Information for Intrauterine Device Users

(Content revised 09/2025)

1. Intrauterine Device (IUD)

  • IUD is a small device which can be used as emergency or regular contraceptive method. It is very effective and the failure rate on typical use less than 1% in the first year
  • It is a long-acting reversible contraceptive option. Fertility returns to normal after the IUD is taken out
    • According to research findings, the fertility rate between IUD non-users and ex-users are similar
  • It is inserted into the uterus by the doctor. Before insertion, the doctor will review your medical history and perform pelvic examination to assess your suitability for an IUD
  • IUDs vary in shapes and sizes, and can last up to 5 to 10 years. After insertion, you need to attend regular check-ups
  • IUDs used in Maternal & Child Health Centres (MCHCs) are non-hormonal. They are made of plastic wound with copper wire, often in a shape of "T" and bear threads at their base for self-checking or examination by the doctor, and for the future removal of the device

2. How IUD works

  • Copper IUD can change the environment of uterus, interfere with sperm motility and decrease the chance of fertilisation. Moreover, the change in the environment of uterus can affect the fertilised egg from attaching to the walls of uterus and thus preventing pregnancy

3. Who are not suitable for using IUDs

  • Majority of the women can use IUDs. If you have any of the following conditions, please seek advice from your doctor for suitability for using IUD:
    • Heavy periods or dysmenorrhea or abnormal vaginal bleeding
    • Severe anaemia
    • Known copper allergy (IUDs used in MCHCs contain copper)
    • Known distorted uterine anatomy (e.g. double uterus, uterine septum)
    • History of gynaecological diseases (e.g. uterine or pelvic infection, tumour, ectopic pregnancy, sexually transmitted infections)
    • Have multiple sexual partners (there is a higher chance of contracting pelvic infection)
    • Known heart problems, e.g. valvular heart disease
    • Other medical conditions, including but not limited to: Wilson's disease, renal dialysis, epilepsy, haematological disorders or use of anti-coagulant/anti-platelet medications

4. Possible risks and complications

It is by no means an exhaustive list of risks or complications associated with the use of IUD (including during the insertion and removal procedures). Complications may happen even with proper procedures in IUD insertion and removal. Whenever complications occur, the woman may need to be referred to Accident & Emergency Department (A&E) or Specialist Out-patient Clinic (SOPC) for further assessment and management. Surgical procedure may be necessary for some of the complications and which may affect future fertility

4.1 During insertion procedure

  • Discomfort or pain during the examination and procedure
  • Fainting or syncope (Vasovagal syncope)
    • During the insertion procedure, minority of the women may experience fainting or syncope due to pain or anxiety
    • It is an uncommon condition and is usually mild
  • Perforation of uterus
    • About one to two out of every 1,000 insertions
    • The risk of perforation was independently increased in the following women:
      • Who are breastfeeding at the time of insertion
      • Insertion within 36 weeks after giving birth
      • Sepsis after miscarriage, abortion or childbirth

4.2 While using

  • Effect on menstrual periods
    • May have heavy, longer or painful menstrual period
  • Pelvic infection
    • Though not common, the risk of pelvic inflammatory disease is increased in the first 3 weeks following insertion when compared with woman without using the device, but overall the risk is very low (<1%)
  • Expulsion of the IUD
    • About 5% of users
    • During a period and most commonly in the first 3 months after fitting the IUD
    • Expulsion rates may be higher in adolescents, those who have IUD inserted after mid-trimester abortions, individuals with fibroids and heavy menstrual bleeding, uterine cavity distortion or those who have had a previous expulsion
  • Ectopic pregnancy
    • The risk for a woman using an IUD is lower than those without using any form of birth control
    • For IUD users, it is important to seek advice from healthcare provider promptly to rule out ectopic pregnancy if suspected pregnancy. The reason is that the device is very effective at preventing intrauterine pregnancy but less effective at preventing ectopic pregnancy
  • The following risks and complications may occur without any known reason while using IUD:
    • Breakage of the IUD thread
    • Breakage of the IUD device
    • Perforation of uterus or cervix

4.3 During the removal procedure

  • The IUD is removed by grasping the attached thread by the doctor. The following risks or complications may occur during the removal procedure:
    • Breakage of the IUD thread
    • Breakage of the IUD device
    • Perforation of uterus or cervix
    • The woman may need to be referred to A&E or SOPC for further assessment and management. Surgical procedure may be necessary for some of the complications.
  • There may be mild abdominal pain and vaginal bleeding within a few days after the removal of the device

5. Insertion Procedure

  • Before the insertion, healthcare professional will explain the insertion procedures and possible risks and complications. Then, you need to sign a consent form for the procedure
  • Doctor will do a pelvic examination and will pass a small instrument into your uterus to check the size of the uterine cavity for suitability of insertion (too big or too small uterine cavity is not suitable for insertion of an IUD device). If the size of the uterine cavity is suitable, the doctor will insert the device into the uterus by using an insertion tube
  • The thread at the base of the IUD device will be cut to leave 2 to 3 cm outside the cervix. It can be used for self-checking or examination by the doctor and for the future removal

6. Points to note after insertion

  • The risk of pelvic infection appears to increase in the first 3 weeks after IUD insertion, but overall the risk is very low (<1%)
    • You may consider to abstain from sexual intercourse or use condoms in the first three weeks after insertion to decrease the possibility of pelvic infection
  • The device may pass out during menstruation; therefore you are advised to check whether the IUD thread is still in place after menstruation by putting your fingers into the vagina
  • If you cannot feel the IUD thread, or non-visible threads during gynaecological examination by healthcare professional, this can mean that:
    • The device has displaced in its position
    • The device has come out
    • The device has perforated the uterus and moved into the abdominal cavity
    • The device being correctly sited but with
      • thread within the cervical canal or uterus, or
      • thread has come off or breakage
  • If you cannot feel the IUD thread, please seek advice from healthcare provider for assessment promptly and use an extra contraceptive method

7. The main reasons for IUD removal are as below

  • The IUD has reached its expiration date and needs to be removed
  • Woman no longer has the need for contraception, for example,
    • She plans to get pregnant or
    • She has reached menopause (The IUD should be removed within 1 to 2 years after menopause)
  • Woman should seek gynaecological advice for IUD removal and alternative contraception if her IUD is found to be displaced (thus ineffective) or she has other complications related to IUD

8. Return to MCHC or seek advice from healthcare providers promptly if you have the following conditions

  • Delayed menses, scanty or heavier menses, persistent vaginal bleeding or vaginal bleeding between periods (intermenstrual bleeding)
  • Suspected or confirmed pregnancy
  • Abnormal or severe abdominal pain
  • Foul smelling or pus like vaginal discharge
  • Cannot feel the IUD thread
  • Suspected displacement or expulsion of the IUD
  • You or your partner feel the IUD during sexual intercourse