Contraceptive IUD (mirena, copper): how does it work? Pricing

What is an IUD?

The Intrauterine Device (IUD) is a long-term contraceptive method with great efficacy. It is reversible, that is, after removing the device, the woman’s fertility returns to normal.

There are 2 types of IUD: copper and hormonal, also known as Mirena IUD or SIU (Intra-Uterine System). Both have similar efficacy and do not cause serious side effects.

The devices are a small piece of plastic in the shape of a T or a horseshoe that are inserted into the woman’s uterine cavity. They operate in the region creating a hostile environment for sperm and preventing fertilization.

According to the World Health Organization (WHO), copper IUDs are considered the safest and most effective long-term reversible contraceptive method that exists. Unlike the pill, there is no forgetting with the IUD, as the device is placed inside the uterus.

Therefore, its use is encouraged to promote birth control in an easier and more efficient way.

Remember that the IUD does not protect against STDs . It is only and only a contraceptive method, that is, that seeks to prevent pregnancy.

Its use is more suitable for women who have already had a child, because women who have never given birth have a higher risk of developing side effects, in addition to exposing themselves to more risk situations of contagion of STDs.

The use of the IUD is a contraceptive method used by only 2% of the population of childbearing age according to the Ministry of Health. Perhaps this is because of the price, or else because of the misinformation that hangs on the subject.

Therefore, find out more about the device in the text below and take the opportunity to answer your questions. Good reading!

What is it for?

The IUD is an efficient and long-lasting contraceptive method. It serves to prevent unwanted pregnancies , but does not offer protection against STDs. Once placed, it is valid for a few years, depending on the type placed.

The copper IUD lasts the longest: 10 years. The hormonal IUD, Mirena, or also IUS, lasts for about 5 years.

Types

There are, in general, only 2 types of IUDs. Both have the same goal, to prevent unwanted pregnancies, but each person’s modus operandi  is different. Understand:

Copper IUD

It is made of plastic and is coated with copper, or copper and silver. The presence of these metals in their composition is toxic to sperm, as it acts by killing them or preventing their motility, which prevents fertilization. It comes in the shape of a T and fixes less efficiently than the SIU, which is in the shape of a horseshoe.

Copper is released in small amounts, causing some changes in the endometrium (tissue that covers the inside of the uterus), mucus and the motility of the tubes. The endometrium becomes thinner, which prevents the fertilized egg from attaching to the wall of the uterus ( nesting ).

Thus, what happens is a mild inflammatory process that does not harm the body, but that makes the region hostile to sperm. The chances of getting pregnant with the copper IUD are approximately 0.7%.

In addition, the copper IUD is considered one of the most effective emergency contraceptive methods today. If placed within a period of 120 hours (approximately 5 days), it guarantees up to 99% success rate, since, in the meantime, it has the possibility and prevents nesting and, thus, pregnancy.

Hormonal IUD / Mirena or SIU

Unlike the copper IUD, the SIU contains levonorgestrel, a substance that is similar to progesterone , a hormone naturally produced by the body. It comes in a horseshoe shape, which has more grip and fixes better in the uterus than the copper IUD, which has a T shape.

The system releases this hormone at a constant rate and in small amounts (approximately 20mcg every 24 hours). This hormonal release can be absorbed into the bloodstream, but it is usually restricted to the uterus.

It promotes the thickening of the normal mucus of the cervical canal (opening to the uterus), in a way that prevents the passage of the sperm, preventing fertilization, in addition to promoting the same inflammatory processes that occur in the copper IUD.

According to the Mirena IUD package insert, approximately two-thirds of women who use this system have a menstrual block. The chances of getting pregnant using the SIU are approximately 0.2%.

Comparison between the IUD and the SIU

The hormonal load of the methods is:

  • SIU: 52mg of levonorgestrel, being released 20mcg per day;
  • IUD: It has no hormones;

Regarding the risk of becoming pregnant:

  • SIU: 0,2%;
  • IUD: 0.7%

Side effects include:

  • SIU: Suspension of menstruation and slight weight gain;
  • IUD: Increased menstrual flow and stronger cramps

Among the advantages:

  • SIU: Reduces menstrual flow and benefits women with endometriosis;
  • IUD: It lasts longer, it is cheaper, it can be used as an emergency contraceptive method and it is not affected by the use of medications;

There are indications:

  • SIU: For women with endometriosis, in menopause or with dysmenorrhea (strong and painful menstrual flow);
  • IUD: For women who have had breast cancer and have no problems with menstrual flow

And contraindications:

  • SIU: Who has had breast cancer in the last 5 years or has liver disease
  • IUD: Women who are allergic to copper or have a dysfunction in the metabolism of this substance

Each in a validity time:

  • SIU: 5 years;
  • IUD: 5 to 10 years.

How does it work?

The IUD is a contraceptive method that works by preventing the sperm from fertilizing the egg. This method does not protect against STDs , but simply seeks to prevent fertilization and pregnancy.

Basically, the device creates a hostile environment for sperm, preventing them from reaching the fallopian tubes, or having a spermicidal effect.

The uterus reacts to the device as a foreign body, causing an inflammatory reaction that interferes with the migration of sperm, fertilization and egg transport. This prevents it, when fertilized, from attaching itself to the wall of the uterus – a process known as nesting.

The two types of IUDs available on the market differ from each other by their mechanism of action. Understand:

Copper IUD

It is toxic to sperm and acts by killing these reproductive cells, that is, it is a device with spermicidal purpose. In addition, it makes the endometrium thinner, preventing the fixation of the fertilized egg in the uterine wall.

Hormonal IUD

It releases a hormone at a constant rate, promoting thickening of mucus in the cervical canal, preventing the passage of sperm, in addition to making the endometrium thinner.

It also affects the movement of sperm inside the uterus and helps to control the monthly development of the uterine lining layer, the endometrium, making it thin and not allowing a fertilized egg to attach to the wall of the uterus.

Who can put it?

IUD placement is indicated for women who are looking for an effective method of contraception, for a long period of time and in a reversible way.

It is one of the most recommended methods for breastfeeding, as it does not interfere with lactation. Another aspect that must be taken into account for the placement or not of the device is found in the woman’s age and parity, that is, whether or not she has had children.

As age and parity increase, the effectiveness of the device also increases along with its tolerance, in addition to a reduction in the incidence of side effects.

This does not mean, however, that women who have never had children cannot have an IUD inserted. In this regard, medical opinion is divergent. Some doctors believe that women who have never had children can have it, others believe that they cannot.

The best thing to do, in case of doubt, is to talk to your gynecologist and assess the risks and benefits involved in placing the device and make the choice that best fits your situation.

How is it placed?

The IUD is placed in the doctor’s office, with no need for surgery or hospitalization.

Using a speculum, a device used to separate the walls of the vaginal canal, the gynecologist cleans the cervix with an antiseptic product to prevent infections. The doctor then introduces the device through the vaginal canal to the uterus. The removal wires from the device are at the bottom of the vaginal canal.

This process lasts between 15 and 30 minutes and can be placed at any time during the cycle. However, the time considered ideal for placing the device is during menstruation, as the cervix is ​​more dilated.

Once placed, the woman should undergo medical monitoring once a year to ensure that the IUD is in the right place. It is also recommended to go back to the gynecologist 1 month after placement to check its location.

Preparations before placement

Before inserting the IUD, the patient will undergo a series of tests to check the clinical and physical conditions, such as a transvaginal ultrasound, evaluation for the presence of STDs and the existence of a pregnancy.

Ultrasound is intended to find out if a woman has uterine polyps or fibroids, as well as the shape of the uterus. In these cases, the implant may not be well positioned, which can also happen if the uterus is very large.

How the IUD is removed

As with placement, removal is done at the doctor’s office. It comes down to pulling the wire attached to the device. In cases where the IUD moves inside the uterine cavity, the doctor may use tweezers or a gynecological brush to find and remove it.

If the IUD perforates the myometrium, muscle of the uterus, it is necessary to have a surgical procedure to remove it.

Advantages and disadvantages

Among the disadvantages are:

  • It can cause the appearance of anemia due to the longer and more abundant periods that the device can cause;
  • Causes risk of infection in the uterus (approximately 1%);
  • If sexually transmitted infection occurs, it is more likely to develop into a more serious disease;
  • Increases the risks of ectopic pregnancy;
  • There is a small risk of perforation in the uterus (1 in 1000);
  • It can cause allergic reactions, although very rare;
  • The device can move out of place on its own;
  • The risk of ectopic pregnancy is greater;
  • Because of its T-shape, it can move around more easily.

But the advantages include:

  • It is a practical and long-lasting method, and can last up to 10 years;
  • It is reversible! You can choose to take the device off and you will still have a chance of getting pregnant;
  • When used correctly, it is 99% effective;
  • You don’t have to worry about forgetting to protect yourself, as in the birth control pill;
  • It does not affect breastfeeding;
  • It does not interfere with sex;
  • The copper version does not contain hormones;
  • The copper IUD can be used as an emergency contraceptive method;
  • Mirena has a very small amount of hormones, reducing its side effects;
  • The hormonal IUD, because it has the shape of a horseshoe, fixes very well.

Contraindications

There are some usage restrictions. In some cases, the contraindications are absolute, that is, IUDs should not be used in any way, while others are relative.

Talk to your doctor about your situation and check the following lists to get an idea of ​​what to talk to your doctor about.

Absolute contraindications

  • Suspected or confirmed pregnancy;
  • Acute or subacute pelvic infection;
  • Uterine malformation that prevents the placement of the IUD, such as bicornuate uterus or didelfo;
  • Suspected or presence of uterine neoplasia (malignant tumor in the uterus);
  • Genital bleeding of unknown origin.

Relative contraindications

  • Vascular heart diseases;
  • Recurrent pelvic inflammations;
  • History of septic abortion or postpartum endometritis in the first 3 months before placement;
  • Anomalies in the intrauterine cavity incompatible with the permanence of the copper IUD;
  • Stenosis (narrowing) of the cervical canal;
  • Previous ectopic pregnancy (pregnancy outside the womb);
  • Hypermenorrhea (abnormally long menstruation) or dysmenorrhea (abnormally short menstruation);
  • Acute cervicitis (inflammation of the cervix);
  • Coagulation changes or the existence of some treatment with anticoagulants;
  • Changes in copper metabolism, such as Wilson’s disease;
  • Uterine prolapse;
  • Between the 2nd and 7th week after delivery;
  • Anemias;
  • Allergy to copper;
  • AIDS.

Side effects

Before inserting the IUD, you should talk a lot with your gynecologist about your health situation and decide with him if this method is right for you. Only after all the pros and cons have been analyzed should you put the device on.

If you follow the doctor’s instructions and always keep an eye out for possible problems, occasional complications will rarely be present.

However, for some women, some side effects may occur after placing the device, such as:

  • Contractions or uterine pain (more frequent in women who have never had children);
  • Minor bleeding after placement;
  • Fainting;
  • Vaginal discharge.

Another thing that the copper IUD can do is make your periods longer and more intense. The pain of menstrual cramps is another factor that can intensify.

These effects, however, only happen to some women and usually disappear after a few weeks after placement.

The hormonal IUD, on the other hand, can cause a reduction or absence of menstrual flow. For some women, this would be more of a benefit than something bad, but it turns out that it can also cause small outflows of menstrual blood, called spotting , or escape bleeding.

In addition, it can cause pimples to increase, headaches, breast pain and tension, fluid retention, ovarian cysts and weight gain.

Adaptation period

It is very common for cramps to increase after the IUD is inserted. However, they are easily circumvented with the use of medications prescribed by the gynecologist. Therefore, a recovery period is not necessary and the patient leaves the office free to return to her activities.

Thereafter, the patient should only return to regular consultations to assess whether the device is in the correct position until it is time to remove it.

Scratchs

There are not many risks related to IUD placement. The procedure for placing this device is simple and the patient can return to normal activities on the same day. However, the procedure is delicate and some complications, such as perforation of the uterus, can happen.

Perforation of the uterus

This problem can happen when the IUD is implanted. At the time of placement, it is possible for the vaginal muscle to contract and the device to end up entering the myometrium, the middle layer of the uterine wall.

In more severe cases, the IUD can migrate into the abdominal cavity and even pierce the intestine. In addition, in these cases, the woman is more susceptible to pregnancy.

It is from the IUD

Often, the uterus may end up expelling the IUD, as it recognizes it as a foreign body. It is precisely for this reason that a consultation should be made 1 month after placement: to see if it is not out of place.

Ectopic pregnancy

The ectopic pregnancy is when the fetus develops outside the womb, in other places, such as in tubes, which is most common, or in the cervix and into the abdominal cavity. This is because, after the IUD is inserted, the fallopian tubes may lose mobility.

Cysts

There may be uterine cysts as a result of IUD placement. When this happens, symptoms like water retention and pain appear. Despite this, these symptoms usually subside and disappear without the need for treatments.

IUD Pregnancy

Like any contraceptive method, the IUD is not 100% effective. So, even though they are low, the chances of pregnancy exist! In such cases, it is recommended to have an ultrasound to perform the removal of the device if it is below the fetus.

If the IUD is on top, however, the ideal is to leave it in the uterine cavity. It is worth remembering that the device can very slightly increase the chances of miscarriage.

Price

The copper IUD can be purchased at any pharmacy for R $ 70.00 to R $ 100.00. Hormonal IUDs cost between R $ 200.00 and R $ 600.00. The price of your placement can be up to R $ 600.00, depending on the doctor.

In Consulta Remédios you can find all the medicines separated by type and also the prices in several pharmacies with e-commerce, save!

However, copper IUDs are offered free of charge by SUS in maternity wards and Basic Health Units (UBSs) for women in the postpartum or postabortion period. The device can be inserted up to 10 minutes after the placenta leaves, but it will still be available to the woman for up to 48 hours.

If it is not placed within this period, the woman must wait 40 days to make a new insertion. In post-abortion cases, the IUD must be placed after curettage .

Comparison between the SIU and the contraceptive pill

The main difference between the hormonal IUD and the pill is in the amount of hormone released into the body. While the IUD releases around 0.2mcg per day, the pill has a dosage of approximately 1mg.

Thus, the contraceptive pill has many more hormones than the IUD. In addition, as the hormones of the IUD are concentrated in the uterus and do not spread into the bloodstream, as is the case with the contraceptive, its side effects are much less.

Common questions

Can I use the IUD if I have never been pregnant?

This is a controversial question. While some doctors say that women who have never become pregnant should not use an IUD, other doctors say that there are no contraindications.

What is known is that women who have had children have a greater tolerance for the device, feel less side effects and experience greater effectiveness of the product. Anvisa, however, recommends that women who have never given birth do not put the device on.

The best option in case of doubt is to talk to your gynecologist. He is the most qualified professional to decide with you whether or not it is a good idea to use the device.

Does the IUD cause abortion?

No!  The IUD is a contraceptive method, that is, it prevents conception, that is, the encounter of the sperm with the egg. Therefore, he doesn’t even let the pregnancy occur.

The other mechanism of action of the IUD is to prevent a fertilized embryo from attaching itself to the endometrium, preventing nesting, that is, fixing the fertilized egg to the endometrium, which, from a medical point of view, is the beginning of pregnancy.

Does the IUD affect ovulation?

The IUD does not alter ovulation . Even the hormonal IUD does not have this effect, since the doses of hormone released by the device are too low to have any significance in the ovulatory process.

Therefore, symptoms such as fluid retention and swelling, common in the premenstrual period of the so-called luteal phase, will continue to occur even after IUD placement.

Does it hurt to put?

In general, most women tolerate the placement of the IUD, without feeling any pain during its placement.

What can cause pain during placement is the fact that the doctor often needs to pinch a part of the uterus in order for the device to be properly placed. It is this part that can be quite painful for some women.

To avoid these effects, many doctors choose to use anesthesia. However, the pain is quite variable and depends on each woman.

It is also the case that some women experience pain and dizziness after  insertion, but these effects usually disappear after a short rest interval.

Is it possible to feel the presence of the IUD during sexual intercourse?

No!  It is very difficult for this to happen, because the IUD is inside the uterus and not in the vaginal canal, which is where penetration occurs.

If you and your partner feel the IUD during intercourse, which is very difficult, see a doctor to see if the device is in the right place.

Some partners may feel the IUD removal thread, but this is unusual. When this occurs, it does not usually cause problems or pain in the partner and the doctor can take action to get around the situation.

How is the bleeding after insertion?

It depends on the type of IUD you have.

The copper IUD is more likely to cause an increase in monthly bleeding. This usually occurs because of the longer duration and intensity of menstrual flow, but it can also be caused by irregular bleeding and leakage between periods.

In the case of the hormonal IUD, the hormone released by the device causes the intrauterine wall to become thinner. This can cause changes in menstruation, causing you to have both longer and shorter periods, with lighter or more intense bleeding. It depends on each case.

The most common in the case of hormonal IUDs is a decrease in flow or total absence of it. When it is placed for the first time, before the wall thin. After placement, women may experience unexpected (minor bleeding) leakage, which usually subsides after the first few months of use.

If these bleeds do not go away, you should see your gynecologist to make sure the bleeding is not linked to another cause.

Can the IUD come out or get stuck in the uterus?

Yes, but this type of phenomenon is very rare. Sometimes muscle contractions in the uterus during menstruation can get the IUD out of place and even cause it to expel. Very rarely, there may be perforation of the wall of the uterus.

The procedure is safe, as it is performed by a specialized and qualified doctor, who will follow all the necessary procedures to ensure the safety and correct placement of the device.

If there is any unusual bleeding, pain or discomfort, the doctor or professional in the field should be informed as soon as possible.

Is it safe to use tampons during menstruation if I am using an IUD?

Yea!  There is no problem using tampons while using the IUD. This is because the device is located inside the uterus, while the menstrual pad and pad are inside the vaginal canal, which is separated from the uterus by a membrane called the cervix. Thus, there is no contact between the two regions.

The only care to be taken is when handling the tampon. Care must be taken not to accidentally pull the IUD removal wires. They are usually very short, not being possible to reach them with just your fingers, but it is worth the attention.

Can I use the IUD for longer than recommended?

The recommended use time for the copper IUD is 10 years. The hormonal IUD is 5. After that time, the device must be replaced with a new device.

After a caesarean, how long do I have to wait to have the IUD inserted?

Unlike normal delivery, in which the IUD can be placed within 48 hours after the delivery of the placenta, the recommended time is 40 days after cesarean section.

Can I breastfeed while using the IUD?

There is no contraindication in relation to breastfeeding and the use of an IUD.

Does the IUD affect fertility?

No!  If you want to have children after having the IUD removed, you have an 85% chance of becoming pregnant after 1 year of having the device removed.

Can I stop using the IUD using a condom?

Definitely not! The IUD is just a contraceptive method. It does not protect you from sexually transmitted diseases (STDs) . So, even with the IUD, keep using a condom .

What is the possibility of getting pregnant using the IUD?

According to data from the World Health Organization (WHO), the IUD is a very effective device to prevent pregnancy. According to the organization, ParaGard’s copper IUD has a 0.8% chance of pregnancy, while the hormone Mirena IUD exposes women to a 0.2% chance of becoming pregnant.

Can the IUD be used as an emergency method of contraception?

Yea!  The copper IUD  is an excellent method of emergency contraception. If you put it within 120 hours (approximately 5 days) after intercourse, it can be up to 99% efficient! Some experts say it is the most effective method of emergency contraception out there.

The good thing about using the copper IUD as an emergency method is that you will have a long-term contraceptive from the moment you put it on. As stated earlier, the copper IUD is valid for up to 10 years!

Was the IUD less effective in the past?

Yea!  The oldest IUDs were different from the current ones. Nowadays, the type of copper and the quantities of that substance have changed, ensuring more efficiency. So always look for devices that carry the number 375 in their name. They have good amounts of copper and will work better.


The IUD is one of the safest methods of contraception today. Its use brings few risks, but it is worth remembering that it does not  protect against STDs.

Do you use an IUD? Do you know someone you want to use? Then send this text to help answer your questions!

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