Benefits and Drawbacks

How effective

The IUD is one of the most effective kinds of birth control available. According to the American College of Obstetricians and Gynecologists, only about 8 of 1,000 women who use the copper IUD become pregnant in the first year of use. According to Planned Parenthood, fewer than 3 women out of 100 who use the progestin IUD become pregnant during the first year of use. The success rate for women using the LNg IUD system is even greater. About 1 in 1,000 women who use the LNg IUD become pregnant in the first year of use. With continued use, even fewer pregnancies occur. A woman can increase her protection by checking the IUD string regularly and talking with her doctor immediately if she notices a problem.

Advantages

• According to Planned Parenthood, more than 95% of women who use IUDs are happy with them.
  
  
• A woman using an IUD is always protected from pregnancy with nothing to remember. She does not need to remember to take a pill every day, for instance.
  
  
• IUDs start working right away and can be removed at any time.
  
  
• IUDs are relatively inexpensive.
  
  
• The risk of side effects is low.
  
  
• IUDs can be inserted 6 weeks after the delivery of a baby or after an abortion.
  
  
• Women who use a copper IUD after childbirth can breastfeed safely.
  
  
• An IUD is not felt by a woman or her partner during sex.
  
  
• Women who cannot use birth control pills because of cigarette smoking or conditions like hypertension may be able to use an IUD.
  
  
• Some women experience less menstrual blood loss and pain with hormonal IUDs.

A doctor must insert and remove an IUD. Serious complications from IUD use are rare.

IUDs come out during the first year of use in about 5% of women who use them. This is most likely to happen during the menstrual period and in women who have previously given birth. Women using IUDs should check their pads or tampons daily while menstruating and feel regularly to make sure the string is in place. If an IUD is expelled unnoticed, a woman may easily become pregnant. If pregnancy occurs while an IUD is still in place, the risk of miscarriage is 50% greater. This risk is decreased by 25% if the IUD is taken out as soon as possible. If the IUD is not removed, a risk of serious infection to the woman exists.

Ectopic pregnancies in IUD users are half as likely as they are in women using no birth control. Ectopic pregnancies are more likely in women who use Progestasert than copper IUDs; however, the overall risk remains less than for women who do not use birth control. Of those using Progestasert who become pregnant, about half of the pregnancies are ectopic. However, to reiterate, the risk of ectopic pregnancy is much less than it is in women who do not use any contraception. Women using IUDs who suspect they may be pregnant should contact their clinicians immediately.

An IUD may puncture the wall of the uterus when it is inserted. This occurs in 1-3 of 1,000 insertions. Cramping and backache may occur in the first few hours after an IUD is placed. Bleeding may occur for a couple of weeks after an IUD is placed. Some women have increased menstrual pain and heavy periods while using the copper IUD, but these symptoms are decreased in those using the hormonal IUD. Pelvic inflammatory disease is also possible with IUD use, especially if a woman is not in a monogamous relationship and has an increased risk of transmission of a sexually transmitted disease (STD).

IUDs do not protect against STDs. STDs can be worse in women who have IUDs, and the chance of getting an STD may be higher in women who use IUDs during the first 4 months after they are placed. IUDs are best for women in relationships in which both partners are monogamous.

Women who should not use an IUD

• Women who are pregnant or who have abnormal bleeding or cancer of the cervix or cancer of the uterus should not use IUDs.
  
  
• Women who have had pelvic inflammatory disease, gonorrhea, or chlamydia within the past 12 months should also not use an IUD. Women with other current reproductive organ infections should not use an IUD until their infection is resolved and their doctor says that an IUD can be used safely.
  
  
• Women with increased susceptibility to infections, such as those with leukemia, AIDS, and those who use intravenous (IV) drugs should not use IUDs.
  
  
• If a woman has abnormalities of the cervix, uterus, or ovaries that would make insertion dangerous, an IUD is not appropriate.
  
  
• Women who are allergic to copper, are having heat treatments, or who have Wilson disease (a rare disease in which copper accumulates in body tissues) should not use the copper IUD.
  
  
• For women who have heart disease, an artificial heart valve, or a ventricular septal defect that has not been repaired, a doctor will carefully evaluate whether an IUD is appropriate because of the possibility of infection.
  
  
• According to Planned Parenthood, because untreated infections associated with IUDs may cause infertility or difficulty becoming pregnant, IUDs are generally not recommended for women who have not yet had any children who may want them, women who want more children, and women who have had difficulty conceiving. However, in their discussion of IUDs, the Reproductive Health Technologies Project disagrees with this claim because IUDs are easily reversible.