Island Sexual Health Society Be informed, not surprised!

Currently in Canada there are 4 Intrauterine options available. Pictured (not to scale): Copper (various types) and the LNG containing IUDS - Mirena, Jaydess and Kyleena (photo not to scale)

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 four types of IUDs currently available:

  • Copper IUD (non-hormonal) (various models are available)
  • Mirena IUD (contains levonorgestrel)
  • Kyleena IUD (contains levonorgestrel)
  • Jaydess IUD (contains levonorgestrel)

The Copper, Mirena and Kyleena types of IUD can be used for up to 5 years while the Jaydess can be used for up to 3 years to prevent pregnancy.

IUDs do not protect against sexually transmitted infections.

At ISHS, we offer specialized IUD insertion clinics every week. Make an appointment to see a doctor about getting an IUD.

IUDs in detail

How to get an IUD

Make an appointment at any of our clinics in Greater Victoria to begin the process of getting an IUD. More than one appointment may be necessary to have an IUD inserted at ISH.

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 must 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 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, Kyleena, or Jaydess IUD will be given an outside prescription to purchase your IUD and will need to bring it along to their insertion appointment. It’s always a good idea to compare prices as prices do differ between pharmacies.

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.

IUD insertion

  • If you are only using condoms as birth control, you will need to abstain from sex for 2 weeks  or from your last period (whichever is less) 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, or ring 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 inside of the vagina feels flexible and fleshy while the cervix located at 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 400 mg 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 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 ensure you receive a copy of the 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.
  • A follow-up appointment is recommended 3 weeks following your insertion.  If you are experiencing pain or cannot feel the strings before your follow up appointment, you should use abstain from sex or a back up birth control method until you can be examined by a physician.

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 the Jaydess 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)

Copper IUD

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 form 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 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.

Mirena IUD

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 for any duration of time up to 5 years. 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.

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.

Kyleena IUD

The Kyleena IUD is a white T-shaped plastic frame (the frame is the same size as the Jaydess and 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 the lowest failure rate (.2% or 2 pregnancies per 1000 users) of any birth control method and is easily reversible.

Jaydess IUD

The Jaydess IUD is a small white T-shaped frame that contains a hormone that is released slowly and continuously. This hormone (levonorgestrol) is a progestin much like the progesterone produced by the ovaries. It thickens cervical mucus so sperm cannot reach the egg and it also thins the lining of the uterus.  The average effective hormone level in the blood is only 8 mcg which is approximately 12 mcg less than that of the Mirena. The Jaydess IUD is effective for any period of time up to 3 years.

The Jaydess is reported to have a .2% (2 pregnancies per 1000 users) failure rate and is easily reversible.

 

IUD advantages and disadvantages

Advantages of the IUD include:

  • Highly Effective
  • Safe, private and continuous protection for up to 5 years (Copper, Mirena, and Kyleena) and up to 3 years (Jaydess).
  • Convenient: all you have to do is check for the strings each month.
  • 99.2% effectiveness for the copper /99.8% for the Mirena, Kyleena and Jaydess
  • Reversibility
  • 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, Kyleena and Jaydess are all suitable choices for users who cannot 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, Kyleena, and Jaydess.  Some users stop getting regular menstrual bleeding, this is safe (16% of Mirena users,  12% of Kyleena users, and 6% of Jaydess users in 1st year)
  • 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.

IUD Removal

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.