If you are interested in reliable contraception and are looking for something different than pills, patches, rings, condoms, or shots, you may want to consider an IUD (intrauterine device). IUDs are in the family of contraception called LARC (long acting reversible contraception). LARC are over 20 times more effective than pills, patches, or the ring and if you want to stop them or desire to get pregnant, you can have them removed at any time.
What is an IUD?
It is a small plastic T-Shaped device that is inserted into the uterus (and it stays in there). Hormonal IUDs release progesterone slowly throughout their lifespan. There are 3 year, 5 year and 8 year products available. This hormone is locally acting in the uterus and thus should have limited to no systemic effects. This makes the IUD a nice option for women who have had perceived hormonal side effects to birth control pills, patches, rings, or shots. The current products on the market include Mirena, Kyleena, Skyla, and Liletta. The copper IUD has no hormones and can be left in for 10 years. The current product on the market is the Paragard.
How do IUDs work?
There is a misperception that IUDs are abortifacient. In fact, this is not true. Both hormonal and copper IUDs work by preventing fertilization of the egg by the sperm. They do this by thickening cervical mucous and/or causing an environment that is toxic to sperm.
What are the benefits of an IUD?
They are very effective, and have a failure rate as good as or better than sterilization at about 0.2-0.6%. They are easy to use! This is what we call “forgettable contraception”…. Just set it and forget it. They are long acting and reversible. So if you wish to become pregnant or just want to stop, they can be removed. They are safe for most women, including teens and women who have never been pregnant. They are an alternative to permanent surgical sterilization. There are very few side effects. There are some non-contraceptive benefits too. The progesterone IUD is often used to help decrease the frequency or heaviness of periods. Many women will ,in fact, not have a period with the progesterone IUD. They do not interfere with sex or daily activities. Lastly, they are very well covered by insurance companies. In fact, most people pay little to nothing to get an IUD and have it inserted!
What about these “myths” you hear about IUDs?
Do IUDs cause infection? Getting a pelvic infection with an IUD in place has a risk of 0.1 to 0.5%.
Do IUDs cause ectopic pregnancy? No they do not. Pregnancy rates are so low with an IUD that the overall risk of an ectopic pregnancy with an IUD in is 10 times less than those without an IUD. That being said, if you happen to get pregnant and have an IUD in place, there is a higher relative risk that it is an ectopic pregnancy. But this number clinically is very low (0 to 5 per 1000 users).
Do IUDs cause infertility? Pregnancy rates are similar in women who have an IUD removed and those who were not using any contraception.
What are the risks of insertion?
There is 0.1% chance the IUD perforates the uterus during insertion and ends up in the abdominal cavity. As mentioned above, there is a 0.1-0.5% risk of getting an infection. About 3% of women will “expel” their IUD, meaning it will fall out. This usually happens within the first year of use. About 5% of IUDs will “migrate” to an imperfect position. Not all of these need to be replaced. It usually depends on symptoms a patient is having. IUD position can be checked by sonogram if you and provider find it necessary.
What are the side effects of an IUD?
There is generally some post insertion cramping that, for most women, can be managed with NSAIDs. This is typically worse in women who have never had children. Bleeding patterns with IUDs can be chaotic for the first 3-6 months. I strongly recommend women see how they are bleeding at 6 months before making decisions on whether or not to keep their IUD.