After the general birth control update last month, I want to discuss intrauterine devices (IUDs) in more detail. An IUD is a long-acting reversible contraceptive method and is very effective in preventing pregnancy. IUDs are the most common form of reversible birth control used worldwide. IUDs are as effective as sterilization, with a less than 1% risk of pregnancy.
There are several different types of IUDs. They can be hormonal or non-hormonal. The hormonal IUDs have progesterone in them. Examples of these IUDs include Mirena, Skyla, and Kyleena. The non-hormonal IUD is called Paraguard. It has a copper component.
Let’s review some common IUD misconceptions
- IUDs are only for women who have had children
It was previously believed that women who have never been pregnant should not use an IUD. However, this is not accurate. Pregnancy status does not dictate who can have an IUD. Insertion may be more painful in a woman who has never given birth, but it is still a great option for birth control and is becoming more and more popular.
- IUDs are not for teenagers
Again, likely due to discomfort and painful insertions, it was thought that IUDs are only for older women. However, this is also incorrect. As long as the patient tolerates the pelvic exam and has a uterus of the appropriate size, an IUD can be used for a variety of different ages including teenagers.
- IUDs cause infections
The risk of infection is not any higher than the baseline risk of an infection (for a woman without an IUD) unless the patient has an active infection (like gonorrhea or chlamydia) when the IUD is inserted. Women who do not practice safe sex with condoms or a monogamous partner are encouraged to use other forms of contraception. There was an IUD in the 1970s (Dalkon Shield) which had a different design than current IUDs, was made of different materials, and did cause complications and more frequent infections. This design is no longer on the market and the current IUDs are safe.
- I know lots of women who have had complications with IUDs
The most common side effects of IUDs are a change in the bleeding pattern (irregular, light, or no periods with hormonal IUD; possibly heavier and more painful periods with copper IUD). The chance of a serious complication like IUD migration or perforation through the wall of the uterus is less than 1/1,000.
- This IUD contains 52mg of levonorgestral which is released at a rate of 20mcg/day.
- It is approved for 5 years of use.
- It prevents pregnancy by thickening cervical mucous to act as a barrier against sperm, by causing a sterile inflammatory reaction which is toxic to sperm, by inhibiting binding of sperm and egg, and by thinning the lining of the uterus which impairs implantation of pregnancy.
- The amount of progesterone hormone circulating in the blood from the IUD is much less than the amount which you would receive from an arm implant or progesterone birth control pills.
- The most common side effect is a change in your bleeding pattern. Many women will have irregular or unscheduled bleeding which is sometimes prolonged for weeks or several months. Over time the majority of women will stop having a period. The bleeding change is due to the hormone and is not dangerous.
- The hormonal IUD can help to treat women who have very heavy periods, painful periods, endometriosis, or endometrial hyperplasia (pre-cancer of the uterine lining).
- This IUD contains 19.5mg of levonorgesteral which is released at a rate of 17.5mcg/day.
- It is slightly smaller than the Mirena. It is also approved for 5 years of use.
- It has the same mechanisms of birth control as the Mirena.
- The bleeding pattern may be slightly different, with most women continuing a monthly period, which is typically lighter. A minority of patients will stop having a period.
- This IUD contains 13.5mg of levonorgesteral which is released at 14mcg/day initially.
- It is the same size as Kyleena, slightly smaller than the Mirena. It is approved for 3 years of use.
- Because of the lower hormone level the bleeding pattern is different, again with most women continuing to have a monthly period.
- The Paraguard IUD has copper wire wrapped around the stem and arms (on right side of above picture).
- The IUD can be used for up to 10 years.
- It can also be used as emergency contraception when inserted within 120 hours after unprotected sex, and then left in place for continued birth control.
- Periods may become heavier, longer, and more painful for the first several cycles after insertion. This rarely causes significant blood loss or anemia and can be improved with nonsteroidal anti-inflammatory drugs (like ibuprofen).
What to know before you get your IUD
- Continue to use contraception to avoid pregnancy prior to insertion. It is recommended that you have NO unprotected intercourse for 2 weeks prior to insertion, or come in for your IUD while on your period.
- Review the risks, benefits, alternatives, and possible side effects, bleeding profiles with your physician
- Eat a meal, stay hydrated, and take ibuprofen before the appointment
- If possible, it can help to schedule the insertion during your period
What to expect the day of insertion:
- Urine pregnancy test
- Set up for pelvic exam on exam table with feet in stirrups
- Speculum is inserted
- Cervix is cleansed
- An instrument may be used to stabilize and hold your cervix
- An instrument is used to measure the size of your uterus on the inside. This will go through your cervix and into the cavity of your uterus
- The IUD is inserted and strings are trimmed to be 3-4cm from your cervix
After the IUD insertion:
- Cramping, menstrual type pain for the next few days
- Light bleeding
- If hormonal IUD is inserted it is ok to continue having light or irregular bleeding for several weeks or months
- String check with your doctor in 4-6 weeks
- If the IUD is inserted within 5 days of your period it will be immediately effective. If it is not close to your period, you should use a backup birth control method (condoms) or abstain from sex for 7 days
- You can use tampons if desired
Benefits of IUDs
IUDs are a great form of birth control because of efficacy (<1% chance of pregnancy) and because after the initial procedure they do not require any maintenance. Your doctor will check for the strings at the 4-6 week visit and then at your annual exams. This can help women who are worried about forgetting to take the pill every day.
IUDs are cost-effective when used for the long term. Many insurances will cover IUDs (check with yours to find out). Hormonal IUDs can help improve periods for women who have very heavy or painful periods. IUDs are reversible and do not cause any delay in return to fertility when women decide they would like to become pregnant. IUDs are also safe for women who cannot take estrogen-containing birth control (smokers age > 35, women with history of a blood clot, women with high blood pressure, etc). For all of these reasons IUDs are becoming more popular, and rates of satisfaction and continuation are high. There are a few contraindications, but discuss with your doctor if you are interested as IUDs are safe for most women.
By Loriana Soma, M.D. - Expert OB/GYN