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Intrauterine Device, Spiral Insertion

Intrauterine Device, Spiral Insertion

Spiral IUD Types

Copper Spirals: Nova T 380 (contains a small amount of silver),Copper T 380 A, Multiload-375 etc. There are a wide range of copper spirals.

Hormonal Spiral IUD (Progesterone IUD): Progestasert and Levonorgestrel-20 Intrauterine System (LNG-20 IUS, MIRENA). These types of progesterone-containing spirals reduce the amount of bleeding.

1-Copper IUD: Copper IUDs are the most widely used spirals in the world and in our country. If we list their types and names; Nova T 380, Copper T 380 Multiload. It acts by releasing copper ions into the uterus to prevent unwanted pregnancy.

Nova T 380: The copper wire is coated on top with silver metal to strengthen it and increase its effectiveness. Its T-shaped arms fit easily into the uterus. It can easily stay in the uterus for many years when placed correctly.

The Copper T 380 A, also known as the Paragard T 380 A, is also suitable for the T-shaped uterus. It consists of a thin copper wire wrapped around a plastic body. Women with a copper allergy cannot use it. Protection against unwanted pregnancy lasts for ten years.

If you have had unprotected sex and need emergency contraception, a copper IUD can be inserted for emergency contraception (to prevent pregnancy) within 72 hours of intercourse.

2-Hormonal IUD (hormonal intrauterine system): The most important hormonal IUDs are Progestasert and LNG-20 IUS (Mirena).

Mirena contains levonorgestel, a synthetic progesterone. The hormone progesterone is released from Mirena into the uterus in very small amounts daily. This hormone reduces both menstrual bleeding and menstrual pain.

Progestasert needs to be changed annually, whereas Mirena lasts for five years. Progestasert is not available in our country.

These spirals do not increase menstrual bleeding like copper spirals, they decrease or even prevent it. Therefore, they are preferred for women with heavy, irregular, prolonged, clotted and painful menstruation. The amount of progesterone released from these spirals is very low. However, it is possible to see other effects due to minimal progesterone entering the systemic circulation.

How does the spiral IUD prevent pregnancy?

The spiral makes changes in the uterus, negatively affects the movement of eggs and sperm in the tubes and prevents pregnancy. In addition, due to the changes it causes in the uterus, sperm reaching the egg is also negatively affected. Like birth control pills, it prevents pregnancy by 99%. The spiral does not protect against diseases such as sexually transmitted diseases and AIDS.

Spiral Fitting Price Turkey 2023

Contraception is very important for every sexually active woman. Unfortunately, the consequences of unwanted pregnancies can be very traumatic. Emotionally, it affects women and families negatively.

Although the price of spiral insertion increased slightly in 2022, it is not unattainable prices. With hearsay information, women think that it is very expensive. However, it should not be forgotten that health is more important than anything else.

Duration of Effect of Spiral

This is usually five years for copper spirals, ten years for T 380, five years for Mirena, five years for Gynefix and one year for Progestasert. When these periods are up, the spiral must be removed. Otherwise, problems such as infection, bleeding and slipping may occur.

If there is no problem, a new one can be inserted immediately on the day it is removed. My preference as a physician is to give the uterus a break for a month or two to rest. In the meantime, another method of contraception should be used.

Is contraception with a spiral an advantageous method for women?

  • The spiral is very successful in preventing pregnancy from the moment it is inserted,
  • The duration of action is 5-10 years depending on the spiral inserted,
  • The spiral is easy for women to adapt to, and there is no risk of forgetting it like with birth control pills,
  • It has very few side effects,
  • Both the woman and her partner are not felt during sexual intercourse,
  • Breastfeeding mothers can also wear it safely, there is no risk for the baby.

It can be inserted at any time (if there is no pregnancy) by the physician. For ease of application and to make sure that there is no pregnancy, I preferably apply it to my patients while they are menstruating.

Is the hormonal spiral more advantageous than other spirals?

It is preferred for women with irregular and prolonged bleeding due to its therapeutic properties. Bleeding intensity improves within 3-4 months.

Reduces menstrual bleeding, reduces menstrual pain. Although it varies according to the body in women, it sometimes stops menstruation completely. This does not mean menopause, there is no bleeding because the uterine wall does not thicken, the ovaries work and produce hormones and there is no menopause. This is not important for us. In fact, many working women are very happy with this situation.

  • It can prevent intrauterine wall thickening (endometrial hyperplasia),intrauterine polyps, and endometrial cancer,
  • Reduces the risk of ectopic pregnancy,
  • It does not cause weight gain.

I have just had my spiral inserted, what can I expect?

  • When it is first inserted, you may have uterine cramps (pain like menstrual pain) and headache for a few hours,
  • There may be light spotting and bleeding for a few weeks,
  • Spirals do not protect against sexually transmitted diseases. You should be careful about this,
  • Women with copper allergy cannot use copper spirals.

Women with cervical wounds (cervical erosion),infection, uterine cancer cannot use the spiral.

What are the side effects of Mirena?

The most common side effect is that it can cause ovarian cysts that shrink spontaneously and do not require treatment, which occurs in about half of the women who have it. Similar side effects caused by birth control pills can also occur in women using Mirena. These include;

  • Breast tenderness,
  • Headache
  • Change in mood,
  • Side effects such as acne are very rare.

These side effects resolve spontaneously after a few months without treatment.

Side effects that can be seen in women who use a spiral

Menstrual irregularities and intermittent bleeding in the form of spotting may be observed for 3 months after spiral insertion.

During the insertion of the spiral, there is a one in a thousand chance that the spiral gets stuck in the uterus or perforates the uterine wall (perforation). Perforation is extremely rare and occurs during insertion. The spiral should be removed when detected. Otherwise, there is a possibility that it may come out of the uterus and enter other abdominal organs. If this happens, it is surgically removed.

The first 3 months after the spiral is applied is a critical time. Three out of every one hundred spirals are thrown out of the uterus and into the vagina, sometimes due to a wrong move or sometimes because the body does not accept it. Some women notice this.

Some do not notice it because they drop it in the toilet. They realize when they become pregnant. If the spiral is usually inserted immediately after delivery, the possibility of expulsion is high. We ask women not to engage in heavy sports, work and sexual intercourse for the first 15 days after the application so that it settles in the uterus. This possibility is eliminated.

Who should not have a spiral?

Newly married women who have not given birth before, except for Gynefix, may experience cramp-like pain when other copper spirals are applied because the uterus is still small, so we do not recommend spiral insertion for these women. For newly married couples who do not plan to get pregnant, we recommend that they use other methods of contraception such as contraceptives and condoms.

  • Couples who have been treated for a sexually transmitted disease in the last three months should also not have a spiral,
  • We do not want spiral insertion until genital infections such as vaginitis and cervicitis have been treated,
  • Women with bleeding disorders or who use anticoagulants cannot use a copper spiral because it increases menstrual bleeding,
  • It is not recommended for those who have miscarriages due to infection and those who develop infections in the uterus after birth, as these infections may recur,
  • Not for women with undiagnosed uterine bleeding,
  • People with anatomical structural defects in the uterus cannot have a spiral,
  • People who are allergic to copper cannot have a copper spiral.

I had an ectopic pregnancy, can I have a spiral? Who can have which spiral?

  • Those who have had an ectopic pregnancy can use copper and hormonal IUDs.
  • Mirena is suitable for those who have irregular and painful menstruation, take blood thinners and have bleeding disorders.
  • Mirena is suitable for those with endometriosis.
  • For those in the risk group for bacterial endocarditis, a spiral can be inserted if appropriate antibiotics are used to prevent infection at the time of insertion and removal of the spiral.
  • People with diabetes and breastfeeding mothers can also use the spiral.

When you apply for a spiral insertion

First, a detailed anamnesis is taken from you. Then a gynecological examination, ultrasound, infection screening and a smear test will be performed. You will be tested for sexually transmitted diseases and pregnancy.

If any problems are detected, your doctor or health professional should treat them before insertion or refer them to the appropriate specialist for treatment. Before insertion, the woman should be informed about the spiral and her questions about it should be answered.

The best time to insert a spiral is usually during menstruation or the first 3 days immediately following menstruation, when the cervical canal is open and pregnancy is least likely. These are the days when the cervix is soft and the risk of pregnancy is the lowest.

If you are confident, it can be inserted at any time when there is no pregnancy. The application time varies between 5-110 minutes. It is normal to have some cramping pain in the uterus after insertion of the spiral.

Some clinics may recommend that women take a painkiller one hour before insertion to prevent cramps and an appropriate antibiotic to prevent possible infection.

Insertion of the spiral is a very short procedure and usually involves only mild pain during insertion. If the woman has a low pain threshold or is very scared, this procedure can be performed under local anesthesia or light sedoanesthesia.

How is the spiral inserted?

To insert the spiral, a speculum is used to open the vagina on the gynecological examination table. First, the vagina is cleaned with a sterile solution. The cervix is held in the appropriate place with a surgical instrument. The spiral in a thin tube is gently passed through the cervical canal and inserted into the uterus.

After the spiral is inserted, the tube is removed. The thread of the spiral is cut about 1-2 cm outside the cervix. After the insertion of the spiral, there may sometimes be nausea and a sharp short-term stinging contraction in the lower abdomen. This is easily overcome with breathing and relaxation exercises. The contraceptive effect starts immediately after insertion.

After the insertion of the spiral, daily routine and normal activities can be resumed immediately. There is no harm in using vaginal tampons immediately after insertion, provided that they are changed frequently.

Spiral Control

Most women can feel the thread of the spiral in the cervix with their fingers. If the thread of the spiral is left short or for some other reason it can be pulled into the uterus and some women may not be able to feel the thread with their fingers. If you were able to feel the thread of the spiral with your fingers before and suddenly cannot feel it, you should start using an additional method of contraception.

Take a pregnancy test if you have a delayed period with a spiral. If our physician does not see the string during the gynecological examination, then the string may have turned into the uterus. In this case, the spiral can be seen in the uterus with ultrasound, or the spiral may have been expelled from the uterus. In this case, the ultrasound will not show the spiral in the uterus.

My advice to women with a spiral is to wash your hands cleanly every three months and then check the spiral thread with your finger in the vagina. If you cannot feel the spiral thread, consult your doctor. Also consult your doctor in case of delayed menstruation, vaginal discharge, odor. We recommend that every woman with a spiral should have a regular annual check-up with a gynecologist.

Problems that require you to see your doctor while using a spiral

  • Excessive menstrual bleeding,
  • Menstrual delay with copper spiral,
  • Inguinal pain and severe pain in the uterus,
  • Sexually transmitted diseases and vaginal discharge with an abnormal odor,
  • Inability to feel the spiral thread,
  • Groin pain with high fever,
  • Removal of the spiral.

The spiral can be removed at any time. It is easier to remove than to insert. However, if the spiral is removed close to ovulation and there has been sexual intercourse recently, pregnancy can occur because the sperm can remain viable for a long time.

Never try to remove the spiral yourself, you may get hurt. The spiral is removed under sterile conditions by a doctor and an experienced health professional by holding it by its string with a special tool. The arms of the spiral lift up and pass easily through the canal in the cervix. If the reason for removing the spiral is not due to infection, bleeding, etc., a new spiral can be inserted as soon as the old spiral is removed.

Sometimes a woman comes to my clinic and says that she cannot feel the thread of the spiral. If I cannot see it during the examination, there are cases when I cannot see the bright reflection of the spiral in the uterine cavity with vaginal ultrasound examination.

In these rare cases, I take a direct abdominal X-ray to check whether the spiral is in the abdomen. If it has entered the uterus between the intra-abdominal organs, it can be removed under operating room conditions by laparoscopy (closed surgery) after its position is determined.

IUD and Pregnancy

The probability of pregnancy with a spiral is very low at 1-3%. If a pregnancy is conceived with the spiral in place, the spiral does not cause disability in the baby. But it slightly increases the risk of pregnancy complications. The risk of miscarriage and premature birth increases. If the thread of the spiral is visible through the cervix at the time of detection, it is appropriate to remove it. When the pregnancy progresses, it is more harmful to keep the spiral in place.

Update Date: 15.08.2022
Op. Dr. Âzer Aras Uluğ
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Op. Dr. Azer Aras Uluğ
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