Intrauterine Devices (IUDs)

The IUD is too often overlooked as a desirable contraceptive option, in large part due to negative publicity and related lawsuits in the 1970s when one poorly designed IUD, the Dalkon Shield, caused high rates of pelvic inflammatory disease (PID). That product was removed from the market and two new, improved IUD designs are now available.  These are considered safe and very effective for women in mutually monogamous relationships at low risk for PID who have already given birth to at least one child.  The greatest barrier to more widespread IUD use is the lack of familiarity of the product among women and physicians alike.  In well-selected patients, IUDs provide reliable contraception for up to 10 years with minimal side effects and complications. After insertion, the only maintenance is a monthly self-check for proper placement of the device and an annual follow-up exam, which all women should have whether they have an IUD or not.  Fertility is completely restored the day the IUD is removed.

An IUD is a mechanical device inserted into the uterus by a health care professional. Three types of IUDs are now available in the United States: the Paragard CopperT 380A ("Paraguard"); the Progestasert Progesterone T ("Progestasert"); and most recently, Mirena. Paragard contains copper and can remain in place for 10 years. Progestasert contains the hormone progesterone and must be replaced annually. Mirena was approved by the FDA in December 2000. It releases levonorgestral -- a type of progestin -- and may remain in place for up to 5 years.

IUDs prevent pregnancy by interfering with the successful meeting of sperm and eggs by either immobilizing sperm prior to fertilization or by changing the uterine lining in some way, thus preventing implantation. Hormone (progestin)-releasing IUD's have the further action of inhibiting pituitary hormones that regulate menstrual cycles, thus preventing egg development and release (ovulation). They also alter the lining of the uterus so that menses becomes shorter and lighter and may even cease altogether. Women who are unable to take oral contraceptives because of contraindications to estrogen may still consider this as a contraceptive option.

IUDs have one of the best contraceptive success rate of any birth control method:  only 8  women in 1000 will conceive within one year while using the IUD, whereas 4 women in 1000 will conceive after having their tubes tied.  Serious complications from IUDs are rare; when they do occur, it is most often during or immediately after insertion. Side effects can include pelvic inflammatory disease (an infection of a woman's reproductive organs), ectopic or "tubal" pregnancy, perforation of the uterus, heavier-than-normal bleeding, and heavy menstrual cramping.

There are some reasons that IUDs should not be used: with a known or suspected pregnancy; with a uterine abnormality or abnormal PAP test; with any allergy to copper or a disease which is affected by copper; having any past or current history of pelvic infection; or with decreased immunity such as patients receiving chemotherapy, radiation therapy, transplant patients, or patients with HIV or AIDS. A woman who becomes pregnant while using an IUD is more likely to develop a tubal pregnancy, to have a miscarriage, or to have a pre-term delivery than a woman who does not have an IUD in place.  There are several famous photos, however, of babies born holding the IUD!

• The IUD and Breast-feeding-The progesterone IUD has not been shown to cause problems in nursing babies and its use is recommended for those women needing contraception while breast-feeding.
  
  
• IUDs come with patient information sheets. You must read and understand this information and you should keep a copy for future reference.
  
  
• It is important to check for the IUD threads every month, ideally after your period. Tell your doctor immediately if you think that the IUD has moved out of place. Do not try to put the IUD back into place inside the uterus. Do not try to remove the IUD.  Do not rely on the IUD for contraception in that situation until you are assured that it is still in place.

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Created: 10/31/2001  -  Donnica Moore, M.D.