, arterial disease, liver disease, heart disease or have had a stroke or some other medical conditions. Please speak to a qualified medical preactitioner for a thorough assessment before having the implant fitted.

Pros

• 99% effective
• Can be used if breastfeeding
• Lasts 3 years
• Fertility is restored quickly for women who want to conceive.
• It is an option for women who cannot use oestrogen based contraception
• It could help reduce heavy or painful periods.

Cons

• Periods may become irregular or stop
• Can cause acne or make existing acne worse
• Some women may experience headaches, mood swings , breast tenderness and nausea in the first few months
• You will need a small procedure to insert and remove the implant
• It does not protect against sexually transmitted infection, so you will need barrier contraception as well.

You should contact a health practitioner, if you can no longer feel the implant, it feels like it has changed shape or you notice any skin changes or pain around the implant site.

The IUD or IUS

Copper IUD on the left  vs IUS 

So the IUD (intrauterine device)and IUS (Intrauterine system)have both been traditionally called the coil and often are referred to collectively as an IUD. Strictly speaking however,  the IUD is a small T shaped copper device that releases copper locally within the womb to prevent pregnancy the IUS releases progesterone.
When inserted correctly, both devices are 99% effective and the IUS can last up to 5 years with the IUD lasting longer up to 10 years.
The copper alters the cervical mucus, which makes it more difficult for sperm to reach an egg and survive. It can also stop a fertilised egg from being able to implant itself. If you're 40 or over when you have an IUD fitted, it can be left in until you reach the menopause or you no longer need contraception.
The IUS is similar in its mode of action. It thickens the cervical mucus, which makes it more difficult for sperm to move through the cervix, and thins the lining of the womb so an egg is less likely to be able to implant itself.For some women, it can also prevent the release of an egg each month (ovulation), but most women continue to ovulate.If you're 45 or older when you have the IUS fitted, it can be left in until you reach the menopause or no longer need contraception.
Before your IUS or IUD is fitted, a practitioner  will do a pregnancy test and also check inside your vagina to check the position and size of your womb.You should also tested for any existing infections, such as STIs, and be given antibiotics as insertion of any device in the presence of infections could make infections worse.
You may have an infection if you have;pain in your lower abdomen,a high temperature or smelly discharge
During the procedure,the vagina is held open, like it is during a smear test (cervical screening) and the IUS/IUD  is inserted through the cervix and into the womb, this can be uncomfortable so please speak to your practitioner about pain relief before hand.
Once an IUS is fitted, it'll need to be checked by a GP after 3 to 6 weeks to make sure everything is fine.Tell the medical practitioner  if you have any problems after this initial check or you want to have it removed.
There is a small risk of expulsion/rejection within the first few weeks of insertion so it is important to always check that it is in place. There is also a very small risk of damage to the womb if not inserted correctly, this should be rare if it is inserted by a trained and experienced practitioner. Also if this method fails and you get pregnant, there is a small increased risk of an ectopic pregnancy.
Checking your IUD/IUS
An IUD/IUS has 2 thin threads that hang down a little way from your womb into the top of your vagina.The practitioner that fits your device will teach you how to feel for these threads and check that the it is still in place. It is reccommended that you check your IUS/IUD  is in place a few times in the first month and then after each period, at regular intervals.
However both devices are not suitable for everyone and it is important that you undergo a thorough consultation with a medical practitioner before deciding.A coil is not suitable for anyone with promblems with the womb or cervix, a pelvic infection or  fibroids that are distorting the shape of the womb. The IUS which releases progesterone may also not be suitable for all the reasons that the implant may not be suitable, refer to list above.
Although both devices are similar, they have different Pros and Cons and I have made a short list for both:

checking for coil threads

IUD-Pros

• Convenient as once fitted, does not interrupt timing of intercourse.
• Lasts long 5-10 years
• Safe to use whilst breastfeeding.
• No hormonal side effects like headaches,  breast tenderness etc
• Fertility is restored once it is removed
• There's no evidence that an IUD will affect your weight or increase the risk of cancer.

IUD-Cons

• Heavier, longer or more painful periods which may or may not improve with time
•  It doesn't protect against STIs, so you may need to use condoms as well
• If you get an infection when you have an IUD fitted, it could lead to a pelvic infection if not treated.

IUS-Pros

• Convenient as once fitted, does not interrupt timing of intercourse.
• Lasts long 3-5 years
• Safe to use whilst breastfeeding.
• It may be a good option if you are not able to take the hormone Oestrogen.
• Your periods can become lighter, shorter and less painful – they may stop completely after the first year of use- this is particularly useful in women who have heavy periods

IUS-Cons

• Periods may become irregular or stop completely, which may not be suitable for some women.
• Some women experience headaches, acne and breast tenderness
• Some women experience changes in mood and libido, but these changes are very small.
• An uncommon side effect of the IUS is that some women can develop small fluid-filled cysts on the ovaries – these usually disappear without treatment
•  It doesn't protect against STIs, so you may need to use condoms as well
• If you get an infection when you have an IUD fitted, it could lead to a pelvic infection if not treated.

So there you have it, it feels like information overload but I thought it was useful to put as much information out there so women can take well informed decisions. Contraception is a deeply personal decision and different women chose different methods for different reasons. The aim of this post was to simplify and demystify these methods so that women do not fear them. They are valid choices and come with their own unique side effect profile as with some other methods. Whilst they are very effective choices,it is important to note the side effects and to take adequate precautions to avoid them. Most pertinent is to always check for coil threads and look out for signs of infection so that medical attention is sought sooner rather than later.

Do you use any of these methods? how have you found them? any horror stories or success stories you want to share? comment below.

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