Intrauterine devices (IUDs), or commonly called coils, are among the most popular and effective forms of contraception. They are small, T-shaped devices that a healthcare provider places inside the uterus to prevent pregnancy. IUDs are highly effective for contraception, with failure rates of less than 1% per year.
IUDs are typically associated with contraception, but they also offer significant benefits to women during perimenopause and menopause. Whilst available as both hormonal and non-hormonal contraception, hormonal IUDs can have a role during the perimenopause and menopause supporting both menstrual symptoms and MHT (menopause hormone therapy) another name for HRT.
What types of IUD are available?
IUDs are small, flexible devices that a healthcare professional places inside the uterus to prevent pregnancy. Insertion requires a trained healthcare professional and is usually done as an outpatient procedure in clinic. There are two main types of IUDs:
Copper coil
A small plastic device with copper wrapped around its stem and in some IUDs, with copper bands on the arms. The copper in the IUD creates an inhospitable environment for sperm, preventing fertilisation. It can also prevent implantation by altering the lining of the uterus. As it is non-hormonal, it is an option for women who cannot or prefer not to use hormonal contraception.
The copper IUD is effective for up to 10 years and provides a highly effective non-hormonal method for contraception.
- IUDs without bands tend to provide contraception for 5 years.
- IUDs with copper bands are effective for 10 years.
Hormonal IUD
A small plastic T-shaped device with a hormonal sleeve around its stem, there are different types of hormonal IUDs with different doses. The progestogen in the hormonal IUD thickens cervical mucus, which prevents sperm from entering the uterus. It also thins the lining of the uterus, reducing the chances of implantation if fertilisation does occur. The hormonal IUD can also stop ovulation in some women, further enhancing its contraceptive effectiveness.
The hormonal IUD is effective for up to 8 years and most of the hormone remains localised reducing the likelihood of hormonal side effects.
- If inserted from the age of 45 years for contraception, it can be left until the age of 55 years for removal.
- The lowest dose hormonal IUD is effective for 3 years and offers a low effective hormonal contraceptive.
- The standard dose hormonal IUDs are effective for 8 years for contraception with the added benefit of thinning the uterine lining for at least 5 years.
IUDs for contraception
For women who are sexually active and not yet post-menopause, IUDs provide a long-term, reversible option for contraception. Because IUDs work in multiple ways to prevent pregnancy, they are very effective forms of contraception.
Once inserted, women do not need to think about contraception every day or worry about missing doses, which makes IUDs a convenient option. As a fully reversible method, upon removing the device, fertility is returned immediately.
IUDs for perimenopause
For women in perimenopause or menopause, coils offer additional benefits beyond pregnancy prevention. Perimenopause is the transitional stage leading up to menopause and the hormonal changes can cause irregular and heavy periods alongside other menopausal symptoms.
One of the most common reasons women opt for a hormonal IUD during perimenopause is to help manage heavy and irregular bleeding.
Menstrual symptom management
One of the most common reasons women opt for a hormonal IUD during perimenopause is to help manage the heavy and/or irregular bleeding that often accompanies during this time. For women who experience heavy periods, especially during perimenopause, a hormonal IUD can significantly reduce menstrual flow or stop periods altogether. This can help alleviate the discomfort and inconvenience of heavy bleeding and improve quality of life.
Coils and HRT
The hormonal changes that occur during perimenopause and menopause can lead to multiple symptoms. For women who are experiencing menopausal symptoms, a hormonal IUD provides the progestogen component of HRT.
On its own, it is not a replacement for HRT but helps keep the lining of the uterus thin while using oestrogen treatment. The small, localised amount of progestogen can help maintain a steady dose to avoid further hormonal fluctuations.
Non-contraceptive benefits
Since the progestogen in hormonal IUDs helps to thin the uterine lining, it reduces the risk of endometrial cancer. For women who have certain risk factors for this condition, such as PCOS, using a hormonal IUD may provide added protection.
Contraception and menopause
Once a woman reaches menopause and has not had a period for at least 12 consecutive months, there is no longer a risk of pregnancy. This applies to women over the age of 50 years. For those who experience menopause under the age of 50 years, it is advised that contraception is no longer required after 24 consecutive months of no bleeding. But speak to your healthcare practitioner before stopping contraception at menopause.
Is an IUD right for you?
The decision to use an IUD, whether for contraception or menopausal symptom management, should be made in consultation with a healthcare provider. A coil insertion requires a procedure, and although the insertion procedure can be painful for some, local anaesthesia options are available. Discussing your priorities and health needs with your healthcare provider helps determine whether an IUD is a good option for you.
IUDs are an effective and reliable form of contraception and they also offer a range of benefits for women navigating perimenopause and menopause. Whether you’re looking for long-term contraception, relief from heavy periods, or management of menopausal symptoms, an IUD could be a viable option to consider.
Be sure to talk to your healthcare provider about your options for personalised care and together you can determine if a coil is the best choice for your needs.
This article was originally published on The Menopause Consortium.
