Contraception and IUD: choosing, inserting, changing, removing, in Paris 16th

The consultation

An assessment, a choice, a prescription

The contraception consultation begins with a conversation: your personal and family history, your medications, smoking, your periods, your plans. The examination includes a blood pressure measurement and, when useful, a gynecological examination and the screening smear test if it is due. A pelvic ultrasound is performed at the practice during the consultation when it informs the choice or checks the position of an IUD. Dr Gatri and Dr Mahdhi-Basli both provide contraception care and IUD or implant insertion and removal: the physician who sees you sets out the methods suited to your situation and writes the prescription. The chosen device is dispensed at the pharmacy; insertion takes place at a dedicated appointment.

After childbirth, contraception is discussed at the postnatal consultation, together with the rest of your obstetric care. After 40, the method is reassessed up to menopause, according to age, smoking and changes in the cycle. Renewals are part of routine gynecological care.

Information

Risks and complications: what to know before deciding

Every procedure carries risks: the doctor who sees you sets them out at the consultation and gives you the information sheets of the French College of Gynecologists and Obstetricians (CNGOF), translated into English, whose wording is used here.

• Common and not serious — insertion of an IUD is sometimes painful, and period-like uterine cramps sometimes persist for a few days; an anti-inflammatory (NSAID) is prescribed if the pain lasts beyond that. With the copper device, periods are quite often longer and heavier. With the hormonal device, in most cases periods stop or become very light, and some usually light bleeding occurs; the other commonly reported side effects are acne, oily skin, hair loss, hot flushes, mood changes and altered libido. After a laparoscopy, abdominal pain, which may extend up to the shoulders because of the gas introduced during the surgery, is usual.
• Rare — the CNGOF sheet states that the risk of infection with an intra-uterine device is very low (under 1%) and that during insertion there is a rare risk of uterine perforation (1 in 1,000). Sometimes insertion is not possible when the cervix cannot open: a further attempt is then offered at the next period. For sterilization by laparoscopy the risks are very rare: injury to the bowel, the urinary tract (bladder, ureter) or blood vessels; in the event of heavy bleeding a blood transfusion is given, and the abdomen is opened (laparotomy) if a major complication occurs. After the operation, a hematoma (haematoma), bleeding inside the abdomen or at the incisions, or an infection (abscess) sometimes appears and calls for treatment adapted case by case: antibiotics, transfusion or further surgery.
• What increases them — the risk of infection is higher in the first 20 days after insertion of an IUD, and it is rare when aseptic insertion rules are respected. A vaginal infection is ruled out before insertion. Contraindications to an IUD are pregnancy, genital infections, uterine malformations and, for the copper IUD, copper allergy, which is exceptional; multiple sexual partners and a history of sexually transmitted infection are relative contraindications. For surgery, certain risks are increased by your condition, your history or by treatment taken before the operation: it is essential to tell your doctor about your personal and family history and about all treatments and medicines you take.
• Signs that should prompt a call — after an IUD insertion: abnormal vaginal discharge, lower abdominal pain, bleeding outside periods, pain during intercourse — it is advisable to consult so that treatment or removal of the device can be considered. After a sterilization: pain, bleeding, vomiting, fever or purulent or foul-smelling discharge at the abdominal or vaginal incisions — you must then contact the surgical team.
• Depending on the procedure · IUD insertion — nylon threads attached to the device allow it to be checked and removed; if your partner feels the thread, it can simply be trimmed. Removal is very easy. Monitoring is generally at about six weeks after insertion, then once a year during a gynecological examination that checks the threads are present and reviews tolerance and any effects felt. CNGOF information sheet — Intra-uterine device (IUD)
• Depending on the procedure · Permanent sterilization — apart from potential complications during or after the operation, this surgery has no side effects on your body, your cycles, your hormones or your daily life. The risks are common to all procedures performed by laparoscopy and mainly concern the neighboring organs. During the procedure, a vaginal or rectal examination, injection of a blue dye, placement of an intra-uterine manipulator, a vaginal pack or a urinary catheter are carried out as needed. CNGOF information sheet — Voluntary sterilization CNGOF information sheet — Laparoscopy
• Depending on the procedure · The implant — the implant is placed under the skin of the arm, under local anesthesia; tenderness and a bruise at the insertion site are usual in the days that follow, and irregular bleeding is the effect most often reported with a progestogen. The doctor who sees you sets out these effects at the consultation, and aftercare instructions are given to you.

Fees

Fees and reimbursement

• Contraceptive implant insertion / removal: €150.
• IUD insertion / removal: €150.
• Consultation for surgery: €120 to €160.
  This consultation takes place at the practice: Dr Gatri examines your situation and explains the options. If a procedure is decided on, you receive a quotation and an informed-consent form to sign; a date is then set for the procedure at the clinic.
• Tubal ligation (sterilization), at the clinic — Dr Gatri's fee: €1,350. This fee includes neither the anesthesiologist nor the clinic charges.
• A written quote is given to you at the consultation and signed before any booking. All fees and the framework: Fees.