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What is an IUD?
An Intrauterine Device (IUD) is a small T-shaped object that is inserted through the cervix and placed in the uterus to prevent pregnancy. A small string hangs down from the IUD into the upper part of the vagina. The IUD is not noticeable during intercourse. IUDs can last 1-10 years.
IUDs are one of the most common contraceptive methods worldwide, but is used somewhat rarely in the US (only several hundred thousand women have them).
How effective are they?
IUDs are more than 99% effective as birth control. Once inserted you are immediately protected from pregnancy.
How do they work?
They are believed to inhibit passage of sperm and maturation of eggs, largely through the promotion of a spermicidal environment inside the uterus. They affect the movements of eggs and sperm to prevent fertilization. They also change the lining of the uterus and prevent implantation.
How do I get one, and how much does it cost?
IUDs require a doctor's office visit. They cost between $250 and $300 every ten years or so, plus the cost of the office visit.
How do you use one?
Getting an IUD involves a visit to the doctor's office. To prevent infection, doctors require women to have check-ups prior to insertion. If anything unusual is found, it is addressed before the IUD is inserted.
Insertion:
An IUD is usually inserted during a menstrual period when the cervix is slightly open and pregnancy is least likely. It may be inserted at any time, however. The procedure for insertion takes about 5-15 minutes. Most women feel cramping during and after insertion. Ibuprofen can help relieve cramping.
Removal:
An IUD can be removed at any time and the procedure is quicker and easier than insertion. If it is removed near ovulation, a woman may become pregnant from recent intercourse before IUD removal.
Types of IUDs
There are two types of IUDs available: ParaGard and Mirena . The ParaGard has a tiny copper wire wrapped around the plastic body and should not be used by anyone who is allergic to copper. The Mirena releases small amounts of a synthetic progesterone hormone. The hormone was added to attempt to decrease the bleeding and cramping that some women have with the IUD. The Mirena is slightly more effective than the ParaGard.
Health Risks:
Getting any vaginal infection while using an IUD can increase the risk of developing a serious pelvic infection. This can result in a loss of fertility. For this reason, women need to assess their own risk for infection. If you have multiple partners or if your partner has multiple partners, your chance of infection is much higher.
Piercing or perforation of the uterine wall may occur during insertion of the IUD. Over time, an IUD may become embedded in the uterine wall. An embedded IUD is still effective, but it can be painful and may need to be removed. There is a risk of surgery and/or sterility if an IUD becomes embedded.
If a woman becomes pregnant while using an IUD, it is highly recommended that she have the IUD removed, whether or not she wants to carry the pregnancy to term. An IUD increases the risk of having a miscarriage or premature birth.
A woman who becomes pregnant while using an IUD is also more likely to have an ectopic pregnancy.
Both the ParaGard and the Mirena IUDs can cause longer, heavier, and more painful menstrual periods, but this is much less common with the Mirena. The increased blood flow may cause anemia. Spotting may occur without serious cause or as a sign of infection.
The Mirena IUD can cause ovarian cysts. Some women using the Mirena stop bleeding altogether. Usually their menstrual periods return when the IUD is removed. Mirena can cause weight gain, headaches, increased blood pressure, acne, depression, and decrease in sex drive.
Effects on Future Fertility
Women who want to become pregnant may have their IUD removed at any time. While most women who stop using IUDs are able to become pregnant, IUDs can have negative effects on a woman's fertility. If perforation, embedding, or pelvic infection occurs, the uterus or tubes may become damaged and lower the chance of pregnancy. In cases of severe damage or infection of the uterus, a hysterectomy (removal of the uterus) may be required, resulting in permanent sterility. The synthetic hormone in the Mirena IUD can cause a delay in return of menstruation and fertility after it is removed
Advantages
Allows sexual spontaneity.
Requires no daily attention.
Immediately effective.
Long-lasting.
Not messy.
Disadvantages
Does not protect against sexually transmitted infections, including HIV/AIDS.
Insertion and removal require clinic visits.
Can be expelled.
Can cause more difficult menstrual periods.
Possible risk to future fertility
Resources
Paragard Web Site
Mirena Web Site
A Woman's Guide to Understanding IUDs (English)
A Woman's Guide to Understanding IUDs (Spanish)
Sources:
Feminist Women's Health Center
Contracept.Info
Manufacturer's web sites
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