Copper-T, Mirena & Implant in Gurugram

No. This is the most persistent myth in Indian contraception and it is not true. The definitive study compared nearly 1,900 women and found no association whatsoever between previous copper IUD use and blocked fallopian tubes. What was associated with blocked tubes was past chlamydia infection. The infection causes the infertility, not the device. After removal, fertility returns immediately - in one study of women who had a copper IUD taken out in order to conceive, 94% became pregnant, and more than half within three months.

Yes. Not having given birth is not a restriction for any of these three methods under WHO and UK eligibility criteria - all three are in the least restrictive category. Insertion has not been shown to be more difficult in women who have not had a baby. The same applies to teenagers and to unmarried women, and nobody at this clinic will ask you to justify wanting contraception.

Neither is better in general; they are better for different women. Choose the Copper-T if you want no hormones at all, want the longest possible duration, or cannot take hormones for medical reasons - but be aware your periods will probably get heavier. Choose the Mirena if your periods are already heavy or painful, or if lighter periods would be a benefit rather than a worry. If your main problem is heavy bleeding, the Mirena is not just contraception, it is the treatment.

The Cu-T 380A lasts 10 years and the Cu 375 lasts 5 years. The Mirena is licensed for up to 8 years for contraception, and 5 years when it is being used specifically to treat heavy periods. The implant is licensed in India for 3 years. All of them can be removed earlier at any time, and none of them needs to be left in until it expires.

Most women describe it as strong period-type cramping for less than a minute, but the honest answer is that it ranges from barely noticeable to genuinely painful, and it tends to be more uncomfortable if you have not had a vaginal delivery. Take a standard dose of ibuprofen or paracetamol about an hour before your appointment. Local anaesthetic options exist and current guidance is that they should be offered and discussed rather than assumed unnecessary - please ask, and please say if you want to stop at any point.

Any time, as long as we can be reasonably sure you are not pregnant. You do not need to wait for your period. The copper device protects you immediately; the Mirena takes 7 days, so use condoms for the first week; the implant protects immediately if fitted in the first 5 days of your cycle, and otherwise needs 7 days of condoms.

The evidence does not support it. Reviewing the trials, the UK's Faculty of Sexual and Reproductive Healthcare concluded that there is no evidence the implant, the hormonal IUS or the copper IUD causes significant weight gain - the average differences measured were under a kilogram and not statistically significant. The copper device contains no hormones at all, so there is not even a plausible mechanism. It is fair to add that the studies are not of the highest quality, so this is 'no evidence of an effect' rather than proof of none.

It depends entirely on which method. The Copper-T tends to make periods heavier and crampier, most noticeably in the first year - the manufacturer's own long-term data shows removals for bleeding or pain falling from 12% in the first year to 2% by the ninth. The Mirena makes them dramatically lighter, with blood loss down by roughly 71 to 95% within six months, though there is irregular spotting for the first three to six months while it settles. The implant makes bleeding unpredictable rather than reliably lighter or heavier.

Expect three to six months. In the first 90 days about two-thirds of women have irregular bleeding; by the end of the first year that has dropped to about one in five, and more than half have infrequent light periods. The commonest mistake is judging the Mirena at six weeks and asking for it out. If you can give it six months, most women are glad they did - but if you want it removed before then, that is your decision and we will do it.

Yes, and it is not harmful. Around 1 in 6 women have no periods by the end of the first year, rising to about 1 in 3 by year eight. The lining is simply staying thin - nothing is building up inside you. Many women regard it as the best part of the method.

It sits in the uterus with two soft threads coming through the cervix. It can only leave the uterus if the wall is perforated during fitting, which happens in about 1.3 of every 1,000 insertions. Far more commonly, threads simply curl up out of reach - which feels alarming but usually means the device is exactly where it should be. If you cannot feel your threads, use condoms and come in; a scan, arranged by referral, will confirm the position, and if the device is correctly sited it can simply be left alone.

The device itself sits inside the uterus and cannot be felt. The threads sit in the upper vagina and soften over time. Occasionally a partner notices them in the first few weeks; if that persists, the threads can be trimmed shorter at a follow-up visit. It is a common question and an easy fix.

About 1 in 20 devices are expelled, nearly always within the first three months. It is more likely after a vaginal birth than after a caesarean, if your periods are heavy, if you have fibroids, and - a detail rarely mentioned - if you use a menstrual cup, because of the suction when it is removed. This is exactly why you are taught to feel for your threads.

The small extra risk of pelvic infection is confined to roughly the first three weeks after fitting, and after that your risk is no different from anyone else's. Overall it is well under 1%. Routine antibiotics are not given because trials show they do not reduce the risk. If you have symptoms of an infection in the weeks after fitting - fever, pain, offensive discharge - come in rather than waiting.

Then it comes out. Removal takes seconds, is far easier than fitting, and needs no anaesthetic. You do not have to justify the decision and you will not be talked out of it. One practical point: avoid unprotected sex for the 7 days before a planned removal, because sperm can survive that long and you would not be covered once the device is out.

Straight away, for all three methods. There is no waiting period and no need to 'clear it out of your system'. With the implant, the hormone is undetectable within a week of removal and ovulation returns within about six weeks in almost everyone. Copper devices have no effect on fertility at all. This is a real difference from the contraceptive injection, which can delay the return of fertility for months.

Only the timing. The rules about when a device can be fitted after childbirth depend on how long ago you delivered, not on how you delivered. Reassuringly, expulsion is actually less likely after a caesarean than after a vaginal birth. If you are breastfeeding and within about eight months of delivery, the risk of perforation at fitting is higher, so the timing is worth discussing.

Yes, and it is by far the most effective option - a failure rate under 0.1%, against roughly 1 to 3% for emergency pills. It can be fitted within 5 days of unprotected sex, or up to 5 days after the earliest date you are likely to have ovulated, whichever is later. That second part matters, because it often means the option is still open after a woman has been told it is too late. And it then continues as ongoing contraception for as long as you want. The hormonal Mirena is not recommended for emergency use - for this it has to be the copper device.

Usually yes. Fibroids that are not distorting the inside of the uterus are no obstacle at all. If the cavity is distorted, an IUD becomes more difficult and more likely to be expelled, and the implant is often the better choice because nothing enters the uterus. When the Mirena is being used to treat heavy bleeding specifically, guidance suggests it as first-line where fibroids are under 3 cm and the cavity is not distorted.

A few. Current infection in the pelvis or cervix, an unexplained bleeding pattern that has not yet been investigated, and pregnancy all rule out fitting an IUD for now - though most of these are temporary. Current breast cancer rules out the hormonal methods but not the copper device, which is often the best option in that situation. Copper is also unsuitable in Wilson's disease. These are all things the consultation is for.

Not routinely. Fitting is guided by examination, and a follow-up check at around six weeks or after your next period is enough for most women. A scan is arranged by referral if your threads cannot be found, if there is pain or bleeding that is not settling, or if there is any doubt about where the device is sitting.

Yes, in the private sector. The single-rod etonogestrel implant was approved by the Drug Controller General of India in 2017 and launched privately in 2018, and has since been added to India's family planning commitments with a phased public rollout. It is licensed here for 3 years. It is still far less commonly used in India than IUDs, which is why many women have never had it offered to them.

Not because it does not work. In the most recent national survey, about 38% of married women relied on female sterilisation and only around 2% on an IUD. That is not a reflection of effectiveness - all three of these methods match sterilisation - it reflects what women have historically been offered and the myths that have grown up around the Copper-T. Having the full range explained to you properly is the point of the consultation.