IUDs, explained

An IUD (intrauterine device) is a small device placed inside your womb. It is one of the most effective ways to prevent pregnancy, and it lasts for years. This guide from Network One Health explains the two types and what to expect.

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Two types of IUD

The copper IUD contains no hormones. It is sometimes called the loop.

The hormonal IUD releases a small amount of a progestogen hormone called levonorgestrel. Its medical name is the LNG-IUS (levonorgestrel intrauterine system).

Both are long-acting and reversible. You can have either one removed whenever you choose.

How well they work

Out of 100 women using an IUD for a year, fewer than 1 gets pregnant, with typical or perfect use (South African guideline and WHO 2025 estimates agree). This is true in real life, because there is nothing to remember.

IUDs do not protect against STIs or HIV. Use condoms as well if you may be at risk.

How long they last

• Copper IUD: 5 or 10 years, depending on the type.
• Hormonal IUD: 5 years for the standard type. There is also a smaller type. Your clinician will tell you how long yours lasts.

If you have a copper IUD put in at age 40 or older, you can usually keep it until you no longer need contraception. The same applies to a hormonal IUD put in at age 45 or older. Your clinician will guide you.

Who can use an IUD

Most women can use an IUD. That includes young women and women who have never had a baby.

An IUD does not cause infertility. It does not raise your risk of infection, pelvic infection or ectopic pregnancy. Your fertility returns straight away after removal.

Your clinician will check your health history to make sure an IUD suits you.

Having an IUD fitted

Before fitting, your clinician will:

• ask about your health and check that you are not pregnant
• do a pelvic examination, and check for signs of infection
• talk to you about your risk of sexually transmitted infections

When it can be fitted

• Copper IUD: within 12 days of the start of your period, or at any time if you are not pregnant. It works straight away.
• Hormonal IUD: within 7 days of the start of your period, it works straight away. At any other time, use condoms or do not have sex for the next 7 days.

An IUD can also be fitted within 48 hours of giving birth, or from 4 weeks after birth.

Will it hurt? Many women feel cramping or pain during fitting. Ask about pain relief before your appointment. Options include anti-inflammatory painkillers and local anaesthetic. Make a plan with your clinician that suits you.

You do not need antibiotics as a routine before fitting.

After fitting

Come back for a check-up after your first period, or 3 to 6 weeks after it is fitted. Your clinician will check that the IUD is in place and that there is no sign of infection.

The strings. An IUD has thin strings that sit at the top of your vagina. Your clinician uses them to remove the IUD. You do not have to check them yourself. If you want to, your clinician can show you how.

There is a small chance that the IUD can slip out. This is called expulsion.

What happens to your periods

Copper IUD

• Periods may be heavier or longer, and spotting is common, in the first 3 to 6 months.
• This is usually not harmful, and bleeding usually gets lighter over time.
• Do not take aspirin for this bleeding. It can make it worse. A clinician can suggest other treatment.

Hormonal IUD

• Spotting is common, especially early on, and usually gets less over time.
• Over time, periods usually become lighter. Some women stop having periods. This is not harmful.

If bleeding is very heavy, or you feel weak or dizzy, see a clinician.

Warning signs after fitting

Watch for signs of infection, especially in the first month. See a clinician straight away if you have:

• pain low in your tummy
• a bad-smelling discharge from your vagina
• fever
• pain during sex
• burning when you pass urine

Also see a clinician soon if:

• you think you might be pregnant
• you have heavy bleeding, cramping or pain that is new or getting worse

If you have an infection, it can usually be treated with antibiotics while the IUD stays in. If you get pregnant with an IUD in place, the IUD may need to be removed. A clinician will check this with you.

The copper IUD as emergency contraception

If you had sex without protection, a copper IUD fitted within 5 days (120 hours) reduces the risk of pregnancy by more than 99%. It then keeps working as your ongoing contraception.

It is the first choice of emergency contraception for women taking some HIV, TB or epilepsy medicines, because these medicines do not affect it.

The hormonal IUD is not recommended as emergency contraception.

Medicines

The copper IUD is not affected by any medicines. The hormonal IUD is not expected to be affected in a significant way.

Where to get an IUD

Contraception is available at public clinics in South Africa. Ask your clinic whether it fits IUDs.

What to expect at Network One Health

At Network One Health, we discuss pain relief and your preferences before fitting, and we see you again after your first period, or 3 to 6 weeks after fitting. If an IUD stops suiting you, removal is a simple request.

Booking and questions: WhatsApp Noma on 065 072 5315.

Emergencies: If you think you have a medical emergency, go to the emergency unit at your nearest hospital or call 10177.