Modern IUDs: An Update

 

What is an IUD?

An intrauterine device (IUD) is a small, plastic device that is inserted into the uterus to prevent pregnancy.

Are there different types of IUDs?

Yes, many different kinds of IUDs are used all over the world. Two types of IUDs are currently available in the United States: one has copper and the other contains the female hormone progesterone. Both are shaped like the letter "T" and are about 1 ¼ inches tall (see picture). Each IUD has a thread or string on the end, which allows the women to check that the IUD is in place; it also makes it easier for your clinician to remove the IUD.

The copper IUD has copper wire coiled around the stem and arms. The copper IUD can be used for up to 10 years. The progesterone device has a hollow stem that contains the hormone progesterone. The hormone is continuously released into the uterus and acts locally, so there are no hormonal effects throughout the body. This IUD must be replaced once a year.

How does the IUD work?

All the ways an IUD can prevent pregnancy are not fully understood. The most recent studies suggest that IUDs work mainly by preventing fertilization, interfering with the normal development of the egg and the sperm's ability to reach the egg.

How effective are IUDs?

IUDs are the most effective form of nonpermanent birth control. The copper IUD is about as effective in preventing pregnancy as sterilization (getting your tubes tied). For every 100 women using the copper IUD, fewer than 1 per year will get pregnant (less than a 1% failure rate). With the hormone-containing IUD, about 3 women per year will get pregnant (about a 3% failure rate).

Are there side effects?

With the copper IUD, the most common side effects are increased menstrual flow and cramps. Cramps can be relieved by the use of over-the-counter pain medication such as ibuprofen or naproxen. These side effects usually lessen after the first few months as the uterus gets used to the IUD. With the hormonal IUD, bleeding may also occur between menstrual periods, although total blood loss and painful periods are reduced.

Are IUDs safe?

IUDs are a safe and effective method of birth control when used by the right women. Although one of the early IUDs used in the 1970s was associated with an increased risk of pelvic infection, this IUD has been off the market for over 25 years.

Who can use IUDs?

Women at low risk of sexually transmitted diseases (STDs) are good candidates for using IUDs. The IUD is best for a woman who is in a steady and faithful relationship with a partner who is faithful and who does not have any sexually transmitted infections.

IUDs DO NOT protect against STDs. STDs can increase a woman's risk of becoming infertile. If you are using an IUD and believe you may be at risk of getting an STD, use a latex condom to help protect yourself. You may also want to discuss with your doctor or nurse whether the IUD is stil a good choice for birth control.

What are the benefits of IUDs?

IUDs are safe, effective, easy to use, and less expensive than most other forms of contraception over the long run. There is no need to remember to use the method every day or with every act of sex. The copper IUD can last for up to 10 years. In addition, because any hormone in the IUD does not affect the entire body, women do not get side effects like nausea, breast tenderness or headache.

What if I get pregnant?

Overall, the copper IUD protects women against having a pregnancy outside the uterus (ectopic pregnancy) compared to women not using contraception. However, if you are using an IUD and suspect you are pregnant, you should see a clinician promptly to rule out an ectopic pregnancy.

How much do IUDs cost?

Prices for the IUDs themselves vary, but range between $100 and $300. The clinic or health care provider also charges for the medical visit and the insertion of the device. About 90% of Planned Parenthood family planning clinics in the United States offer the IUD. In government-funded family planning clinics, about 50% offer the IUD to low income women. On the other hand, your insurance policy may not cover the cost of the IUD and the insertion visit. If you are covered by a health maintenance organization (HMO) you are likely to have insurance coverage for IUDs. Check with your health care plan and your doctor.