Insertion of an intrauterine device (IUD) under ultrasound guidance
IUDs are mainly used for contraception. However, today they are additionally used to help women with thickened endometrium or heavy periods. Devices that release a low dose of a progesterone-like hormone (levonorgestrel), such as the Mirena IUD, have been shown to markedly reduce and often even stop menstrual blood flow.
It is important that you are not pregnant at the time of insertion of an IUD. Therefore, it is most often inserted just after you have had a period; usually between day 5 and 10 of your cycle.
Why should you have an IUD inserted under ultrasound guidance?
Ultrasound assessment of the pelvis prior to inserting an IUD will ensure that it is safe to proceed and confirm the uterine cavity can accommodate the device.
Most women experience some discomfort when an IUD is inserted. However, this can be minimised by the procedure being performed by a specialist gynaecologist using ultrasound guidance; as the ultrasound allows the device to be directly visualised as it is moved through the cervical canal to enter the uterine cavity. Ultrasound guidance is particularly useful for women with either a uterus that is tilted backwards (retroverted uterus) or contains uterine fibroids. When studied as a group, those women who undergo insertion of an IUD by a specialist using ultrasound guidance report less discomfort than insertion of an IUD without ultrasound guidance.
Additionally, ultrasound assessment immediately after IUD insertion provides both you and your doctor instant confirmation that the device is correctly positioned within the uterine cavity.
What to expect?
It is normal to experience some discomfort with this procedure. At times, it can be moderately strong, like bad period pain. We routinely place local anaesthetic gel into the cervix at the time of the procedure to minimise your discomfort. Still, taking simple analgesia such as Naprosyn/Naprogesic approximately one hour prior to the procedure will help reduce any discomfort you may experience. You must not take Naprosyn/Naprogesic if you are allergic to the medication, allergic to aspirin or allergic to other nonsteroidal anti-inflammatory drugs.
Occasionally, women may feel faint during the procedure, but this generally resolves quite quickly.
You will have a pelvic ultrasound scan performed prior to the procedure, which will be helped by you arriving with a comfortably full bladder.
After our doctor explains the procedure to you, a speculum will be placed into the vagina so that the cervix can be clearly seen. The sonographer will also be scanning your lower abdomen to enable our doctor to see the angle of the cervix relative to the uterus, and to assist in guiding the IUD into its correct position within the uterine cavity. Once the device is successfully inserted, the placement and orientation of the IUD within the uterine cavity will be assessed using 3D ultrasound.
It is normal to experience crampy-type period pain and some light bleeding after the procedure. This can be managed using simple analgesia.
The risk of infection from the procedure is very small. You will be advised to avoid wearing tampons for the first few days after the procedure to keep this risk low. However, a pad or panty-liner may be used, if required.
A Copper IUD will start working as an effective contraceptive immediately. However, it is advisable to use an alternative form of contraceptive for one week after insertion of the Mirena IUD, as it takes a little longer to be effective.
Removal of an intrauterine device (IUD) under ultrasound guidance
Approximately 80-90% of IUDs can be removed under ultrasound guidance when the strings of the device are not visible with a speculum examination. This procedure can be performed at any stage of the menstrual cycle.
You will have a pelvic ultrasound scan performed prior to the procedure, so we recommend you arrive with a comfortably full bladder.
Why should you have an IUD removed under ultrasound guidance?
Occasionally the strings to remove the IUD are not visible with a speculum examination, and removal of the device under ultrasound guidance may be an alternative to surgical removal.
Ultrasound assessment of the pelvis prior to the removal of an IUD will assist with identifying the location of the IUD, the location of the strings attached to the lower end of the device, and ensure that there are no impediments to the easy removal of the device.
What to expect when an IUD is removed?
It is normal to experience some discomfort with this procedure. At times, it can be moderately strong, like bad period pain. We routinely use local anaesthetic gel placed into the cervix at the time of the procedure to minimise any discomfort you may experience. Nevertheless, taking simple analgesia such as Naprosyn/Naprogesic approximately one hour prior to the procedure will also help reduce the cramping that may occur. However, you must not take Naprosyn/Naprogesic if you are allergic to the medication, allergic to aspirin or allergic to other nonsteroidal anti-inflammatory drugs.
Occasionally, women may feel faint during the procedure, but this generally resolves quite quickly.
