According to a 2012 study which sought to reveal how American woman view intrauterine devices for birth control, the majority of those surveyed had inaccurate information about the efficacy and health concerns associated with IUD’s. Areas of misinformation included:

Efficacy: Most women did not know that IUD’s are more effective than the pill
STD’s: Nearly half of the women did not know that IUD’s do not increase STD risk
Cost: Most women did not know IUD’s are more cost effective over time than the pill

In other developed countries, especially throughout Europe, IUD’s are a leading form of birth control. For comparison’s sake, consider the following: IUD’s were used by only 2% of U.S. women on contraception in 2002, whereas countries such as Norway reported usage rates of greater than 20%.

I cannot speak to why IUD’s lack popularity among American women, but I do believe this lack of popularity, in part, explains why so many of us have incorrect information. With less popularity comes less use, and therefore less exposure to information (both professionally and through the experience of friends and family). IUD use appears to be on the rise in the U.S., but many woman are still hesitant to consider this form of birth control due to a lack of understanding. IUD’s are not ideal for everyone, and when appropriate, I advise patients to look elsewhere for contraception. However, in many cases IUD’s are a reasonable and safe alternative to systemic hormonal options, such as oral contraceptive pills and the Depo-Provera shot.

Below is the basic information I share with my patients when they are considering an IUD. If knowledge is indeed power (and I believe it is), I hope that the following basics of IUD contraception empower you to select your best form of birth control.

~~~    ~~~   ~~~   ~~~   ~~~   ~~~   ~~~   ~~~   ~~~   ~~~   ~~~   ~~~   ~~~   ~~~   ~~~   ~~~   ~~~   ~~~

Screen shot 2013-02-25 at 6.13.24 PM

IUD’s are ideal for women seeking long-term, reversible birth control, and especially those in monogamous relationships with least exposure to STD’s.

There are 3 types of IUD’s available in the U.S.:
1. Paraguard — Copper, hormone-free, lasts approximately 10 years
2. Mirena — Localized progestin, lasts approximately 5 years
3. Skyla — Localized progestin, lasts approximately 3 years (recently FDA approved)

Paraguard is the better choice for hormone-sensitive women. However, it does increase bleeding and cramping and should not be the first choice for those with irregular, heavy, or painful cycles.

Mirena is the better choice for women with heavy, painful periods. The localized hormone decreases bleeding and calms the smooth muscle of the uterus. For some women, there may be minor systemic symptoms from the progestin, including nausea, breast tenderness and headaches.

Skyla is a recently FDA-approved IUD that (like the Mirena) supplies localized progestin, but in a smaller dose. Whereas the Mirena contains 52mg of Levonorgestrel at time of insertion, Skyla contains 13.5mg. Skyla may be a more appropriate choice for women with heavy, painful menses who are more hormone sensitive, and also for those hoping to conceive in the next five years.

For women hoping to conceive in the near-future:
1. I do not recommend an IUD unless you plan to wait at least 2 years before trying to conceive.
2. This recommendation is based on cost and inconvenience of discomfort. IUD’s cost between $500-$1,000 and the insertion process can be painful, as can removal. In some cases, the IUD will be expelled by the uterus and insertion must be repeated.

Some advantages to consider:
1. Compliance is automatic – no need to remember your pill or schedule an injection
2. IUD’s will not suppress your body’s hormonal system (though sensitive women may feel some symptoms of hormonal imbalance when using the Mirena)
3. Most woman can conceive immediately after removal
4. Decreased pain & bleeding with the Mirena

Some disadvantages to consider:
1. Discomfort during insertion (mild pelvic & back pain should resolve after the first few days)
2. Irregular menstrual cycles for up to 6 months
3. Increased pain & bleeding with the Paraguard
4. IUD’s do not protect against sexually transmitted diseases

Though an IUD does not increase risk of STD’s (a common misperception according to the study mentioned above), there are rare but significant health risks that every woman should understand before selecting this form of birth control:

PID – Pelvic Inflammatory Disease
IUD’s do not increase the risk of acquiring STD’s, but they do increase the risk of developing Pelvic Inflammatory Disease if you do become infected. PID is an infection of the uterus and fallopian tubes that lead to infertility and may even become life-threatening if untreated. I recommend an alternative form of birth control for women with a history of Pelvic Inflammatory Disease, or those at increased risk for STD’s such as Chlamydia. Remember, IUD’s do not protect against STD’s. Combine with a barrier device such as a condom to prevent spread of infection.
Expulsion

The uterus will sometimes partially or fully expel the IUD via smooth muscle contractions. This is most likely to happen shortly after insertion, but it can occur at any time, causing pain and bleeding. The old IUD must be removed and a new one inserted.
“Lost” IUD
Less commonly, an IUD will slip out of place within the uterus and day surgery may be required to remove the contraceptive. IUD position and need for surgical intervention can be assessed with pelvic ultrasound.
Ectopic Pregnancy
A very small percentage of women may become pregnant while using an IUD. For this group, there is an increased risk of ectopic pregnancy. Similar issues of pregnancy, miscarriage and increased risk for ectopic pregnancy are present with other forms of contraception, as well.

 

Remember, these are only the basics. Make an appointment with your healthcare provider to discuss your specific questions and needs.

 

Dr. Kaley Bourgeois

 

 

Sources:

Callegari, LisaS. “Perceptions of intrauterine contraception among women seeking primary care.” Contraception. (2012): n. page. Print. <http://www.contraceptionjournal.org/article/S0010-7824(13)00048-6/abstract>.

FAQ: Contraception.” . The American Congress of Obstetricians and Gynecologists, Web. 25 Feb 2013. <http://www.acog.org/~/media/For Patients/faq014.pdf?dmc=1&ts=20130225T1735419185>.

Sonfield, Adam. “Popularity Disparity: Attitudes About the IUD in Europe and the United States.” Guttmacher Policy Review. 10.4 (2007): n. page. Print. <http://www.guttmacher.org/pubs/gpr/10/4/gpr100419.html>.