Intra-Uterine Device (Copper)

Sexual and Reproductive Health

What is an IUD?
An intrauterine device is an object inserted through the cervical canal by a medical practitioner and placed in the uterus to prevent pregnancy. It has threads which hang down into the vagina, which a person can feel using her fingers to make sure that the device is correctly positioned.

How does the IUD work?
Different IUDs are licensed to be left inside the uterus for periods ranging from 5 years to 10 years (depending on the type of IUD). The IUD is like the intrauterine system (IUS) but instead of releasing the hormone progesterone like the IUS, the IUD releases the copper into the womb. The IUD prevents pregnancy by:

  • Impairing the viability of the sperm and ovum through the alteration of the Fallopian tube and uterine fluids. This reduces the chances of the ovum and sperm meeting, thus impeding fertilisation.
  • Altering the cervical mucus, making it hard for an embryo to implant.


How many IUDs are available?
There are over 10 different kinds of copper IUDs available. There is also the intra-uterine system (IUS) which works with a hormone (progestogen), has fewer side effects, increased efficacy and lasts up to 10 years.

The decision of which IUD to insert will depend on the person and the size of her uterus.

How effective is the IUD?
The IUD is from 98% to nearly 100% effective in preventing pregnancy, depending on the device. Newer IUDs have failure rates of less than 1 per 100 after 1 year of use.

When can I have an IUD fitted?
You can start any day of the menstrual cycle if the healthcare provider is sure that you are not pregnant.

How is it fitted?

  • Your medical practitioner will check your vagina to check your uterus and size of your womb.
  • You may need a smear test, to check for existing infections (STIs) and treatment accordingly.
  • The insertion of the IUD should not take more than 5 minutes.
  • The IUD is inserted through the cervix and into the uterus (the vagina is held open for entry).
  • You may feel period-like pains and cramps after insertion for a few days. You can also take painkillers if you need to.


How do I know that it is still in place?

  • An IUD has two thin threads that hang down away from your uterus, on top of your vagina.
  • You may be taught to feel those threads and check that they are in place.
  • If you think that the IUD is dislodged or not in place you may want to use more protection (such as condoms) against pregnancy during sex.


Can I get pregnant when can I remove the IUD?
An IUD may be removed at any time if a person wants to become pregnant. An IUD is removed by a medical practitioner who visualises the IUD threads in the vagina and gently pulls out the IUD. It is usually advised that IUDs are removed 1 year after menopause.

What are the advantages of the IUD?

  • Effective immediately.
  • No drug interactions.
  • Reversible and highly effective.
  • Does not interfere with sexual intercourse.


What are the disadvantages of the IUD?

  • Heavy and prolonged menstrual periods.
  • Excessive menstrual pain.
  • Slightly increased risk of ectopic pregnancy if there is an IUD failure.
  • Increased risk of pelvic infection.
  • Expulsion of the IUD.
  • Perforation of the uterus, bowel, and bladder.
  • Malposition of the IUD.
  • Pregnancy caused by expulsion, perforation, or malposition.


What are the risks of IUD?

  • Pelvic infections.
  • There is a small risk of getting an infection in the first 20 days after it has been fitted.
  • Thrush. You may experience thrush every now and then. Speak to your medical practitioner if you have IUD and keep getting thrush.
  • Rejection.
  • There is a small risk that your body may push out the IUD or it may move. It usually happens as soon as it is fitted.
  • There is a small risk of an ectopic pregnancy in case the IUD fails.
  • Damage to the uterus. It is extremely rare that an IUD can make a hole in the uterus during insertion. If you are in pain, go to your medical practitioner immediately.


Who can use an IUD?
Most persons can use the IUD, including those who are HIV positive. Your medical practitioner will guide you according to your medical history.

The IUD may not be suitable for you in case of:

  • Pregnancy.
  • Undiagnosed genital tract bleeding.
  • Previous ectopic pregnancy.
  • Pelvic or vaginal infection; once treated an IUD may be fitted.
  • Abnormalities of the uterus existing since birth (e.g. a bicornuate uterus).
  • Allergy to components of the IUD, e.g. copper.
  • Wilson's disease.
  • Heart valve replacement or previous history of bacterial endocarditis because of increased risk of infection.
  • HIV and AIDS because of reduced immune system and increased risk of infection.


Relative risks include:

  • History of pelvic infection.
  • Excessive menstrual pain and/or heavy and prolonged menstrual periods.
  • Fibroids and endometriosis.


What to remember:

  • Your kind of IUD.
  • When to have the IUD taken out.


Can I bleed when I start the IUD?
Bleeding changes and cramps are common. Go to your medical practitioner if these changes are bothering you.

How do I know if I have an infection?

  • Pain in your lower abdomen.
  • High temperature.
  • Smelly discharge.


Can I switch to another method of contraception?
Yes, you can change to another method of contraception whenever you wish. Speak to your medical practitioner to further discuss other reliable methods.

Can I have an IUD fitted after a miscarriage?
The IUD can be inserted immediately after a miscarriage.

I have just had a baby. When can I have an IUD fitted?
An IUD can be fitted after 4 weeks have passed since giving birth. You will need an alternative contraception from 3 weeks after birth until the IUD is inserted. In certain circumstances an IUD can also be inserted 48 hours after birth.

It is safe to use an IUD when you are breastfeeding. It will not affect your milk supply.

How often should I go for a check-up?
Your medical practitioner will tell you when your next appointment is. However, do not wait for the next appointment if:

  • You have missed a menstrual period, or think you may be pregnant.
  • You think you could have an STI or HIV/AIDS.
  • The IUD strings seem to have changed length or are missing.
  • You experience severe pain in lower abdomen.


If I have the IUD, am I protected from Sexually Transmitted Infections?
No, only male and female condoms (when used correctly and consistently) protect you from STIs.