07 Apr Choosing a right method of contraception -Intra-uterine contraceptive device (IUCD)
Choosing a right method of contraception is important for women who have completed the family. The choice would depend on the needs and the physical conditions of the couple as well as the efficacy and safety of the method.
Intra-uterine contraceptive device (IUCD) is a popular choice in Singapore. It is a small, T-shaped, flexible plastic device which is inserted into the womb usually after menstruation by a trained doctor.
Two types of IUCD are commonly used. One is the Copper device where fine copper wires are wound round the shaft of device. A small amount of copper is released into the womb, preventing the sperm from moving up the fallopian tube to fertilize the egg. It is effective in preventing pregnancy in 95-98 per cent of cases and can be placed in the body for 3 to 5 years.
The other type is known as a hormone impregnated device. The hormone releases slowly in the womb causing thickening of the mucus secretion of the neck of the womb (cervix) and thinning of the womb lining. The mucus will prevent the sperm from swimming up the genital tract and the thin lining will make the fertilized egg difficult to implant. Contraception rate is 99 per cent and the device can last for up to five years.
The advantages of IUCD are:
• Few side effects
• High contraception rate
• Easy insertion and removal
• Sexual pleasure is not affected
• Can be inserted while breastfeeding.
The disadvantages are
• Vaginal discharge and menstrual cramps occur as IUCD is a foreign body
• IUCD cannot prevent sexually transmitted diseases. This may lead to pelvic infection, infertility or ectopic pregnancy.
• Copper device occasionally causes heavy periods while hormone impregnated device usually lead to scanty, irregular or no menses.
• Perforation of the womb is an uncommon complication. The IUCD pierces through the womb and enters partially or completely inside the abdomen. This may result in unplanned pregnancy and abdominal discomfort. The device has to be surgically removed from the abdominal cavity.
In the newsletter in August this year, the Singapore Health Sciences Authority reported a study by European researchers which showed a higher perforation rate if IUCD is inserted during the 9 months after delivery and in breastfeeding mother. This occurred in 13 out of ten thousand cases. Two cases have been reported locally in 2001 and 2013.
In view of these recent data, it is advisable for those who want contraception after childbirth or during breastfeeding to postpone the insertion of IUCD till a later date.