IUD insertion in Marrakech: choosing, inserting, following up

It is a small, flexible, T-shaped device placed inside the uterus by the natural route. It prevents the egg and sperm from meeting and makes the uterine lining less favourable to a pregnancy. Its effectiveness is over 99%, and it works without you having to think about it. It does not protect against sexually transmitted infections.

The copper IUD:

• contains no hormone and does not change ovulation;
• can make periods heavier or more painful, especially in the first months;
• works for five to ten years depending on the model.

The hormonal IUD (levonorgestrel):

• releases a very low dose of hormone locally;
• often lightens periods, sometimes to the point of stopping them, and relieves heavy and painful periods;
• works for three to eight years depending on the model.

The choice depends on your periods, your history and your preferences.

An IUD suits most women, including those who have not had children: the decision is made after discussion at consultation. It is not advised if a pregnancy is possible, in case of an ongoing genital infection, unexplained bleeding not yet investigated, certain abnormalities of the uterus or cancer of the cervix or uterus. The hormonal IUD has a few additional contraindications, which the doctor reviews with you.

A consultation takes stock: gynaecological examination, a pregnancy test if needed, a check for infection depending on the situation, an ultrasound if useful. Insertion is often done during or just after a period, but is possible at any time if pregnancy is ruled out. After a birth, it is generally done from a few weeks on. A painkiller taken beforehand can help.

You are settled as for a gynaecological examination. The cervix is disinfected, the depth of the uterus is measured, then the IUD is introduced with a fine tube and two small threads are left in the vagina. The procedure lasts a few minutes. It causes cramps, sometimes sharp but brief; each step is explained to you, and you can ask for a pause. A short rest follows insertion.

Cramps and light bleeding are possible for a few days. With the copper IUD, periods are often heavier in the first months; with the hormonal IUD, irregular bleeding is common for three to six months before easing. A check is planned a few weeks after insertion to verify the position, then regular follow-up. The doctor tells you from when you are protected, depending on the model and the timing of insertion.

Complications are rare: expulsion of the IUD (especially in the first months), perforation of the uterus (exceptional), pelvic infection in the weeks following insertion. A pregnancy with an IUD is very rare, but must be reported without delay.

Consult in case of fever, intense pelvic pain, foul-smelling discharge, a missed period, heavy bleeding or if the threads can no longer be felt.

Removal is simple: the doctor gently pulls on the threads, in a few moments. It can be done at any time if you wish, and at the latest on the date it stops being effective. A new IUD can be inserted straight away. After removal, fertility returns quickly.