Intrauterine Device (IUD)
An Intrauterine Device or IUD is a long acting, highly effective and reversible contraceptive method. The IUD is a small, flexible plastic device that is inserted into the uterus to prevent pregnancy.
In Canada there are 2 categories of IUDs currently available:
- Copper IUD (non-hormonal) (various models are available)
- Hormone containing IUDs
- Mirena IUD (contains levonorgestrel)
- Kyleena IUD (contains levonorgestrel)
The Copper can be used for up to 5 or 10 years (depending on the type) to prevent pregnancy. Mirena and Kyleena types of IUD can be used for up to 5 years.
IUDs do not protect against sexually transmitted infections. We recommend using a barrier method (condom, dam, glove) with an IUD to reduce the risk of STIs.
At ISHS, we offer specialized IUD insertion clinics every week. Make an appointment to see a health care professional about getting an IUD. Please indicate when booking if you are interested in pursuing this as an option so an appropriate appointment will be given. Hormone containing IUDS are often covered by extended medical benefits or may be covered by fair pharmacare if you qualify.
IUDs in detail
How to get an IUD
Make an appointment at our clinic to begin the process of getting an IUD. More than one appointment may be necessary to have an IUD inserted at ISH.
If you are looking for an IUD clinic in other areas of Canada, the RAICE website will help you locate a clinic.
Pre-insertion education and screening
Before getting an IUD, you may have an orientation session with one of our educators that outlines the benefits. side effects and risks. During this visit an education checklist will be signed indicating which type of IUD you choose.
Secondly, you must see a doctor to determine whether you can safely use an IUD, and be screened for infections (chlamydia and gonorrhea).
All clients wanting a Copper IUD insertion with us usually purchase the IUD at our Quadra Street location on the day of insertion. The total cost for a Copper IUD is $100.80. We are unable to accept and fill prescriptions from other doctors or clinics. If you are purchasing your IUD from an outside source, you must bring the IUD with you to your insertion appointment.
All clients wanting a Mirena or Kyleena IUD will be given an outside prescription to purchase your IUD and will need to bring the IUD along to their insertion appointment. It’s always a good idea to compare prices between pharmacies as prices do differ and aim to pick up your IUD at least 1 week before insertion in the event a pharmacy does not have one in stock and will need to order it.
The cost of an IUD insertion is covered through your provincial medical services coverage. If you are a private pay client, an insertion fee will apply.
If you cancel, reschedule or change your insertion appointment less than 48 hours before your insertion, you will be charged a $50 administration fee that is payable immediately. You will not be permitted to book another insertion until this fee is paid. This fee is to prevent last minute cancellations and changes to our IUD schedule that could impact other patients.
- If you are only using condoms as birth control, you will need to abstain from sex for 2 weeks or from the start of your last period (whichever is later) until the IUD can be inserted. This is important to ensure that you are not pregnant at the time of insertion. If you do not follow these instructions, our doctors will not insert an IUD. If you are using the pill, patch, ring, or shot continue on your method – it’s not necessary to abstain from your last period if you have been using it correctly.
- If you are replacing an existing IUD with a new one, you must abstain for 7 days prior to insertion.
- If the risk of pregnancy can be excluded, an IUD may be inserted at any time during the cycle. It is important to continue using your current birth control method for 7 days post insertion.
- For those who have recently given birth, IUD insertion is offered after 8 weeks post-partum. If you had a Caesarian delivery and/or are breastfeeding, please inform the doctor at your pre-screening appointment.
- Make sure you are comfortable locating your cervix prior to your insertion appointment. The walls of the vagina feel flexible and fleshy while the cervix located near the end of the vagina will feel round and firm. You may also feel a sensation of pressure when you touch your cervix. Knowing where your cervix is prior to the insertion will help you when you do your string self check following insertion.
- The insertion appointment lasts about 40-60 minutes while the actual insertion takes less than 5 minutes. We recommend that clients take 600 mg (3 regular strength) – 800 (2 extra strength) of ibuprofen prior to insertion appointment as that will help with any discomfort you may experience.
- Please eat a light meal 90 minutes prior to your appointment.
- Please bring someone to accompany or drive you home if you are able to as some people may experience cramping or dizziness after insertion.
- If you’ve booked an IUD appointment with us, please refer to your IUD Appointment Reminder Sheet for more info.
Following your IUD insertion:
- Refer to the IUD Patient Aftercare sheet you’ve been given
- After insertion it is normal to experience some cramping and light bleeding. If this feels more uncomfortable than during a menstrual period, contact the clinic to book an appointment to be seen.
- Please refer to your aftercare instructions as you will have to check your IUD strings regularly to ensure proper placement.
- You need to use a back up method of contraception for 7 days after insertion if you’re sexually active during this time.
- A follow-up appointment is recommended 4-6 weeks following your insertion. If you are experiencing pain or cannot feel the strings before your follow up appointment, you should abstain from sex or use a back up birth control method (condoms) until you can be examined by a physician if you are using an IUD for pregnancy prevention.
How IUDs work
The main way that an IUD works is to prevent fertilization; the copper utilizes copper to achieve this while the Mirena and Kyleena use a progesterone type hormone. An IUD does NOT cause an abortion.
An IUD is a very effective method of pregnancy protection. They are 99+% effective at preventing pregnancy. They do not prevent Sexually Transmitted Infections, so we always recommend use of barriers such as condoms, dams and gloves to help reduce the risks and regular testing.
Quick Reference IUD comparison chart (PDF)
The copper IUD has a T-shaped plastic frame wrapped in copper wire. The copper is slowly released into the uterine cavity.The Copper ions in the uterine fluids are toxic to sperm. The Copper IUD stops sperm from making their way through the uterus into the fallopian tubes reducing the ability of the sperm to fertilize an ovum. Ovulation is not affected. The copper IUD is highly effective. Among typical users approx. 8 in 1000 users (.8%) will experience a pregnancy in the first year of use.
Copper IUD as Emergency Contraception:
The copper IUD can be inserted within 7 days after intercourse and is 99.2% (.8% or 8 pregnancies per 1000 users) effective against pregnancy. One of the other benefits of using Copper IUD as emergency contraception is that it can remain in the uterus for up to 5 or 10 years as a long term method. This option is not available as a drop-in service and is only available with an appointment at our Quadra Street location.
Call us for an appointment if you are interested in pursuing this option.
The Mirena IUD is a white T-shaped plastic frame which contains a hormone that is released slowly and continuously. This hormone (levonorgestrol) is a progestin much like the progesterone produced by the ovaries. There is no estrogen in the Mirena IUD. It thickens cervical mucus so sperm cannot reach the egg and it also thins the lining of the uterus. The majority of users continue to ovulate. The Mirena IUD can be used effectively for any duration of time up to 5 years. It can be removed and replaced at the five year mark if someone continues to wish using this method. The average effective hormone level in the blood is 20 mcg which is considerably lower than that of the birth control pill.
Some extended benefit plans cover a portion of the device cost. Check with your benefit provider to confirm eligibility. Other people may be eligible for coverage through Fair Pharmacare in BC.
The Mirena is reported to have the lowest failure rate (.2% or 2 pregnancies per 1000 users) of any birth control method and is easily reversible.
The Kyleena IUD is a white T-shaped plastic frame (the frame is smaller than the Mirena) which contains a hormone that is released slowly and continuously. This hormone (levonorgestrol) is a progestin much like the progesterone produced by the ovaries. There is no estrogen in the Kyleena IUD. It thickens cervical mucus so sperm cannot reach the egg and it also thins the lining of the uterus. The majority of users continue to ovulate. The Kyleena IUD is effective for any duration of time up to 5 years. The average effective hormone level in the blood is 12 mcg which is considerably lower than that of the birth control pill.
Some extended benefit plans cover a portion of the device cost. Check with your benefit provider to confirm eligibility.
The Kyleena is reported to have a similar failure rate to the Mirena (.2% or 2 pregnancies per 1000 users during 1st year of use) and is easily reversible.
IUD advantages and disadvantages
Advantages of the IUD include:
- Highly Effective
- Safe, private and continuous protection for up to 5 or 10 years for the Copper or up to 5 years for Mirena and Kyleena.
- Convenient: all you have to do is check for the strings each month.
- 99.2% effectiveness for the copper /99.8% for the Mirena and Kyleena
- Low cost (over time)
- Research suggests that both the Copper and Mirena IUDs reduce the risk of endometrial cancer.
- Mirena decreases menstrual cramping and dramatically decreases menstrual blood loss ( ~90% reduction in menstrual blood loss). Mirena can reduce the pain of endometriosis.
- Copper, Mirena and Kyleena are all suitable choices for users who cannot or do not wish to use estrogen containing methods including breastfeeding users.
Disadvantages of the IUD include:
- Potential for increased menstrual cramping and blood flow with Copper devices. This differs for each user.
- Irregular bleeding/spotting for 3-6 months after the insertion of a Mirena and Kyleena. Some users stop getting regular menstrual bleeding, this is safe (16% of Mirena users, 12% of Kyleena users)
- Hormonal side effects with Hormonal IUD use are uncommon. The amount of levonogestrel that transfers into the bloodstream is only 5-10% of the birth control pill. Uncommon side effects (1-10% of users) may include headache, acne, mood changes, ovarian cysts, an increase/change in vaginal discharge and/or breast pain.
- There is a 1-10% chance of side effects including irregular bleeding, heavier or lighter periods, headaches, acne/oily skin, ovarian cysts and abdominal/pelvic pain.
- There will be brief discomfort at the insertion of the IUD. This is normal and the degree of discomfort will vary from person to person.
- An IUD does not provide protection against sexually transmitted infections. We encourage the use of condoms to reduce the risk of STIs and add pregnancy protection.
Risks of the IUD include:
- Uterine perforation: rate of 1 per 1000 insertions (rare). All perforations occur or are initiated at the time of IUD insertion. Risk factors for perforation include IUD insertion early after delivery of a baby, an inexperienced inserter or a uterus that doesn’t move around easily.
- Infection: a rate of 1 in 1000 risk for pelvic infection exists in the 20 days following the insertion but the risk is the same as a non-IUD user thereafter. Exposure to STIs are responsible for pelvic infection (PID) occurring after the first month of use not the actual device itself. It is important to remember that the IUD does not protect against STIs.
- Expulsion: 3% or 3 in 100 risk of IUD expulsion (falling out) leading to risk of pregnancy, usually in 1st year. Risk factors for expulsion include insertion too early after delivery of a baby and previous expulsion. A user who has previously expelled an IUD has a 30% chance of expelling a subsequent IUD.
- Failure: If a user becomes pregnant with an IUD in place, the presence of an ectopic (also known as tubal) pregnancy must be excluded. IUDs do not increase the risk of an ectopic pregnancy. If the user chooses to continue the pregnancy, the risk of miscarriage is increased as long as the IUD remains in place.
Removing an IUD is usually a simple process that can happen during a typical office visit with any of our doctors. A doctor removes an IUD by inserting a speculum and using the threads to slide the IUD out from the uterus through the cervix. Some users may experience some brief cramping during removal but usually not to the extent of cramping experienced during insertion.
If you want to become pregnant the IUD can be removed at any time of your cycle.
If you don’t want to become pregnant, a user must abstain from vaginal intercourse for 7 days prior to removal or have begun a hormonal method at least 7 days prior to removal to minimize the risk of pregnancy.
Island Sexual Health is a member of RAICE (Rapid Access IUD Centres of Excellence). RAICE is a network of clinics and health care providers across Canada who are experts in IUD insertion and care.
RAICE clinics must meet the following criteria:
(1) have an expert IUD insertion team;
(2) accept patients making their own appointments without referral by their health care provider;
(3) appointments for IUD discussion and insertion made quickly;
(4) offer training in their communities to the public and/or to other health care providers;
(5) are committed to continuously improving the care they provide;
(6) must provide access to the copper IUD as emergency contraception.
Visit the website to find the nearest RAICE clinic near you.