Jeanne Faulkner 2/2008
The doctors at Women's Health Today are really excited about IUDs. As a matter of fact, at a recent article planning meeting, there was a bit of a squabble about who got to do the article on IUDs. Catch phrases like "not your mother's IUD" flew around the room with everyone finally agreeing that, "Oh all right, Dr. Grant can do it." Once the rest of the docs quit pouting, the information started pouring out on why IUDs are so darn cool.
IUD stands for intrauterine device - a little T-shaped plastic device that's placed inside the uterus. Used worldwide by somewhere between 85 and 100 million women, it's more than 99% effective in preventing pregnancy, lasts as long as 12 years (depending on type) and is crazy convenient. Once inserted, you don't have to think about birth control at all.
Though stories of IUD-like devices pop up here and there in history, the first effective IUD was developed in the 1930's. Early models were associated with risks for bleeding, uterine perforation, and infection. Among those was the controversial Dalkon Shield that was banned in the 1970s and gave IUDs the bad rap many women still remember.
Today's IUDs are among the most popular methods of reversible birth control. Two are used in the United States today - The ParaGard (also called the Copper T) and the Mirena. Both are well-tested and far safer than their 70's sisters.
Both the ParaGard and the Mirena work on a similar premise: The major way they prevent conception is by changing the way sperm and egg move. A much more secondary function is to prevent a fertilized egg from implanting into the uterine lining. Dr. Grant says, "essentially, IUDs change the environment in the uterus from one that makes it easy for sperm and egg to get together to one that's inhospitable to the process."
The Mirena continuously releases small amounts of the hormone progesterone which thickens cervical mucus and prevents sperm from getting into the uterus. It may prevent some women from ovulating (releasing eggs). The copper on the ParaGard affects the cervical mucus as well as the shape and function of sperm.
IUDs won't prevent sexually transmitted diseases like gonorrhea or HIV and, in fact, can make them more severe. So, women should protect themselves with condoms.
Women with horrid cramps, heavy or irregular menstrual bleeding are often surprised when their doctors suggest treating the symptoms with a Mirena IUD. The small amount of locally absorbed progesterone dramatically reduces the build-up of the endometrium – the uterine lining that's shed with your period. Less endometrium means less bleeding, cramping and misery. Dr. Grant says, "Not only is it a reliable and safe form of contraception, but the substantial reduction in bleeding it can produce is a huge bonus. With the Mirena, women truly can achieve menstrual nirvana. What's not to like?" The Mirena works for five years. After that it should be removed or replaced.
The ParaGard is a simpler device of flexible plastic and copper. It's hormone-free which is good news for women who can't or don't want to mess around with their own natural cycles. Though some women complain of heavier menstrual bleeding, cramping or spotting during the first few months of use, the majority adjust quickly. The big bonus? It's good for up to 12 years of no-brainer, fully reversible contraception.
Side effects usually clear up within the first few months but may include spotting, changes in menstrual flow, cramps and backache. Some Mirena users complain of mild headache, nausea, acne, and mood swings but at rates much lower than those using the pill, patch or ring.
Occasionally, the IUD can partially or completely slip out of the uterus. When that happens, pregnancy can occur. The chance of pregnancy with either IUD is 1:300, about the same as with a tubal ligation (having your tubes tied). If a pregnancy does occur, the chance of a tubal pregnancy is also greater with IUDs.
Very rarely, the IUD can pass through the uterine wall. Usually it occurs during insertion, but an ultrasound study can help locate the IUD. If it has passed outside the uterus, it can be removed with a laparoscopy (outpatient surgery)
Pelvic infections occur rarely and are usually due to bacteria getting into the uterus during insertion or via sexually transmitted diseases like Chlamydia or gonorrhea. That’s why IUDs should only be used by women with a steady partner.
Some women can't use an IUD. If you're pregnant, have a sexually transmitted disease; an abnormal Pap, cancer of the cervix or uterus, unexplained vaginal bleeding, or experienced a pelvic infection after childbirth or an abortion, the IUD may not be a good choice for you. If you're allergic to copper, we won't use the ParaGard. If you have or had breast cancer or severe liver disease, the Mirena's not for you. We'll talk about it.
Previously, IUDs were reserved for women who had previously had a baby. Now they’re considered acceptable for any women who desires one.
Even though we’ve talked a lot about IUDs as contraception, the Mirena also is an excellent way to treat abnormal or undesired bleeding. We can even use it to “oppose the effects of estrogen” on the endometrium among post-menopausal women. That’s really great because many women hate progesterone pills but have no side-effects with the Mirena.
We schedule three appointments for IUD insertion –
Your provider will insert a speculum into the vagina and guide the IUD in a slender plastic tube through the cervix. The IUD is pushed through the insertion-tube and it springs open in the uterus. The insertion-tube is removed and you're done. A soft, bacteria-resistant nylon string extends from the IUD into the vagina and serves as a way to check the IUD's placement and a way for your provider to remove the IUD.
We'll teach you how to check the string (trimmed to extend about 2 inches out of the cervix) monthly to be sure your IUD’s in the right place. Neither you nor your partner will be aware of the string during sex. You'll call us if the string is shorter or longer than usual, you can't find it at all or you feel a hard plastic bump (the IUD may be dislodged)
Call us if you have cramping for more than a week or spotting for more than month after insertion. If your menstrual bleeding remains heavy for more than three months after IUD insertion or you have abdominal pain, pain or bleeding with sex, fever, chills or unusual vaginal discharge we want to know about it.
Obviously, you never want to attempt removing your own IUD. That's a job for professionals, but it can be done in the office, more quickly and easily than the inserstion. The vast majority of IUD users are totally happy them. As Dr. Grant said, "it's not your mother's IUD" anymore. Now it's akin to "menstrual nirvana." You've come a long way baby.