Tiny device, big impact for women
Since Dr Geeta Singh first qualified as a gynaecologist, numerous medical developments have increased the choices available for women – but none more so than the hormonal IUD.
The intrauterine device (IUD) is a small T-shaped plastic device that is inserted through the cervix to sit inside the uterus. It has revolutionised contraception for women, offering effective, long-acting, and reversible control over their reproductive ability.
Implants and IUDs have existed in various forms since 1909, although the safety flaws of early designs prevented widespread uptake. In Aotearoa, the copper IUD was made available in the 1970s, and a modern design remains an option for those preferring non-hormonal methods today.
In the 1990s, the hormonal IUD entered the field. Borrowing the T-shape design from the copper IUD, this option could slowly release tiny amounts of progestogen, a synthetic form of progesterone, directly into the uterus.
“Hormonal IUDs [the Mirena or Jaydess] are usually associated with contraception first,” says Dr Geeta Singh, Specialist Obstetrician and Gynaecologist. However, its origin story lies with menses-related issues, developed initially as a means for treating heavy, painful or prolonged periods.
Today, the hormonal IUD has become an essential tool for treating women with heavy menstrual bleeding and painful and crampy periods where no underlying cause can be found. This is because the controlled delivery of progestogen reduces the growth of the uterine lining.
“Less uterine tissue means less shedding, so that can eliminate pain for some patients,” says Dr Singh.
Additionally, it can treat endometriosis because it reduces the thickness of endometrial tissue deposits.
“If there’s a suspicion or a diagnosis, we can trial an IUD before conducting surgery,” says Dr Singh. “Some women prefer to have a laparoscopy to be certain, but others want to try something that might help straight away.”
Another area where IUDs can help is during menopausal hormone therapy (MHT). The use of oestrogen patches is associated with a risk of endometrial hyperplasia (thickening of the uterine lining), which can, in turn, pose a cancer risk. An IUD fitted as part of therapy delivers progestogen to thin the lining, counterbalancing the oestrogen’s impact.
Since 2019, hormonal IUDs have been fully funded for all uses, making the option “much more accessible for many more women”. An IUD can be fitted by a trained GP, a gynaecologist or at a Sexual Wellbeing Aotearoa clinic (formerly Family Planning).
It’s not for everyone, however, so it’s important to discuss your history with a specialist.
“We have to rule out conditions like fibroids or polyps first,” she says, “and there are some situations in which an IUD is not appropriate.”
Dr Singh is keenly aware of the conversation happening on social media about pain during IUD insertion.
“There are many ways we can make the procedure less painful,” and recommends that people talk honestly to their GP rather than listen to what influencers are saying. “Every woman experiences pain differently. We can give Misoprostol to soften and dilate the cervix, and that can reduce pain. A local anaesthetic is used to numb the cervix, and Penthrox is an option in some clinics too.”
Having it fitted under general anaesthetic is also an option for people who are very anxious, she says, or for those who have never had penetrative sex before, as “it can be quite confronting if someone is not mentally prepared.”
Irrespective of how it is placed or what it is used for, the IUD makes a considerable difference to the lives of many New Zealand women.