Adopted by more and more women, the IUD (intrauterine device) is a reliable and unconstrained method of contraception. When the baby plan comes true, however, it is time to withdraw it. All our explanations on the IUD before, during and after pregnancy.

The IUD is a small, flexible, T-shaped 3 to 4 cm plastic device inserted into the uterus. The mode of action depends on the type of IUD:

The hormone IUD

(Mirena ©, Jaydess ©) contains, in its vertical branch, a small reservoir which will release regularly and throughout the life of the IUD a progestogen (levonorgestrel). This hormone has several contraceptive actions: it thickens the secretions of the cervix, making sperm migration more difficult, and decreases the development of the uterine lining, which is then unsuitable for implantation. The hormone IUD can be left in place for up to 3 years (Jaydess ©) to 5 years (Mirena ©).

The copper IUD

It consists of a plastic support with flexible side arms around which a copper wire is wound. Copper has two contraceptive actions: by virtue of its cytotoxic effect, it hinders the migration of spermatozoa to the uterus, and causes changes in the uterine lining, making it unfit for nesting. Different copper IUDs are marketed in France, with different sizes: “standard” or “short” (reserved for women who have never had a child). The copper IUD can be left in place for up to 4 years to 10 years depending on the model.

The insertion of the IUD is carried out in an office during a gynecological examination, by a midwife or a doctor. The copper IUD works the same day; the hormonal IUD 2 days later. In this period of time it is therefore advisable to use a condom in the event of sexual intercourse. For both types of IUD, an annual check-up is recommended.

The IUD can be removed at any time when you want to start a design project. Baby tests can begin as soon as the IUD is removed. Studies do not show impaired fertility after IUD removal (1).

Note, however, that the hormonal IUD can cause an atrophying effect on the endometrium, which will then need a few cycles to regenerate (2).

The time taken to regain normal fertility thus varies from one woman to another, depending on the various factors affecting fertility (age, medical history, smoking, weight, etc.).

The withdrawal of the IUD takes place in the office, during a gynecological examination.

The IUD ends with two nylon threads cut very short at the entrance to the uterus, at the time of insertion. These threads, which in principle are not felt by the partner (if not, do not hesitate to consult so that the practitioner can cut them again) allow the IUD to be removed. The gesture is simple and only lasts a few seconds: using forceps, the doctor or midwife gently pulls on the threads in order to extract the IUD from the uterine cavity. The gesture is generally painless.

Postpartum, the IUD (copper or hormonal) can be inserted 4 weeks after childbirth, even if breastfeeding (3)

Like any contraceptive method, the IUD is not 100% effective… but almost: the hormonal IUD is 99,8% effective; that of copper 99,2% (4). Which makes it one of the most effective means of contraception, especially since once in place, there is no error in use.

Although exceptional, pregnancy under an IUD can therefore occur. As soon as the pregnancy is known it is advisable to consult your gynecologist quickly. The doctor will first make sure that it is not an ectopic pregnancy, because when a woman with an IUD is pregnant, the percentage of GEU is a little higher than among pregnant women without contraception (only the risk of GEU under IUDs is extremely low due to the contraceptive effectiveness of the IUD).

If possible, the gynecologist will remove the IUD before 12 weeks of pregnancy. Note that this gesture is associated with a risk of miscarriage.

But sometimes it is impossible to remove the IUD because with the increase in the volume of the uterus during pregnancy, the threads are brought up towards the uterine fund, and therefore impossible to reach. The IUD will then be left in place throughout the pregnancy.

A systematic review (5) has shown that IUD pregnancies are pregnancies at risk, in particular of spontaneous miscarriage, premature rupture of membranes, premature delivery and chorioamniotics (infection of the amniotic cavity). The pregnancy should therefore be closely monitored and the mother-to-be should consult quickly in the event of abnormal signs (bleeding, unusual vaginal discharge, fever). The risk is lower if the IUD could have been removed early in pregnancy, but it still exists, the study also shows.