Complications

Possible complications include:

• vasovagal bradycardia and hypotension after insertion - even when apparently straightforward
  
  
• colicky pain - usually subsides gradually but may persist
  
  
• menstrual loss - periods tend to be heavier and prolonged for a few months after insertion (1,2); rarely, there may be intermenstrual bleeding. Increased loss after a device has been in place for years suggests underlying pathology
  • women should be advised to seek medical advice, to exclude infection and gynaecological pathology, menstrual abnormalities persist beyond the initial 6 months of use (2)
    
    
• increased risk of pelvic infection - indicated by pain during or after intercourse, pain in the lower abdomen, or unusual vaginal discharge, especially if the patient has a fever. A review regarding the risk of pelvic infection and copper IUCDs concluded (1):
  • insertion of modern copper IUDs carries a small increased risk of pelvic inflammatory disease (PID), particularly within the first 3 weeks of fitting
  • before insertion of an IUD, all women at increased risk of sexually transmitted infection (e.g. women under 25 years of age and/or those who frequently change sexual partners) should be offered testing for chlamydial infection
  • IUDs should not be offered to women with current suspected or proven sexually transmitted infection or those with a history suggesting that their, or their partner's, current behaviour puts them at increased risk of having such infection.
    
    
• pregnancy with a IUCD in place is associated with: - 5 fold increased risk of an ectopic pregnancy; from 1 in 250 pregnancies to 1 in 50 - increased risk of abortion; 50% of cases if IUCD left in place; 25% of cases if IUCD removed
  • note however that since the IUD is a very effective method of contraception, the absolute risk of pregnancy is very low (2)
    • the annual ectopic pregnancy rate for IUD users is 0.02 per 100 woman-years, compared to 0.3–0.5 per 100 woman-years for those not using contraception. Alternative contraceptive methods which inhibit ovulation will, however, reduce the risk of ectopic pregnancy to a greater degree
      
      
• perforation of the uterus occurs in 1 in 1000 first fittings. This may be asymptomatic or painful. Surgical removal may be necessary
  
  
• women should be advised that the most likely cause of IUD failure is expulsion. The risk of this happening is around 1 in 20 and is most common in the first year of use, particularly within 3 months of insertion (2)

There is no convincing evidence that modern copper IUDs impair fertility.

Insertion tends to be more difficult, painful and associated with more severe side effects in nulliparous women.

Reference:

1. Drug and Therapeutics Bulletin (2002); 40 (9): 67-9.
2. FFPRHC Guidance (January 2004). The copper intrauterine device as long-term contraception. J Fam Plann Reprod Health Care. 2004 Jan;30(1):29-4