Contraception - intrauterine devices (IUD)

What is an intrauterine device (IUD)?

An intrauterine device (IUD) is a small contraceptive device that is put into the uterus (womb) to prevent pregnancy. The 2 types available in Australia are the:

• copper IUD (also called the non-hormonal copper IUD)
• hormonal IUD (Mirena™ and Kyleena™).

Kyleena is a lower dose version of Mirena and has been available in Australia since 2020.

The copper IUD is designed to stay in place for up to 10 years and the hormonal IUDs (Mirena™ and Kyleena™) for 5 years. Both can easily be removed sooner, if needed.

Like the contraceptive implant, IUDs are known as long-acting reversible contraception (or LARC) because they work over a number of years.

Copper IUD

The copper IUD is a small, T-shaped, plastic and copper device. It constantly releases a small amount of copper into the uterus.

The copper IUD can also be used for emergency contraception instead of the emergency contraceptive pill (‘morning after pill’) if it's within 5 days of unprotected sex.

Hormonal IUD

The hormonal IUDs are small, T-shaped, plastic devices (sold as Mirena™ and Kyleena™ in Australia). They slowly releases a hormone (progestogen) into your uterus. Progestogen is like the hormone produced by the ovaries.

Effectiveness of IUDs

Both copper and hormonal IUDs are more than 99% effective at preventing pregnancy.

IUD insertion

Your doctor or nurse practitioner will write you a script and you can get the IUD from a pharmacy. Sometimes you can buy a copper IUD from the clinic providing the IUD insertion. The IUD is inserted inside your uterus by a trained doctor or nurse.

The IUD has a fine nylon thread attached to it which comes out through the cervix (opening to the uterus). If you feel high up inside your vagina, you can check that the thread is there and know the IUD is still in place. Because it is high up in the vagina, the thread cannot be seen.

It’s good idea to make a record of the date when you had the IUD inserted. You will need to make sure it is taken out before it expires (5 or 10 years, depending on the type, after being inserted).

Cost of IUDs

The hormonal IUD prescription is covered by the Pharmaceutical Benefits Scheme in Australia. It costs around $7 if you are a Health Care Card holder and around $43 if you are not.

The copper IUD is not covered by a Health Care Card. The cost in pharmacies can be around $70 to $120. There may also be an insertion cost from the health professional.

The overall cost of the procedure will vary depending on whether you attend a private or public provider. If you don't have a Medicare card or private health insurance, it will be more expensive.

Advantages of IUDs

Advantages of copper or hormonal IUDs include:

• They are more than 99% effective in preventing pregnancy.
• They last for a long time – Mirena™ and Kyleena™ can last for 5 years, and the copper IUD can last for 10 years.
• They are safe to use if you are breastfeeding.
• No medications stop them from working.
• They provide another contraceptive choice if you have difficulty taking the hormone oestrogen. (The combined pill and the vaginal ring contain both oestrogen and progestogen.) The hormonal IUD only contains progestogen and the copper IUD has no hormones.
• Once put in, you don’t need to do anything more apart from checking the thread each month after your period to ensure it has not moved out of the correct position.
• The device can be taken out at any time by an appropriately trained doctor or nurse.
• Your chance of getting pregnant will go back to normal as soon as the copper or hormonal IUD has been taken out.

Advantages of the hormonal IUD include:

• Most users have no vaginal bleeding at all, or a light regular period.
• Periods may be less painful.

Advantages of the copper IUD include:

• It is a choice for those who do not want to use hormonal contraception.
• It is a very effective method of emergency contraception.

IUD possible side effects

Possible side effects include:

• When first inserted, some may experience period-type cramping that usually settles after a few days.
• Sometimes the IUD can come out. This is more common in the first 3 months of it being inserted.
• Your period will change. Spotting or frequent bleeding is common in the first 3 to 6 months. By 6 months around 90-95% of people may have a light regular period or no bleeding at all (this is not harmful to the body).
• You may experience tender breasts, headaches, skin changes and mood changes. These side effects nearly always settle with time. The hormonal IUD has not been shown to cause weight gain.

Copper IUD possible side effects

Possible side effects from the copper IUD include:

• Spotting or frequent bleeding in the first 3 months. This nearly always settles with time and your regular bleeding pattern will return.
• Heavier periods.

IUD and potential health risks

In about 1 in 500 people, a small hole in the wall of the uterus (womb) may be created while the IUD is being inserted. The IUD can move through the hole and sit in the wrong place. If this happens, keyhole surgery (known as a laparoscopy) is required to have the IUD removed.

Around 1 in 300, may get an infection when the IUD is first inserted. This can be successfully treated with antibiotics.

It is very unlikely to get pregnant when using an IUD. If you do get pregnant with an IUD in place, there is a higher chance of ectopic pregnancy. This means that the pregnancy may settle in the fallopian tubes (pathway of the egg to uterus). If this happens, seek urgent medical assistance.

When an IUD is not suitable

An IUD might not be a good option for you if you have:

• a uterus that is not the usual shape
• a current pelvic infection.

The hormonal IUD might not be a good option for you if you have:

• been treated for breast cancer
• severe liver disease.

The copper IUD might not be a good option for you if you have:

• heavy periods
• low iron levels
• endometriosis.

Pregnancy when using an IUD

If you become pregnant while using an IUD, see a doctor or nurse as soon as possible and have the IUD removed. The doctor or nurse will also need to rule out a pregnancy in your fallopian tubes (ectopic pregnancy).

If the IUD is removed, you can choose to continue or terminate the pregnancy (have an abortion).

If the IUD is not removed and you continue with the pregnancy, there is a higher risk of miscarriage or delivering the baby early (premature labour).

Using an IUD after the birth of a baby

You can have an IUD inserted within 2 days after giving birth.

If it’s not inserted straight after birth, then you need to wait at least 4 weeks.

IUDs are safe to use if you are breastfeeding.

Conceiving a baby and IUDs

If you want to become pregnant, an IUD can be removed at any time by a doctor or a nurse. Your fertility will quickly return.

Other types of contraception

There are many contraceptive methods available in Australia. When choosing the method of contraception that best suits your needs, it can help to talk to a doctor or nurse about your options. Different methods may suit you at different times in your life.

A doctor or nurse can give you information about:

• the benefits and risks of using various methods of contraception
• how well each method works
• the possible risks and side effects
• how easy it is to use
• how much it costs
• how each method meets your current and future needs.

Other methods include the contraceptive implant or injection, the vaginal ring or the combined oral contraceptive pill.

IUDs do not protect you from STIs

Neither type of IUD gives protection from sexually transmissible infections (STIs). It’s important to practise safer sex, as well as to prevent an unintended pregnancy.

The best way to lessen the risk of STIs is to use barrier methods (such as external or internal condoms) for oral, vaginal and anal sex with all new sexual partners. Condoms can be used with IUDs.

Information in community languages

The following information is available from Health Translations Directory:

The hormone-releasing IUD (PDF) by Family Planning NSW

• Arabic
• Assyrian
• Burmese
• Chinese (simplified)
• Dinka
• Farsi (Persian)
• Khmer (Cambodian)
• Korean
• Lao
• Serbian (Cyrillic)
• Swahili
• Thai
• Turkish
• Vietnamese

The copper IUD (PDF) by Family Planning NSW

• Arabic
• Assyrian
• Burmese
• Chinese (simplified)
• Dinka
• Farsi (Persian)
• Khmer (Cambodian)
• Korean
• Lao
• Serbian (Cyrillic)
• Swahili
• Thai
• Turkish
• Vietnamese

Long acting reversible contraception - LARC (PDF) by Royal Women's Hospital, Victoria

• English
• Karen
• Nuer
• Oromo
• Somali
• Tigrinya

Where to get help

• Your GP (doctor)
• Your school nurse or welfare coordinator. Some secondary schools provide access to an adolescent health trained GP on site
• Your local community health service
• Your pharmacist
• Many community health services and some public hospitals have clinics including family planning, sexual health and women’s health
• Private clinics offering abortion also offer contraceptive services
• 1800 My Options – Victoria’s sexual and reproductive health information and phone line service Tel. 1800 My Options (1800 696 784)
• Sexual Health Victoria (SHV) – book an appointment online or call Melbourne CBD Clinic: (03) 9660 4700, Box Hill Clinic: (03) 9257 0100 or (free call): 1800 013 952 (Monday to Friday 9 am – 5 pm). These services are youth friendly
• Melbourne Sexual Health Centre (Monday to Friday 8:30 am – 5 pm) Tel. (03) 9341 6200 or 1800 032 017 or National Relay Service (for people with a hearing impairment) (03) 9341 6200
• Thorne Harbour Health (formerly Victorian AIDS Council) Tel. (03) 9865 6700 or 1800 134 840 (toll free)
• The Centre Clinic, St Kilda Tel. (03) 9525 5866
• Equinox Gender Diverse Health Centre (Monday to Friday 9 am – 5 pm) Tel. (03) 9416 2889 or email: equinoxadmin@thorneharbour.org
• PRONTO! Clinic for men who have sex with men. Book online or Tel. Tel. (03) 9416 2889
• Ballarat Community Health Sexual Health Clinic – book online or Tel. (03) 5338 4541
• Bendigo Community Health Services Sexual and Reproductive Health Hub – book online Tel. (03) 5406 1200 or (03) 5448 1600
• Gateway Health Sexual and Reproductive Health  – Clinic 35, Wodonga (Monday to Friday 9 am – 5 pm) Tel. (02) 6022 8888 and Wangaratta Tel. (03) 5723 2000 or email: info@gatewayhealth.org.au
• Sunraysia Community Health Services, Mildura (Monday to Friday 8:30 am – 5 pm) Tel. (03) 5022 5444 or email to: schs@schs.com.au
• Barwon Health Sexual Health Clinic (no GP referral, walk-in service Tuesdays 2 pm – 6:30 pm) Tel. (03) 5226 7489
• Victorian Aboriginal Health Service Fitzroy: Tel. (03) 9419 3000 and Preston Tel. (03) 9403 3300 (Monday to Friday 10 am – 4 pm) and after-hours locum service Tel. 132 660 or Epping: Tel. (03) 8592 3920 (Monday to Thursday 9 am-5 pm, Friday 9 am-4 pm)