Intrauterine devices, commonly known as IUDs, have been around for almost 50 years. They are terrific at preventing unwanted pregnancy and have high rates of satisfaction among users. Yet fewer than 6 percent of women in the United States used IUDs from 2006 to 2008, according to the American Congress of Obstetricians and Gynecologists (ACOG). Why are they not a first choice of contraception or used more than they are?
There are hormonal and non-hormonal IUDs available: Skyla, Mirena, and Paragard.
A bit of history: Even though the concept of IUDs has been around since the early 1900s, it wasn’t until the Dalkon Shield was marketed in the ’60s and ’70s that IUDs were more widely used. However, due to design flaws in the shield, many users experienced bad infections and a few people died. The Dalkon Shield was taken off the market and the bad reputation of IUDs remained seared in the minds of the public. Today, newer IUDs are much improved — with a better design and fewer problems, fewer than 1 percent of users have serious complications. But still they remain underused and misunderstood, according to some health experts.
Recently, studies have shown that IUDs are an excellent choice for teens who usually want a long-term method of birth control that is easy to use and easily reversible. As a matter of fact, ACOG states that IUDs are the most effective reversible contraceptives available and are safe, reliable, and cost-effective for most users, including teens.
Other methods of birth control, like the Pill, rely on consistent use, which can be difficult for some users to comply with. This problem is eliminated with the use of an IUD, which can prevent pregnancy for years. Once inserted in the uterus by a health care provider, you don’t need to do anything else to prevent pregnancy.
Today, three IUDs are available in the United States: Skyla, Mirena, and Paragard. Skyla is the first new IUD on the market in 12 years, and has been available since February.
Skyla and Mirena are hormonal IUDs. They contain a progesterone that releases small amounts of the hormone daily, directly in the uterus. Over time, the amount of hormone progressively decreases until it’s time to replace the IUD. For Mirena, replacement is every five years. Skyla, which contains a smaller dose of the hormone, is good in place for three years.
Paragard, the only other IUD available, is hormone free. It contains copper, which remains effective for 10 years and can also be used as emergency contraception if inserted up to five days after unprotected sex.
The hormonal IUDs are thought to prevent ovulation similar to birth control pills. But with Paragard you still ovulate normally each month but sperm may not be able to fertilize the egg or the egg may not be able to implant on the uterine wall. With any IUD, pregnancy is prevented approximately 99 percent of the time, making it highly effective.
IUDs need to be inserted (and removed) by your doctor or health care provider, but once in place you need do nothing else to prevent pregnancy. They do not interfere with sex or daily activities and it’s OK to use tampons. They can be inserted early after giving birth and are usually OK to use when breastfeeding. The hormonal IUDs may help with menstrual pain and heavy bleeding. All are easily removed by a doctor if you decide to become pregnant.
They do not prevent STDs or HIV — you must still use a condom for that. And you cannot use them if you have certain pelvic infections, inflammatory disease, or some other diseases. You can check to see if they remain in place by feeling for two small threads in your cervix, but should never try to remove an IUD by yourself.
Side effects may include spotting and changes in bleeding. Some women using the hormonal IUDs may even stop having periods after one year. You may have abdominal or pelvic pain, acne, headaches, or ovarian cysts, which may go away with time. If you think you may be pregnant, it’s extremely important to see your doctor immediately because there can be serious complications such as ectopic pregnancies, which can be life-threatening. At any time if you experience severe pelvic pain, pain during sex, unexplained fever, unusual vaginal discharge, or signs of pregnancy, you should contact a health care provider right away. Overall, fewer than 1 percent of users develop serious complications.
IUDs can be pricey initially. Their cost can be several hundred dollars and then there is a cost for a doctor to insert or remove them. But they may be cost-effective over the long-run, no monthly prescription fees for example. Under the new Affordable Care Act and the women’s preventive care plan, IUDs might be covered by some insurance plans, making them even more affordable options.
If an IUD sounds like an interesting option for you and you want to learn more, contact your local Planned Parenthood health center for an appointment.
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