IUD

IUD 101: How It Works, Types, Benefits & Costs

An IUD is one of the most widely known contraceptives provided for women. Learn more about how it works, its types, benefits and costs in Malaysia.

by Ain Nadzirah

Intrauterine Device (IUD) has been widely acknowledged to be one of the most effective contraceptives or birth control provided for women, a great alternative to the commonly used condoms. Contraception has been promoted extensively in everyone’s lives mainly for quality family planning, as it is regarded as one of the fundamentals in a marriage. In fact, through the Ministry of Women, Family and Community Development, the Malaysian government has initiated family planning efforts with the establishment of the National Population and Family Planning Act in 1966. 

Since then, health professionals are bound to introduce you to female contraception methods after you give birth to your first child. The rationale behind such a strategy is to ensure an optimal distance for a subsequent pregnancy and for couples to plan their family size. Aside from functioning as a means of family planning, contraception prevents a myriad of health problems caused by unsafe sex such as sexually transmitted diseases (STDs) and most importantly, unintended pregnancies. 

What is IUD?

IUD

IUD stands for Intrauterine Device and is also known as the coil. It is a method of birth control in the form of a small T-shaped device made out of plastic, with a thin string attached to the bottom. 

Despite its intimidating-looking appearance, a growing number of women and health professionals are expressing their interest in the use of IUDs. The major reason being is due to its high success rate of more than 99% in preventing pregnancies long-term.  

Types of IUD 

Generally, there are two types of IUD available:

  • Hormonal (Progestin-releasing IUD)

As the name suggests, a hormonal IUD acts by releasing a hormone called progestin into the wall of the uterus. Progestin is the artificial or synthetic form of progesterone hormone which is produced naturally in a woman’s body during pregnancy. This type of IUD can last up to 5 or 6 years.

  • Non-Hormonal (Copper IUD)

Instead of releasing hormones, the copper wire wrapped around the arms and stem of the T-shaped IUD lets out and dissolves copper molecules into the uterus which are toxic to the survival of sperms. The longevity of copper IUD lasts longer up to a maximum of 10 to 12 years.

How does it work?

Both IUDs share similar functions in creating an unwelcoming environment for pregnancy by:

  • thickening the mucus in the cervixslimy fluid at the entrance of the uteruswhich helps to block sperms from travelling further to the egg in case we ovulate and therefore is spermicidal (able to reduce the survival rate of sperms and kill them).
  • affecting the fluid in the uterus and fallopian tubes to limit the movement of sperms.
  • thinning of the uterus lining which makes it difficult for a fertilized egg to be implanted.
  • activating the foreign body responsewhereby our immunity system will recognize the IUD as a foreign object and will then secrete white blood cells to fight against all kinds of unfamiliar cells, including sperm cells. 
  • (for hormonal IUD) constantly keeping the level of progesterone hormone elevated to prevent ovulation. When there is a high progesterone level, our ovaries will normally stop producing more ova or eggs. No eggs mean no fertilization and therefore, zero pregnancy.

Costs and availability

The insertion and removal of IUDs are charged differently according to the type of IUD used.

Cost of Hormonal IUD: Insertion is charged between RM800 to RM1,100 at private clinics, while removal is around RM20. A common brand available in Malaysia is Mirena.

Cost of Copper IUD: Insertion is approximately RM80 to RM110 at government clinics and RM500 to RM600 at private clinics. Typical brands recommended in Malaysia are Multiload, Mona Lisa, and Nova-T.

Nevertheless, it is relevant to note that the above charges only serve as an average estimation, thus are subject to higher costs as the year passes.

Benefits of IUD 

  • Cost-effective

You only need to spend expensively once per insertion for long-lasting protection.

  • Easily reversible

If you change your mind on pregnancy after insertion, all that is needed is a simple removal or expulsion by your doctor. 

  • Convenient

Once insertion takes place, you do not have a daily schedule to adhere to and no longer have to fret for the next 10 years, except for regular check-ups.

  • Safe for breastfeeding moms

Unlike some birth control pills, IUDs do not contain estrogen hormones which can affect the production of breast milk. 

Disadvantages of IUD

  • Unable to protect you against STDs

As there is still direct contact and no barrier between you and your partner during sex, it is advisable to practise safe sex by using it together with condoms to lower the probability of infections.

  • Must be done at a clinic setting

The insertion and removal procedure should only be administered by healthcare professionals as it requires examination of your internal reproductive organs. 

  • Risks of pelvic infection 

Pelvic infection can be a potential risk if the health professional does not practise good hygiene during insertion or removal of IUD into your uterus.

  • Risks of reproductive-related complications.

If misplaced in the uterus, it can lead to complications to the womb that may be detrimental to your health during pregnancy in the future. 

Which IUD is better?

If the two IUDs above serve the same roles, you may wonder why they expel different substances and if one type is better than the other. Upon deliberating with your doctor, the choice of IUDs might depend on the following considerations: 

Medical conditions

If you are allergic to copper or living with Wilson’s diseasea genetic disorder that accumulates excess copper in your organs due to its inability to be eliminated from the body, it is sensible to opt for the hormonal IUD. However, if you are unable to use hormones due to medical histories such as breast cancer and blood clot which risks may be increased by progesterone hormones, you might want to explore the copper IUD as an alternative.

Menstruation patterns 

Hormonal IUD might be more appealing to women who have been experiencing heavy periods every month. This is because the progesterone hormones from the IUD can help to regulate them to be lighter or possibly to no bleeding at all, aside from reducing menstrual cramps. As opposed to non-hormonal IUD, the copper released may result in heavier periods and bad cramps due to chemical reactions to copper. 

Family planning 

As a married person, it is normal to contemplate over plans of having kids in the future. If your plans are not going to be expected anytime soon, choosing an IUD that is durable for a longer period, in this case, copper IUD, is more viable. 

Personal preferences

For certain women, copper IUD is more preferred because experiencing hormonal changes such as weight gain, acne, breast tenderness, and mood swings as side effects of using progestin-releasing IUD may be unfavourable. 

What to expect during insertion

Before

Inserting IUD can be an intricate procedure, which is why you should book an appointment with your trained doctor several days or weeks prior. It is crucial to ask for clarifications regarding any questions and uncertainties that you may worry about before proceeding any further. This is when he or she will walk you through a list of various contraception methods to weigh the pros and cons. If you have decided to settle on IUD as birth control, you should consult on the overall procedureincluding which type of IUD fits you the best according to your medical records, age, and personal preferences. 

Having your doubts cleared up can help minimise anxiety and tension on the actual day of insertion, which later eases the pain or discomfort that might arise. Still, if you express concern over the pain, do seek advice from your doctor on whether there is a need to consume pain relievers. 

During

  1. It is advisable to come early as you will be requested to undergo a urine test to ensure no signs of pregnancy and sexually transmitted diseases (STDs).  
  2. The doctor will conduct a pelvic examination which is similarly performed during a Pap smear. This means that the method of inserting two gloved fingers that are lubricated inside the vagina shall be expected. 
  3. They will first apply an antiseptic liquid to clean your vagina from any possible infections. A speculum is then used to open the walls of the vagina to check the condition of your internal reproductive organs i.e. vagina, cervix, uterus, and ovariesparticularly the position of your uterus. 
  4. Once completed, the doctor will measure the length from your cervix to the uterus with a medical tool called ‘sound’, to confirm that the IUD will fit properly within your uterus cavity and not protrude into any of the internal organs. 
  5. The doctor will fold down the arms of the T-shaped IUD into a small tube with a slider on the handle. Next, the tube will be inserted through your cervix into the uterus according to the depth as measured previously. 
  6. Once the IUD is placed at an optimal position, they will push the slider to release its arms back to its ‘T’ shape before removing the tube.
  7. The final step is to trim the string at the bottom of the IUD so that only one to two inches is left hanging in your vaginal canal, for ease of replacement or removal if needed. 

The insertion itself takes up only about 5 minutes but the entire process can extend up to 30 minutes. However, you may want to stay for an extra few minutes to relax until you feel ready to go. Hence, it is best to bring someone to accompany you on the way home in case you do not feel well. 

After

The healthcare professional will provide you with the details of the IUD including follow-up dates and expiration of the IUD. You will likely be advised to get a good rest for the remaining parts of the day right after the insertion, as there may be a feeling of discomfort and mild cramping lingering afterwards. 

Post-insertion care, especially in the first few months or years, should be observed as you try to get comfortable with the presence of an IUD in your uterus. Side effects such as vaginal bleeding or spotting, irregular periods and mild cramps are common as your body will take some time to adapt before it can return to its normal state. Even so, if the side effects continue to prolong or worsen for more than 3 months, please seek medical help immediately. 

Frequently Asked Questions on IUD

When can an IUD be inserted?

Insertion of IUD can take place at any time as long as there is a guarantee that you are not pregnant, which is why you are required to take a urine test at the beginning of the procedure. Some health providers may recommend insertion during menstruation due to two reasons; menstruation confirms no pregnancy, and the cervix is softer during this time so insertion will be less painful. 

When can an IUD be removed?

IUD is easily reversible so it can be taken out by a healthcare professional whenever you wish to stop your birth control and start conceiving. 

If you intend to resume the same contraception method but your IUD reaches its expiration, you should consult your doctor for a replacement. This is important as an expired IUD staying in your uterus might lose its effectiveness in preventing pregnancy and may also lead to other health complications.  

Who can use an IUD?

Contrary to popular misconceptions, IUDs are safe for almost everyone, including teenagers and single women. Aside from inhibiting pregnancies, a major use of hormonal IUDs is to aid in adjusting your heavy menstruation to lighter periods, as well as easing menstrual crampsboth of which are extremely useful particularly for young ladies 

Can an IUD be out of place? 

It is rare but there is a possibility of the IUD slipping out of place or even falling out. Some symptoms to look out for:

  • The string sticking out of your vaginal canal seems shorter or longer than usual.
  • You can feel the hard plastic part of the IUD protruding.
  • Your partner can feel the hard plastic part during sexual intercourse.
  • You experience abnormal pain or heavy bleeding that extends more than 3 months. 

To avoid such circumstances, it is essential to make regular check-ups with your doctor in the first few months after the insertion. In no case should you pull the string yourself without any medical supervision as it can cause unintended internal injuries. 

How long does it take for an IUD to work?

Non-hormonal or copper IUD works immediately upon insertion, which makes it a great emergency conception. So if you recently have unprotected sex and worry about the likelihood of unwanted pregnancy, a copper IUD can help you solve the problem.

On the other hand, hormonal IUDs are effective immediately only if insertion occurs during menstruation. If not, it will need an extra 7 days to fully function which compels you to have backup birth control like condoms during this period.

Can sexual intercourse be performed with an IUD?

Absolutely. IUD should not affect sexual activities, except for your partner feeling the presence of the string. Apart from that, sex with an IUD is not supposed to cause any pain to both you and your partner.  

Can I still get pregnant while using an IUD?

Despite the high rate of effectiveness, there is still a small chance for you to be impregnated. As a precaution, seek medical advice as soon as you experience early symptoms of pregnancy or positive test results. Being pregnant with an IUD can lead to a higher chance of miscarriage and other reproductive-related risks like ectopic pregnancywhen a fertilized egg is implanted outside of the uterus usually somewhere in the fallopian tubes. 

Key Takeaways

All in all, Intrauterine Devices or IUDs can serve as your best bet in preventing unwanted pregnancies because it is long-lasting, reliable and can be easily reversed if you have a change of plans for conception in the future. IUDs are generally safe for women of all ages; however, there are many factors to consider such as medical history, condition of your reproductive organs, financial capability, and personal comfort before your doctor can allow the use of IUD. As this type of birth control requires the supervision of health professionals, regular doctor consultations and appointments are recommended whenever you feel uneasiness or abnormal pain to avoid possible health risks.

Our body as a woman deserves the utmost care and one of the ways to ensure that is through a good decision made after weighing all possible considerations. So if you have second thoughts on IUDs, no worries! There are always other methods to opt for that can suit your needs better. 


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References

Gunzburger, J. (2020, January 10). How Long Should I Wait to Have Sex After Getting an IUD? Nurx. https://www.nurx.com/faq/how-long-should-i-wait-to-have-sex-after-getting-an-iud/

HH Siraj. (2012, April 27). Contraception. MyHealth – Ministry of Health Malaysia. https://www.cdc.gov/reproductivehealth/contraception/index.htm

Paimin, F. (2019, August 23). Family Planning. MyHealth – Ministry of Health Malaysia. http://www.myhealth.gov.my/en/family-planning/ 

Higginbotham, V. (2018, July 05). Copper Intrauterine Device (IUD). The Embryo Project Encyclopedia. https://embryo.asu.edu/pages/copper-intrauterine-device-iud

Higginbotham, V. (2019, September 06). Hormone Releasing Intrauterine Devices. The Embryo Project Encyclopedia. https://embryo.asu.edu/pages/hormone-releasing-intrauterine-devices 

How To Prepare For IUD Insertion. (2020, October 5). Raleigh Gynecology & Wellness. https://gynraleigh.com/how-to-prepare-for-iud-insertion/

Mauer, E.D. (2021, August 19). Could You Get Pregnant With an IUD? Parents. https://www.parents.com/pregnancy/signs/symptoms/pregnancy-with-an-iud-is-it-possible/

Ministry of Women, Family and Community Development. (n.d.). National Population and Family Planning Act. https://www.lppkn.gov.my/index.php/en/features/akta-lppkn 

Suraya. (2019, September 4). The Comprehensive Guide to Cost of Birth Control in Malaysia. Ringgit Oh Ringgit. https://ringgitohringgit.com/saving-money/birth-control-in-malaysia/

What To Expect After An IUD Removal. (2020, December 24). Raleigh Gynecology & Wellness. https://gynraleigh.com/what-to-expect-after-an-iud-removal/ 

When is the best time to have an IUD inserted? (2020, March 18). Planned Parenthood Regina. https://www.plannedparenthoodregina.com/when-is-the-best-time-to-have-an-iud-inserted/  

Women’s Health Team. (2020, May 22). Do the Benefits of an IUD Outweigh the Potential Side Effects? Cleveland Clinic. https://health.clevelandclinic.org/do-the-benefits-of-iuds-outweigh-the-potential-side-effects/ 

World Health Organization. (2015). Medical eligibility criteria for contraceptive use (5th ed.). https://apps.who.int/iris/bitstream/handle/10665/181468/9789241549158_eng.pdf

About the Writer
Ain Nadzirah
Ain is just another small-town film buff who treats her car rides as a stage to belt out show tunes and musicals. It is not a strange sight to spot her talking to her 14 cats at home, or arguing with her grandma over having too many (and counting) potted flowers.
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