IUDs Explained: A Plain-Language Guide for Women in George and the Garden Route

This article is educational content based on current peer-reviewed guidelines. It does not replace personalised medical advice. Whether an IUD is suitable for you specifically, and which type, is a decision to make in consultation with a doctor who knows your full history.

The two types of IUD — and how they actually work

There are two broad categories of IUD available in South Africa:

Copper IUDs are hormone-free. They release small amounts of copper into the uterus, which is toxic to sperm and prevents fertilisation. They do not prevent implantation of a fertilised embryo — they prevent fertilisation from happening in the first place. Copper IUDs typically remain effective for up to 10 years, and evidence now supports effectiveness for at least 12 years in some cases.

Hormonal (levonorgestrel-releasing) IUDs release a small dose of a progestin (levonorgestrel) locally inside the uterus. They work in three main ways: thickening cervical mucus so sperm cannot reach the egg, thinning the lining of the uterus, and in some women, partially suppressing ovulation. Most women continue to ovulate while using a hormonal IUD — the contraceptive effect is primarily local, not systemic. Hormonal IUDs come in different doses and sizes, with different approved durations:

• 52 mg levonorgestrel IUD — approved for 8 years
• 19.5 mg levonorgestrel IUD — approved for 5 years
• 13.5 mg levonorgestrel IUD — approved for 3 years

The larger devices last longer and have stronger effects on bleeding; the smaller devices are sometimes chosen for women who have never been pregnant, where the slightly smaller diameter may make insertion easier.

How effective they are

Both types of IUD are among the most effective reversible contraceptives available, with first-year pregnancy rates under 1%.

• Hormonal IUD: 0.1 to 0.2 pregnancies per 100 women in the first year of use.
• Copper IUD: 0.5 to 0.8 pregnancies per 100 women in the first year of use.

A 2024 meta-analysis of randomised trials found that hormonal IUDs are statistically more effective than copper IUDs, although both have very low pregnancy rates overall. Continuation rates at one year are high — around 88% for hormonal IUDs and 85% for copper IUDs.

Non-contraceptive benefits of hormonal IUDs

For many women, the hormonal IUD is chosen — or kept in place — for reasons that have little to do with contraception:

• Heavy menstrual bleeding: The 52 mg hormonal IUD is internationally approved and reduces menstrual blood loss by 79–97%. More effective than oral medications, even in women with fibroids or on blood-thinners.
• Painful periods: Significantly reduced.
• Endometriosis and adenomyosis: Effective for managing pain and symptoms.
• Menopausal hormone therapy: Can provide the progestogen component of MHT.

The copper IUD, in contrast, often makes periods slightly heavier and crampier, particularly in the first few months.

Pain management at insertion — what current evidence actually supports

Insertion pain is the single biggest concern most women have about IUDs, and the science has moved meaningfully in the last two years. The American College of Obstetricians and Gynecologists' Clinical Consensus No. 9 (2025) and a 2025 Cochrane review have clarified what works and what doesn't.

What works:

• Lidocaine (local anaesthetic) is the best-evidence intervention. Multiple formulations have been studied — paracervical block, 10% lidocaine spray, 5% lidocaine-prilocaine cream, and topical lidocaine gel — all reduce pain compared with placebo.
• Nonpharmacological measures — calm environment, clear explanation, unhurried pacing, support person — make a meaningful difference.
• Ultrasound guidance during insertion has been shown to reduce pain scores and procedure time.
• Post-procedure anti-inflammatories help manage cramping in the hours after insertion.

What does not work, despite being widely offered:

• Pre-procedure NSAIDs taken shortly before insertion are not effective for reducing pain at the time of insertion. This is counterintuitive — many clinicians still recommend them — but the 2025 ACOG consensus is explicit. NSAIDs help afterwards, not beforehand.
• Misoprostol is not routinely used. The 2025 Cochrane review found little benefit and an increase in pre-placement cramping.

Most women describe insertion as uncomfortable rather than painful, and the discomfort lasts only a few minutes.

IUDs for women who have never had a baby and for teenagers

IUDs are safe and effective in nulliparous women (those who have never been pregnant) and in adolescents. Both the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics endorse their use in these groups.

In the large US Contraceptive CHOICE study, 62% of adolescents aged 14–20 chose a long-acting reversible contraceptive, with high satisfaction and continuation. There is no evidence that IUD use causes infertility. Historical concerns were based on older device designs and inadequate accounting for sexually transmitted infections as the real underlying cause of tubal damage.

Complications — what the large cohort data actually show

The APEX-IUD study, which analysed 326,658 IUD insertions in the United States between 2001 and 2018, is the best contemporary dataset on IUD complications.

Uterine perforation is the serious complication women most often ask about:

• 0.21% at 1 year after insertion
• 0.61% at 5 years

In other words: fewer than 1 in 150 women over 5 years, in the worst case.

Expulsion (the IUD moving out of the uterus on its own) is more common:

• 2.3% at 1 year
• 4.5–4.8% at 5 years

Pelvic infection risk is low. Most IUD-related infection happens in the first few weeks after insertion. STI screening is usually discussed as part of the pre-insertion assessment at NeoHealth.

GP-performed vs specialist-performed insertions — what it means in George

One of the most important shifts in contraceptive care over the last decade is the evidence that trained general practitioners insert IUDs with safety and effectiveness comparable to specialists.

A Brazilian study of 24,865 insertions and a Dutch national study of 840,766 placements both found similar clinical outcomes between primary care and hospital settings. In the Netherlands, 77% of IUDs are now placed in primary care.

What this means in the Garden Route specifically: specialist gynaecologist access in George generally involves waiting several weeks, travelling to a hospital-based practice, and paying private specialist fees. For most women, a trained female GP performing IUD insertions in-rooms is clinically equivalent, faster to access, and more affordable. Patients referred from Wilderness, Sedgefield, Mossel Bay, and Knysna are typically able to combine a consultation and an IUD fitting in a single George visit.

When an IUD isn't suitable

Most women can safely use an IUD. Conditions that make one or both types unsafe include:

• Pregnancy (known or suspected)
• A uterine cavity distorted by large fibroids or congenital abnormalities
• Current pelvic infection or untreated STIs
• Unexplained vaginal bleeding pending investigation
• Active cervical or endometrial cancer
• Current breast cancer (for hormonal IUDs only)
• Copper allergy or Wilson's disease (for copper IUDs only)

A full medical history and examination before insertion is how these things are checked.

The copper IUD as emergency contraception

One fact that is not widely known: copper IUDs are the most effective form of emergency contraception available.

Inserted within 5 days of unprotected sex, a copper IUD has a pregnancy rate of around 0.1% — that is 99.9% effective. Unlike oral emergency contraception, its effectiveness is not affected by body weight, and once inserted it provides ongoing contraception for up to 10 years.

Important: This article provides general information on intrauterine devices based on current peer-reviewed guidelines and is intended for educational purposes only. It is not personalised medical advice.

Related articles and services

• Women's health at NeoHealth in George
• Choosing contraception — a South African guide
• Cervical screening in South Africa
• Perimenopause and menopause — the 2026 evidence