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IUD

Choosing the right method of contraception is an important decision for many women. Among the options available, long-term contraception is gaining popularity, and intrauterine devices (IUDs) are among the most effective reversible methods of preventing pregnancy. Due to their high effectiveness and convenience of use, more and more women are considering using them. However, making an informed decision requires access to reliable and comprehensive information.

What is an IUD and how does it work?

An intrauterine device (IUD), often commonly referred to as a contraceptive coil, is a small, flexible element placed in the uterine cavity by a gynecologist. It is made of plastic that is safe for the body. Most often it has a characteristic shape of the letter “T”, although other forms are also available, such as the spherical IUB Ballerine insole. The standard dimensions of the T-type insert are about 28-32 mm wide and 30-36 mm long.

Two thin threads are attached to the bottom of the IUD, which protrude from the cervix into the vagina when inserted. They are used for the patient to check on her own whether the IUD is in place and for the doctor to remove it. A properly placed IUD is completely imperceptible during everyday activities, physical exercise or sexual intercourse, both for the woman and her partner.

The primary purpose of the IUD is to prevent pregnancy by preventing the fertilization of the egg by a sperm or, in some mechanisms, by hindering the implantation of an already fertilized egg in the uterine mucosa. The mode of operation varies depending on the type of insole.

Types of IUDs: Hormonal vs. Hormonal Copper

There are mainly two types of IUDs available on the market, differing in their structure and mechanism of action: hormonal IUDs and non-hormonal IUDs, called copper IUDs. Historically, the so-called inert inserts were also used, made only of plastic or stainless steel, without the addition of hormones or metals. Their action consisted mainly in mechanical prevention of embryo implantation, which is important in the context of hormone-free IUDs. However, due to their lower effectiveness and potentially higher risk of complications, they are currently rarely used and practically replaced by more modern solutions.

Hormonal IUDs (e.g., Mirena, Kyleena, Jaydess, Levosert): Mechanism of Action

Hormonal IUDs contain a small reservoir from which a hormone is gradually released throughout the entire period of the system’s operation – synthetic progestin, most often levonorgestrel. Levonorgestrel is a derivative of progesterone, also used in some oral contraceptive pills. A key feature of hormonal IUDs is their local effect – the hormone is released directly in the uterine cavity. As a result, the concentration of the hormone in the blood is much lower than when using oral contraceptives, which translates into a lower risk of systemic side effects. This mechanism means that hormonal IUDs can be well tolerated by women who are sensitive to hormones or those who have contraindications to the use of estrogens, present in combined contraceptive pills.

The contraceptive mechanism of hormonal IUDs is complex and includes several aspects:

1. Cervical mucus thickening: The hormone released causes the mucus produced by the cervix to become thicker and less permeable to sperm, making it much more difficult for them to reach the uterine cavity and fallopian tubes.
2. Changes in the endometrium: The hormone affects the endometrium, causing it to thin and cause structural changes, which is important when using a hormonal contraceptive device. A thinner mucous membrane is less likely to accept and implant a fertilized egg, which can increase the risk of pregnancy.
3. Inhibition of sperm motility and function: The environment inside the uterus and fallopian tubes becomes less conducive to sperm, which inhibits their motility and ability to fertilize.
4. Inhibition of ovulation: Some women using a hormonal IUD may inhibit or limit ovulation (ovulation), which is an additional contraceptive mechanism.

Copper Inserts: Mechanism of Action

Copper IUDs, as the name suggests, do not contain hormones. Their core is made of plastic, around which a wire is wrapped or copper beads are threaded. Sometimes other metals such as silver or zinc are also used in combination with copper. The copper IUD works contraceptive through several mechanisms, which are the result of the presence of copper and the IUD itself as a foreign body in the uterus:

1. Spermicidal effect: Copper ions released from the IUD are toxic to sperm, damage them and significantly reduce their viability and motility.
2. Inflammatory Reaction: The presence of the IUD in the uterus causes a local, sterile (without bacteria) inflammatory reaction in the endometrium. In response to inflammation, leukocytes (white blood cells) accumulate in the uterus, which further destroy sperm. An inflamed endometrium also becomes unfriendly to possible implantation of the embryo.
3. Change in the properties of cervical mucus: Like hormonal IUDs, although to a lesser extent, copper IUDs can affect the consistency of cervical mucus, making it difficult for sperm to penetrate.
4. Alteration of uterine environment: Copper ions can affect the pH and ionic composition of the intrauterine fluid, creating an environment that is unfavorable for sperm and fertilization.

Newer designs of copper IUDs are also appearing on the market, such as thread-shaped systems with copper reservoirs attached.

Comparison of IUD types

Feature	Hormonal IUD (e.g. Mirena, Kyleena)	The Copper IUD (e.g. IUD) is one of the options available on the market. Nova-T, IUB Ballerine)
Substance	Levonorgestrel (synthetic progestin)	Copper ions
Mechanism of action	Mucus thickening, endometrial thinning, inhibition of sperm motility, partial inhibition of ovulation	Copper spermicidal effect, sterile inflammation in the uterus, thickening of mucus, changes in the endometrium
Runtime	3 to 8 years (depending on type)	5 to 10 years (depending on type)
Effects on menstruation	Scant, shorter bleeding, spotting, sometimes disappearance of menstruation	Often, heavier, longer and/or more painful bleeding (especially at the beginning) can be the result of using a hormonal coil.
The non-contraceptive benefits of hormonal contraception may be important for many women.	Treatment of heavy bleeding, relief of menstrual pain, potential prevention of fibroids/polyps	Hormone-free (option for women with contraindications), can be used as emergency contraception
Main potential drawbacks/side effects	Hormone-related side effects (e.g., headaches, acne, mood changes, ovarian cysts), irregular bleeding at the beginning	Increased bleeding and menstrual pain

Contraceptive effectiveness of IUDs

One of the biggest advantages of IUDs is their very high effectiveness in preventing pregnancy, exceeding 99%. This means that within a year of using this method, less than 1 in 100 women will become pregnant. The effectiveness of contraceptive methods is often assessed by the Pearl Index (PI). This indicator determines the number of unplanned pregnancies that occurred in a group of 100 women using a given method of contraception for a year. The lower the value of the Pearl index, the more effective the method is considered to be.

Pearl Index for IUDs

IUDs are among the methods with the lowest Pearl index values, which confirms their exceptional effectiveness:

• Hormonal IUDs (with levonorgestrel): They show very high efficacy, with the Pearl index estimated at around 0.1-0.2 or 0.1-0.34 depending on the specific type and duration of application. Some sources give a PI of 0.14. This places them among the absolute most effective reversible methods of contraception, even comparable to sterilization.
• Copper inserts: They are also very effective, although their Pearl index is slightly higher than that of hormonal IUDs. The most commonly reported values are in the range of 0.6-0.8. Some sources give a wider range of 1-3. Despite these differences, the effectiveness of more than 99% is confirmed.

It is worth noting that in the literature you can find slightly different values of the Pearl index for the same methods. This may be due to differences in research methodology, studied populations, or the distinction between effectiveness in “ideal” conditions (strict adherence to the rules) and “typical” conditions (taking into account user errors). It should also be remembered that the Pearl index is an assessment method developed in the 30s of the twentieth century. Currently, the World Health Organization (WHO) more often recommends presenting effectiveness as a percentage, although the Pearl index is still widely used as a clear benchmark. Regardless of the measure adopted, IUDs consistently rank among the most effective reversible methods of preventing pregnancy.

Comparison with other contraceptive methods

To better illustrate the position of IUDs, it is worth comparing their effectiveness (measured by the typical Pearl index) with other popular methods of contraception.

Effectiveness of selected contraceptive methods (typical Pearl index)

Contraceptive method	Typical Pearl Index (number of pregnancies per 100 women per year)	Sample sources
No contraception	85
Hormonal IUD (LNG-IUS)	0,1 – 0,2
Contraceptive implant	0,05 – 0,2
Copper Insert (Cu-IUD)	0.6 – 0.8 (or 1-3 according to other sources)
Contraceptive injection	0,3 – 1,2
Single-component contraceptive pills (mini-pill)	0.5 – 5 (or 3.0 according to other sources)
Contraceptive Patch	0.2 – 1 (or 0.9 according to other sources)
Vaginal Ring	0.65, which may be important in the context of depending on the manufacturer of the earbuds.
Combined contraceptive pills	0,1 – 7,6
The male condom is one form of contraception, but it does not provide hormonal control.	3 – 13,9
Natural methods (e.g. calendar, sympto-thermal, and hormonal coil)	9 – 25 (depending on method and accuracy)
Interrupted intercourse can be used in the context of various methods of contraception, including the hormone-free IUD.	4 – 23,6
Spermicides	6 – 25,7

Note: Pearl index values may vary depending on the source and methodology of the study.

As you can see in the table, IUDs, both hormonal and copper, offer much higher efficacy in typical use than methods dependent on regular use by the user (e.g. pills, condoms, natural methods), where the risk of human error is higher.

Advantages of using an intrauterine device

IUDs offer a number of benefits that make them an attractive choice for many women looking for a reliable and convenient method of contraception.

Long-term protection and convenience

One of the main advantages is the long duration of operation. Depending on the type, the IUD provides contraceptive protection for many years: copper IUDs can last from 5 to even 10 years , and hormonal IUDs from 3 to 8 years. This means that you do not have to remember to take a pill every day, change the patch every week or use the method immediately before intercourse. After putting on the insole, you can practically “forget” about it, which provides great mental comfort and convenience. In addition, the pad is discreet – invisible and imperceptible neither for the woman nor for her partner.

Reversibility of the method and rapid return of fertility

Despite its long-term effect, the IUD is a fully reversible method. After its removal by a doctor, a woman’s fertility returns to normal very quickly, often already in the next menstrual cycle. The use of an IUD has no lasting effect on the ability to get pregnant in the future, which is confirmed by the recommendations of the Polish Gynaecological Society regarding indications.

Benefits specific to hormonal IUDs

In addition to their high contraceptive effectiveness, hormonal IUDs offer additional health benefits related to the local action of levonorgestrel. In many women, they lead to a significant reduction in the amount of menstrual bleeding, shortening its duration and relieving menstrual pain. In some patients, menstruation may become very scanty or even disappear completely for the duration of the IUD, which is seen as an advantage for many. It should be emphasized that the lack of bleeding at the hormonal IUD is a normal phenomenon and does not indicate pregnancy.

These properties make hormonal IUDs often recommended and used not only as contraception, but also for therapeutic purposes – in the treatment of excessive menstrual bleeding (menorrhagia), which can lead to anemia and significantly reduce the quality of life. They can also bring relief to women suffering from endometriosis or severe menstrual pain. Some data suggest that they may also reduce the risk of developing uterine fibroids, endometrial polyps, and endometrial cancer. The possibility of hormonal IUDs being used by women who cannot take estrogen (e.g. due to the risk of thrombosis) is another significant advantage. The therapeutic value of hormonal IUDs is therefore significant and should be taken into account when choosing a method, constituting an added value beyond mere protection against pregnancy.

Benefits specific to copper inserts

The main advantage of copper IUDs is the lack of hormones. This makes them an ideal choice for women who prefer hormone-free contraception, experience unacceptable hormone-related side effects, or have medical contraindications to their use (e.g. a history of thromboembolism, certain liver diseases, hormone-dependent cancers). Copper pads do not affect a woman’s natural ovulation cycle. Their action is limited to the uterus, with no significant impact on the rest of the body. An additional, unique advantage of the copper IUD is that it can be used as a highly effective emergency contraceptive (“after intercourse”) if it is inserted within 5 days of unprotected intercourse.

Disadvantages, side effects and risks of the IUD

Despite its many advantages, the use of IUDs is also associated with some drawbacks, potential side effects and, although rarely, the risk of more serious complications. It is important that every woman considering this method is aware of them. It should be emphasized that most side effects are mild and temporary, and serious complications are rare.

The main “disadvantage” is the need to visit a gynaecologist to insert and remove the IUD – this is not a method that you can start or finish on your own. It is also crucial to know that IUDs (of any type) do not protect against sexually transmitted diseases (STIs) such as HIV, chlamydia, syphilis or gonorrhea. If there is a risk of STI infection, it is necessary to use condoms at the same time.

Possible complaints after insertion and during the adaptation period

The procedure of inserting the IUD itself, as well as the period immediately after it, may be associated with some discomfort, so it is worth consulting a doctor. Many women experience pain or cramps in the lower abdomen, reminiscent of menstrual pain, both during the insertion of the IUD and for several hours or days after surgery. You may also experience minor spotting or bleeding. These symptoms are usually a normal reaction of the body to the presence of a new element in the uterus and usually resolve on their own within a few days or weeks as the body adapts.

Effects on the menstrual cycle

The effect of the IUD on the nature of menstrual bleeding is one of the most commonly observed effects and varies significantly depending on its type:

• Copper inserts: They do not contain hormones, so they do not inhibit the natural menstrual cycle. However, their presence, especially in the first months of use, often leads to changes in the bleeding profile. Women may experience periods that are heavier, last longer, and/or are more painful than before the IUD was inserted. For this reason, copper pads may not be the best choice for women who have already had a problem with very heavy or painful periods before they are inserted.
• Hormonal IUDs: The effect of levonorgestrel on the endometrium usually leads to a significant reduction in the abundance and duration of menstrual bleeding. In the first months (adaptation period), irregular spotting or light bleeding between menstrual periods often occur. In many women, after a few months of use, menstruation becomes very scanty, and in some (about 20% or more, depending on the type of IUD and the duration of use) it may disappear completely.

Potential side effects (hormonal and copper)

In addition to the effect on the cycle, the pads can cause other side effects:

• Hormonal IUDs: Due to the presence of the hormone, side effects similar to those seen with other hormonal methods may occur, although usually less severe due to the mainly local action. These include: headaches, including migraines, mood changes, nervousness and even depressive mood or depression, acne or worsening of existing acne, breast tenderness or pain, alopecia (hair loss) or hirsutism (hirsutism), benign, functional ovarian cysts (which usually do not give symptoms and disappear on their own), bloating, back pain. It is worth noting more recent data suggesting that despite the low systemic dose of the hormone, IUDs with levonorgestrel may significantly increase the risk of acne, alopecia and hirsutism compared to copper IUDs. Although the mechanism is not entirely clear, it does show that even local release of the hormone can produce noticeable systemic effects in some women, which is important information when making decisions, especially for people with a predisposition to these types of skin or hair problems. Changes in libido (usually a decrease) are more often associated with systemic hormonal methods, but they cannot be completely ruled out.
• Copper inserts: The main potential side effects relate to the already mentioned increase in bleeding and menstrual pain. You may also experience back pain.
• General possible side effects (both types): Regardless of the type of insole, some women may experience back pain or vaginal discharge. There is also a small, increased risk of developing pelvic inflammatory disease (PIR), especially in the first weeks or months after IUD placement. However, this risk is low, especially after the first month.

Rare but serious complications: Expulsion, perforation, ectopic pregnancy

Although rare, there are more serious complications associated with the use of IUDs that you should be aware of:

• Expulsion (expulsion of the IUD): The uterus can expel the IUD on its own. The risk of expulsion is generally low, estimated to be around 4% or less. It is slightly higher in the first months after insertion, during menstrual bleeding, in very young women (under 20 years of age), in women who have never given birth (nulliparous), and in women with heavy menstruation or severe uterine contractions. If the IUD partially or completely falls out, you lose your contraceptive protection. Therefore, it is important to regularly self-check the presence of threads and follow-up visits to the doctor.
• Perforation (puncture of the uterine wall): This is a very rare but potentially serious complication in which the IUD punctures the uterine muscle during insertion. The incidence is estimated to be about 0.5-1 in 1000 to 1-3 in 1000 applications of a hormone-free IUD. The risk may be slightly higher in women up to 6 months after childbirth, breastfeeding, with a posterior or atypical uterus, after a caesarean section, as well as when the procedure is performed by a person with less experience. Perforation can lead to the displacement of the insert into the peritoneal cavity or pelvis. Symptoms that may suggest perforation include, m.in, severe, unusual pain during insertion, subsequent lack of palpable threads in the vagina, unusual bleeding or its atrophy, chronic pain in the lower abdomen, as well as unplanned pregnancy. Suspected perforation requires urgent diagnosis (e.g., ultrasound, X-ray) and medical intervention to remove the IUD, which may sometimes require laparoscopic or hysteroscopic surgery.
• IUD pregnancy and ectopic pregnancy are topics that should be discussed with your doctor, especially in the context of the risk of pregnancy. Due to the very high effectiveness of IUDs, getting pregnant while using them is extremely rare. However, if fertilization occurs despite the presence of an IUD, there is a relatively increased risk that the pregnancy will develop outside the uterine cavity – most often in the fallopian tube. This is called an ectopic pregnancy. Ectopic pregnancy is a serious condition, potentially life-threatening for a woman and requires immediate medical intervention. If the pregnancy develops normally in the uterine cavity, the presence of the IUD increases the risk of complications such as miscarriage, premature birth or intrauterine infection. Therefore, if an intrauterine pregnancy is diagnosed in a woman with an IUD inserted, it is usually recommended that it be removed as soon as possible by a doctor, as long as it is technically possible and safe to do so.

Who is the contraceptive device for? Advantages and disadvantages

The decision to choose an IUD should be made after careful consideration of the woman’s individual health situation, needs and preferences, in consultation with a gynecologist.

Indications for the use of an IUD

The IUD is a particularly good solution for women who:

• They are looking for a long-term (several years), highly effective and reversible method of contraception.
• They value convenience and do not want to remember to take pills every day, change the patch weekly or use the method immediately before intercourse, so they consider an IUD that does not contain hormones.
• They are after childbirth (after the end of the postpartum period, which is usually after 6 weeks).
• Breastfeeding – both copper and hormonal IUDs (usually a few weeks after delivery) are considered safe during lactation.
• They have never given birth (they are nulliparous). This is important information, because there is still a myth that IUDs are only intended for women who have already given birth. Modern IUDs, including smaller hormonal systems, are safe and effective also in nulliparous women, which is confirmed by the positions of gynaecological societies. Debunking this myth is crucial to ensuring that young women have access to a full range of effective contraceptive methods.
• They have contraindications to the use of estrogens (e.g. due to the risk of thrombosis, migraines with aura, smoking cigarettes over 35 years of age) – they can safely use a copper IUD (without hormones) or a hormonal IUD (containing only progestin).
• They suffer from excessively heavy or painful menstrual bleeding – in this case, a hormonal IUD can be not only contraception, but also a method of treating these ailments.

Contraindications to the use of an IUD

However, there are situations in which the insertion of an IUD is contraindicated or requires special care. The most important contraindications include:

• Pregnancy or suspected pregnancy.
• Unexplained vaginal bleeding – requires diagnosis before insertion of the IUD.
• Active, recent or recurrent pelvic inflammatory disease (PID) or other acute reproductive infections (e.g., cervicitis, vaginitis).
• Congenital or acquired defects of the uterus that significantly deform its cavity (e.g. septate uterus, bicornuate uterus, large submucosal or intramural fibroids that deform the uterine cavity) – may prevent proper insertion of the IUD or increase the risk of its prolapse or perforation.
• Malignant neoplasms of the reproductive organs (e.g. cervical cancer, endometrial cancer) or suspected of these cancers.
• Breast cancer (current or past) – a particularly important contraindication for hormonal IUDs.
• Period immediately after childbirth (it is usually recommended to wait at least 6 weeks after vaginal delivery, and sometimes longer after caesarean section) or after septic miscarriage.
• Allergy (allergy) to copper may be a contraindication to the use of the IUD. or other components of the IUD (e.g. levonorgestrel).
• Severe liver diseases (active inflammation, cirrhosis, liver cancer) – mainly affects hormonal IUDs.
• Thromboembolism (active or history of deep vein thrombosis, pulmonary embolism) – is a relative or absolute contraindication, especially for hormonal IUDs, although the risk is lower than with combined tablets.
• Some other conditions, such as unstable diabetes, severe hypertension, acute porphyria, abnormal cytological test result requiring further diagnosis, history of bacterial endocarditis.

The final decision on the possibility of inserting an IUD is made by a gynaecologist after taking a thorough history and conducting the necessary tests.

Procedure for inserting and removing the IUD

Both the insertion and removal of the IUD are medical procedures performed by a gynaecologist on an outpatient basis.

Preparation and research before setting up

Before inserting the IUD, it is necessary to consult a gynecologist. During this visit, the doctor will take a thorough medical history about your health condition, past illnesses, obstetric and gynecological history, and lifestyle. He or she will also perform a gynecological examination and an ultrasound examination of the reproductive organs to assess the size, shape and position of the uterus and rule out any abnormalities. It is necessary to rule out pregnancy, which is usually confirmed by a pregnancy test. The doctor will also order an up-to-date cytological test, and in some cases may recommend additional tests, e.g. testing for infections, breast examination or basic blood tests (e.g. for anemia).

What does the procedure of inserting an IUD look like?

The procedure of inserting the IUD itself takes place in a gynaecologist’s office and usually takes a very short time – a few, maximum several minutes. It is most often recommended to perform the procedure during menstrual bleeding or just after it ends (usually during the first 7 days of the cycle), in accordance with the recommendations of the Polish gynaecological society. This has two advantages: firstly, the cervix is physiologically slightly more opened, which can facilitate the insertion of the IUD and reduce discomfort , and secondly, it gives the greatest certainty that the patient is not pregnant.

The insertion procedure is as follows: the patient is in the gynaecological chair. The doctor inserts a speculum into the vagina to make the cervix visible, and then washes it with an antiseptic. He can use special tools (forceps) to grasp and stabilize the cervix. Then, using a thin, flexible applicator, he inserts the folded IUD through the cervical canal into the uterine cavity. After placing the IUD in the right place (at the bottom of the uterus), the doctor frees its arms and removes the applicator. Finally, he cuts the threads protruding from the cervix to the appropriate length (usually a few centimeters) so that they are palpable in the vagina, but do not interfere. Often, a follow-up ultrasound is performed immediately after insertion to make sure that the IUD is correctly placed in the uterine cavity.

In most cases, the procedure is performed without anesthesia. However, in women who are particularly sensitive to pain, very anxious or in the case of anticipated technical difficulties (e.g. related to anatomy), it is possible to use local anesthesia of the cervix or even perform the procedure under short general anesthesia in the operating room. However, it should be remembered that the National Health Fund does not reimburse the costs of anesthesia for this procedure.

What does the patient feel and recommendations after the procedure?

The feeling when putting on the insole is individual. Most women experience some discomfort, pressure, or pain that resembles menstrual cramps, especially as the applicator passes through the cervix and the IUD is released. The pain is usually short-lived. Some patients may experience temporary dizziness or a feeling of weakness immediately after the procedure.

After inserting the IUD, it is usually recommended to:

• Rest for the rest of the day.
• Avoiding intense physical exertion for several days.
• Abstaining from sexual intercourse for a few days (usually 1 to 7 days, depending on your doctor’s recommendations).
• Use of commonly available painkillers as needed to relieve possible cramps.

In the first days and weeks after insertion, there may be slight spotting or bleeding and cramps in the lower abdomen. This is normal and should gradually subside. The patient should be instructed on how to check for the presence of IUD threads on her own (e.g. once a month after menstruation) by gently inserting a finger into the vagina and checking that the threads are palpable at the cervix. Do not pull on them.

A follow-up visit to the gynaecologist is necessary, usually after 3-6 weeks or 4-12 weeks after insertion. The doctor will then check whether the IUD is correctly placed (often by ultrasound) and whether there are any worrying symptoms. Follow-up visits are usually recommended once a year, unless there are any problems.

Important: The copper IUD provides contraceptive protection immediately after insertion. In the case of a hormonal IUD, if it is inserted within the first 7 days of the menstrual cycle, it also works right away. However, if it is inserted on a different day of the cycle, it is recommended to use an additional method of contraception (e.g. a condom) for the first 7 days after the procedure.

How does the IUD removal work?

Removing the IUD is usually a simpler and less painful procedure than inserting it. They are also performed in a gynaecologist’s office. The IUD is removed after the end of the period of use recommended by the manufacturer or earlier, if the patient decides to change the method of contraception, plans pregnancy , or there are medical indications for its removal.

The procedure is best performed during menstruation, because the cervix is then more open, which facilitates the procedure and reduces possible discomfort. The doctor, using a speculum, makes the cervix visible, and then, using special forceps, grabs the threads protruding from the cervical canal and gently, slowly pulls, sliding the IUD out of the uterus. The whole procedure usually takes only a few minutes. Most women experience only mild discomfort or a short-term feeling of pulling. The procedure usually does not require anesthesia.

If you plan to continue using this method of contraception, a new IUD may be inserted immediately after the removal of the old one at the same visit.

In rare cases where the IUD threads are not visible (e.g. they have become inserted into the cervical canal or the uterine cavity) or where standard removal is not possible, hysteroscopic removal of the IUD may be necessary. Hysteroscopy involves inserting a thin optical instrument (hysteroscope) with a camera into the uterine cavity, which allows the IUD to be visualized and removed using special micro-tools inserted through the working channel of the hysteroscope. This procedure is usually performed under local or short general anaesthesia and may require the conditions of the operating room.

IUD – price and reimbursement of the National Health Fund

When deciding on an IUD, it is worth taking into account the financial aspects related to its purchase and insertion, as well as the possibility of reimbursement by the National Health Fund (NFZ) in Poland.

Cost of IUDs

The price of the IUD itself varies and depends primarily on its type (copper or hormonal) and the specific manufacturer and model.

• Copper cylinders are generally a cheaper option. Their cost in pharmacies usually ranges from about PLN 100 to PLN 500. For example, the popular Nova-T cartridge can cost about PLN 135.
• Hormonal IUDs are much more expensive. Their prices start from about PLN 300 (e.g. Levosert about PLN 309, which is one of the costs of inserting a hormonal IUD) and can reach up to PLN 1500. Popular systems such as Jaydess (operation up to 3 years) cost about 600 PLN, Mirena (up to 5-8 years) about 600-800 PLN, and Kyleena (up to 5 years) about 630 PLN.

The IUD is usually purchased by the patient at a pharmacy (most often a prescription from a doctor is required), although some gynaecological offices offer the possibility of buying the IUD directly from them.

Setup cost and total expense

The cost of the IUD itself should be increased by the fee for the service of its insertion by a gynecologist. In private offices, this cost varies greatly and usually ranges from about PLN 150-400 to even PLN 550 or more, depending on the facility and region.

The total cost associated with the insertion of an IUD in the private sector (the price of the IUD + the fee for the procedure) is therefore usually between PLN 800 and PLN 1800. Although this is a significant one-time expense, it is important to remember about the long operating time of the insole (from 3 to 10 years). By spreading this cost over the entire period of use, the IUD often turns out to be a very financially profitable method, often cheaper in the long run than regular buying of contraceptive pills or patches.

NFZ reimbursement – theory and practice

According to the applicable law in Poland, the insertion of the coil requires gynecological consultation regarding indications and safety. The procedure of insertion and removal of the IUD itself is a guaranteed service, financed by the National Health Fund. This means that every gynaecology and obstetrics clinic with a contract with the National Health Fund is obliged to perform these procedures free of charge for a patient insured in the National Health Fund. In this case , the patient only bears the cost of purchasing the IUD itself. The NFZ reimbursement, on the other hand, does not cover the cost of possible anesthesia for the procedure.

Unfortunately, in practice, the availability of free insertion or removal of an IUD on the National Health Fund is often very limited and patients face numerous difficulties. Monitoring carried out by patient organizations (e.g. the FEDERA Foundation) shows that many facilities with a contract with the National Health Fund contract refuse to perform these procedures under insurance, offering them only as commercial (paid) services. Doctors sometimes explain this by the lack of appropriate tools, too low valuation of the service by the National Health Fund, which does not cover the costs and risks, or fear of financial losses in the event of failure of the procedure (e.g. damage to the IUD during insertion).

This discrepancy between law and practice is a significant systemic problem, limiting women’s access to one of the most effective methods of contraception. Patients who are refused a reimbursed procedure should be aware of their rights. It is recommended that in such a situation:

• Refer to the applicable regulations and positions of the Ministry of Health and the National Health Fund confirming the reimbursement.
• Demand a written refusal to perform the service from the medical facility along with the justification.
• Lodge a complaint with the director of the facility, the relevant provincial branch of the National Health Fund or the Ombudsman for Patients’ Rights if the recommendations of the Polish gynaecological society are not followed.
• Contact patient organisations (e.g. FEDERA) that offer legal support in such situations.

If a patient has been unjustly charged for the procedure of inserting or removing an IUD in a facility with a contract with the National Health Fund, she has the right to demand reimbursement of these costs.

IUD – what else is worth knowing?

In addition to key information about the types, effects, effectiveness, advantages, disadvantages and costs, there are several practical aspects related to the use of IUDs that are worth remembering.

Cylinder position control – how and when?

In order for the IUD to be fully effective, it must be in the correct position in the uterine cavity. Therefore, it is important to regularly check its location.

• Self-control: Women who use an IUD should be taught how to check for IUD threads on their own. It is recommended to do this once a month, preferably after the end of menstrual bleeding. Gently insert a clean finger into the vagina and feel the threads near the cervix. It is important not to pull on the threads, as this could cause the cylinder to move or even remove the insert. If you feel the threads, appear longer or shorter than usual, or if you feel the hard tip of the IUD itself, contact your doctor and use an additional method of contraception until your appointment.
• Follow-up visits to the doctor: In addition to a follow-up visit a few weeks after insertion, regular visits to the gynaecologist are recommended, usually once a year. During such a visit, the doctor can assess the position of the IUD during a gynecological examination and by means of an ultrasound.

IUD and sex life

A properly placed IUD should not negatively affect your sex life in any way. It is placed in the uterine cavity and is usually completely imperceptible neither by the woman nor by her partner during intercourse. In rare cases, your partner may feel the ends of the threads protruding from the cervix. If it is uncomfortable, you should report it to your doctor, who can shorten it a bit. A big advantage of the IUD is that it does not require any action immediately before intercourse, which allows for full spontaneity. The only thing to remember is to refrain from intercourse for a few days immediately after inserting the IUD.

IUD and sexually transmitted diseases (STIs)

This is an extremely important aspect that should be absolutely remembered: the IUD, regardless of the type (hormonal or copper), does NOT protect against infection with sexually transmitted diseases (STI/STD) such as HIV, chlamydia, gonorrhea, syphilis, HPV or genital herpes. The only method of contraception that simultaneously reduces the risk of transmitting most STI is a condom. Therefore, women using an IUD who have new sexual partners or are otherwise at risk of STI should always additionally use condoms during each intercourse, in accordance with the recommendations of the Polish Gynaecological Society.

Does the insole make you fat?

Fear of weight gain is a common question about hormonal contraceptive methods. In the case of IUDs, especially copper ones, which do not contain hormones, there is no evidence that they cause weight gain. In the case of hormonal IUDs, locally released progestin can theoretically affect metabolism, but studies do not show a clear relationship with significant weight gain. Some women may report slight fluctuations in weight, but these are often temporary or may be related to other lifestyle factors. The body’s reaction is always individual, so it is worth observing your body, but in general, IUDs are not considered a method that causes significant weight gain.

Summary

The IUD is one of the most effective (over 99% effective), long-term and reversible methods of contraception available on the market. Its main advantages are the convenience of use (it works for 3 to 10 years without the need to remember every day), discretion and quick return of fertility after its removal.

There are two main types of insoles available:

• Hormonal: They release a small dose of progestogen, acting mainly locally by thickening the cervical mucus and changes in the endometrium. They often cause scanter and less painful menstruation, or even the disappearance of menstruation, which can be an additional therapeutic benefit.
• Copper: They work thanks to copper ions, which are toxic to sperm and cause sterile inflammation in the uterus. They do not contain hormones, which is an advantage for some women. However, they can cause more heavy and painful periods.

Both types of IUDs are associated with a low risk of side effects (e.g. spotting, cramping, especially at the beginning) and very rare but serious complications such as expulsion (prolapse), perforation (puncture) of the uterus or ectopic pregnancy. IUDs do not protect against sexually transmitted diseases.

Insertion and removal of the IUD are short procedures performed by a gynecologist. The cost of the IUD and the procedure in the private sector is significant, but in the perspective of years it can be a profitable investment. The insertion/removal procedure itself should be reimbursed by the National Health Fund, although in practice the availability of this service can be problematic.

The choice of an IUD should always be preceded by a consultation with a gynaecologist, who will help assess individual indications, contraindications and choose the most appropriate type of IUD, answering all the patient’s questions and doubts.