IUD Consent Form

IUDs are small, T-shaped devices made of flexible plastic that are put into the uterus.

There are two types:

  • Copper IUDshave copper.
  • LevonorgestrelIUDs (LNG IUD) have a hormone called levonorgestrellike the progesterone (progestin) made by a woman’s body.

How does an IUD work? — Both IUDs work by preventing sperm from reaching an egg. Copper IUDs act as spermicide, and also block sperm from moving. LNG IUDs thicken a woman's cervical mucus. The mucus blocks sperm and keeps it from joining with an egg.

The Copper IUD can also be used as emergency contraception (EC) when put in within 5 days of unprotected sex.

How well do IUDs work?

For every 100 women who use an IUD, 1 or maybe none, will get pregnant each year.

Depending on when in your cycle the IUD is placed, you may need to use a backup method until the IUD begins to work.

Once your IUD is placed there’s nothing you have to do in order to make your IUD work and being able to get pregnant comes back quickly after removing the IUD.

The Copper IUD is good for up to10 years but if you want to get pregnant before then or you would like it removed for any reason, come in, we will remove it and your ability to get pregnant will return towhatever is normal for you immediately.

LNG IUDs are good for 3 or 5 years depending on which one you choose but if you want to get pregnant before then or you would like it removed for any reason, come in, we will remove it and your ability to get pregnant will return towhatever is normal for you immediately.

How well does Copper IUD work as EC?

It is the EC that works the best. It reduces the risk of pregnancy by more than 99% when put in within 5 days of unprotected sex.

How is the IUD put in? — We will examine you and put a speculum into your vagina. Your doctor or nurse will hold your cervix with an instrument. The IUD will be put into the opening in your cervix and into the uterus. You may feel cramping. A short length of plastic “string” will hang down into your vagina. Whenever you want to, you can check the string to make sure that the IUD is still in place.

Before the IUD is put in, you may be offered medicine to help open your cervix. You may also be given medicine to numb the cervix.

Advantages of IUDs

LNG IUDs

  • fewer menstrual cramps
  • lighter periods / less blood loss — often periods stop after a few months

less anemia (iron poor blood)

Copper IUD

  • no hormones
  • can be used for emergency contraception

What might happen during and after I have my IUD placed? — You may have

  • mild to moderate pain when the IUD is put in
  • spotting, bleeding, cramping or backache for a few days
  • irregular periods or spotting between periods in the first 3 –6 months
  • heavier periods and worse menstrual cramps — with Copper IUD

The IUD does not protect you from sexually transmitted infections (STIs).

Possible risks with placement of an IUD

Perforation — Very rarely, about 1 out of 1,000 placements the IUD could make a hole in your uterus when it is being put in. It could be pushed through the wall of the uterus. This is called perforation. It could damage your internal organs. Surgery could be needed to remove the IUD.

Expulsion —Occasionally, about 3-4 out of 100 placements, the IUD will slip out of the uterus. This is called expulsion. You can become pregnant if it happens. The IUD must be removed/replaced if it comes out part way.

Pregnancy — IUDs are very effective but no method of birth control is 100%. There is a small chance that you could get pregnant. You should see your doctor or nurse right away if this happens. Your IUD would need to be removed. And we would need to make sure the pregnancy was in the correct place in the uterus and not in your tube. This could lead to serious health problems.

Infection — Your chance of getting a pelvic infection (PID) from an IUD is slightly increased in the first 3 weeks after the IUD is put in. If you get PID — whether or not you have an IUD — you need to get treatment with antibiotics right away. If PID is not treated, it may be harder to get pregnant in the future.

Women with certain health problems can’t use an IUD. Talk to your doctor or nurse about your risks and health problems. Your doctor or nurse will examine you and help you decide if an IUD is right for you. You may need special tests or extra visits to the clinic.

Warning Signs — Call the clinic right away if you

  • notice any change in the length of the string or can feel part of the IUD with your finger
  • have ongoing pain or bleeding with intercourse
  • have signs of pregnancy
  • have unprotected sex with someone who has an STI
  • have unusual pain, cramping, or soreness in your lower belly or stomach
  • have unusual vaginal discharge
  • have unexplained fever or chills
  • have bleeding from the vagina that is heavier than usual

If you decide to get an IUD — Read the package insert that comes with it. The information may be different from ours. Let us know if you have questions.

How is the IUD removed? – Having your IUD taken out or replaced is usually very simple. Your doctor or nurse will do it for you by gently pulling on the IUD strings. Rarely, if the IUD doesn’t come out easily, a surgical tool may be needed to take out your IUD. Very rarely, surgery may be needed.

What about other methods of birth control? — There are many other methods of birth control. We will offer you information about them and answer your questions.

What about other methods of EC? — There are EC pills such as levonorgestrel EC (LNG EC) and ulipristal acetate (UPA) that you can use. You can also choose to wait and see if you become pregnant. We are happy to discuss all your options with you.

Take care of your health —Don’t forget to get regular checkups and screening for STIs and cancer.

What if I have an emergency?
Call us immediately at XXX-XXX-XXXX, go to the nearest emergency room, or call 911.
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