By: Winnie Natu, MSIV
The intrauterine device (IUD) is a small plastic device that is inserted into the uterus and is one of the safest and most effective forms of reversible birth control for women. Currently there are two major options on the market: Mirena, a progestin-releasing IUD and ParaGard, a plastic T-shaped device partially wrapped in copper wire.
Despite its safety, efficacy, and benefits, the US has one of the lowest rates of IUD use worldwide. The purpose of this blog is to resolve some common misconceptions about IUDs and to answer questions that several women, like you, may have!
Case 1: A 28- year-old female with no past medical history comes in to discuss her options for birth control. She is currently in a monogamous relationship with her boyfriend and uses Loestrin Fe for contraception. She does a lot of travelling for work and is inconvenienced by having to take a daily pill. She does not want to have children in the near future but definitely wants to have a family someday. She has heard about IUDs but is worried that getting one might prevent her from ever having children.
This is a common misconception however an IUD is a completely reversible contraceptive device: it begins working as soon as it is fitted and stops as soon as it is removed with no effect on future fertility.
Case 2: A 20-year-old college student comes in for concerns with her current birth control pills. She is experiencing spotting between periods and often forgets to take her daily pill. She has had 3 sexual partners in the past 6 months and uses condoms occasionally. She has never been pregnant or had an STI but is concerned about the possibility of both and wants more information about her contraceptive options. When you mention an IUD she says she doesn’t want that because it increases the risk of something called pelvic inflammatory disease.
The World Health Organization has done multiple studies that all conclude the same thing: overall, women using an IUD have no increased risk of pelvic infection or infertility compared with women who used other types of birth control. In fact, Mirena acts to thicken cervical mucus and suppress or reduce endometrial bleeding and may offer some protection against an already low risk of PID. However it is important to remember than neither an IUD nor birth control pills protect against STIs! Only barrier contraceptives such as condoms can achieve this. This young woman should be screened for STIs and have a pregnancy test and if negative, she would be a candidate for an IUD.
Case 3: A 39-year-old woman that has given birth to her second child 3 months ago is interested in long term but reversible birth control. She has heard about an IUD but is worried that it wont be as effective as the birth control pills she has used in the past.
A new study on perception of birth control has concluded that it's not clear whether women have an overly optimistic view of the effectiveness of the birth control pill or an overly pessimistic view of the IUD. However, the fact is that IUDs can be left implanted for years, and are more than 99% effective at preventing pregnancy. In contrast, the birth control pill has been found in real-world practice to be about 95% effective.
IUDs are an excellent choice of contraception for women who are seeking a long-term and effective birth control method, particularly those wishing to avoid risks and side effects of contraceptive hormones.
The progestin-releasing Mirena is now considered to be one of the best options for treating heavy menstrual bleeding
The copper-releasing IUDs do not have hormonal side effects and may help protect against endometrial (uterine) cancer.
Certain women may be poor candidates for IUDs including women with current or recent history of pelvic infection, women that may be currently pregnant, have had a recent abnormal Pap smear, have or have a history of untreated cervical or uterine cancer, and women with an anatomically abnormal uterus that is very small or large.
Please ask your doctor for information about IUD placement and review the following links for learning more about IUDs!