Facts about and Definitiion of IUDs (Intrauterine Devices)
- An IUD is a small, T-shaped device that is inserted into a woman's uterus to prevent pregnancy.
- Two types of IUDs are available in the US; 1) a copper-containing IUD, and IUDs that release hormones.
- IUDs must be inserted and removed by a health-care professional.
- Before having an IUD inserted, you will undergo pregnancy testing and testing to rule out pelvic infection.
- IUDs are over 99% effective in preventing pregnancy.
- IUDs are a long-term reversible methods of birth control.
- Side effects of IUDs depend upon the type of IUD that is inserted.
- You should check every month to ensure your IUD is still in place.
- The placement of your IUD can be done in the doctor's office.
- Depending on the type, some IUDs can be left in place for up to 10 years.
What Is an IUD? What Do They Look Like? How Do They Work?
An intrauterine device (IUD) is a small T-shaped plastic device that is placed in the uterus to prevent pregnancy. A plastic string is attached to the end to ensure correct placement and for removal. IUDs are an easily reversible form of birth control, and they can be easily removed. However, an IUD should only be removed by a medical professional. An IUD is a form of long-acting reversible contraception (LARC).
Intrauterine device (IUD)
The precise mechanism of the contraceptive action of IUDs is not known, and hormonal and copper IUDs work in different ways. Neither type of IUD affects ovulation or the menstrual cycle (period).
What Are the Types of IUDs?
Currently in the United States, 2 types of IUDs are available; copper (ParaGard) and hormonal (Skyla or Mirena). Approximately 2% of women who use birth control in the United States currently use IUDs. Hormonal IUDs release progesterone hormones.
With hormonal IUDs, a small amount of progestin, a hormone similar to the natural hormone progesterone, is released into the uterine lining. This hormone thickens cervical mucus and makes it difficult for sperm to enter the cervix. Hormonal IUDs also slow down the growth of the uterine lining, making it inhospitable for fertilized eggs.
With a copper IUD, a small amount of copper is released into the uterus. Copper IUDs may prevent sperm from being able to go into the egg by immobilizing the sperm on the way to the Fallopian tubes.
How are IUDs Removed? Can I Remove It Myself?
You should never try to remove an IUD yourself because serious damage can result. A health-care professional usually can remove an IUD very simply by carefully pulling the string ends at a certain angle. This causes the IUD arms to fold up and the IUD to slide out through the cervix. If the IUD is being replaced, a new one can usually be inserted immediately.
Rarely, the cervix may need to be dilated and a grasping instrument is used to free the IUD. If this occurs, a local anesthetic is used. Very rarely, hysteroscopic surgery may be necessary, where a small telescope is used to help remove the IUD.
Where Do I Go to Get an IUD? Which Types of Doctors Insert Them?
Women who are interested in using IUDs for birth control should contact their doctor or local Planned Parenthood Health Center. Usually, IUDs are inserted by gynecologists or (OB/GYN).
Choosing Your Birth Control Method
How Is an IUD Inserted? Does It Hurt?
Before an IUD is placed, a physical examination is important to make sure that your reproductive organs are normal and that you don't have a sexually-transmitted disease (STD). The health-care professional will ask you about your medical and lifestyle. IUDs are not appropriate for every woman.
You should discuss any questions you have with your doctor about IUDs before having it placed.
An IUD can be placed during an office visit and remains in place until a health-care professional removes it. It can be inserted at any phase of the menstrual cycle, but the best time is during the menstrual period because this is when the cervix is softest and when women are least likely to be pregnant. You may be instructed to take an over-the-counter (OTC) pain reliever an hour before insertion to prevent cramps. Cramps may be uncomfortable during insertion. Sometimes, an anesthetic may be injected into the cervix prior to insertion to reduce pain from cramping.
- To place the IUD, a speculum is used to hold the vagina open.
- An instrument is used to steady the cervix and uterus, and a tube is used to place the IUD.
- The arms of the T shape bend back in the tube and then open once the IUD is in the uterus.
- Once the IUD is in place, the instruments are withdrawn.
- The string hangs about an inch out of the cervix but does not hang out of the vagina.
Once the IUD is placed, you can return to normal activities such as sex, exercise, and swimming as soon as you are comfortable. Strenuous physical activity does not affect the position of the IUD. You also can use tampons as soon as you wish after an IUD is placed.
How Effective Are IUDs?
IUDs have been shown to be over 99% effective in preventing pregnancy. A woman can increase her protection by checking the IUD string regularly and talking with her doctor immediately if she notices a problem.
What Are the Advantages of IUDs?
- 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.
- IUDs can be inserted 4 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 (high blood pressure) may be able to use an IUD.
- Many women experience less menstrual blood loss and pain with hormonal IUDs.
Advantages of copper IUDs (ParaGard)
- The copper IUD is the most commonly used type of IUD worldwide.
- It can be left in the body for up to 10 years.
- It can be removed at any time if a woman wishes to become pregnant or if she does not want to use it anymore.
- The arms of this IUD contain some copper, which is slowly released into the uterus.
- Side effects of the copper IUD can include heavier periods and worsening of menstrual cramps.
Advantages of hormonal IUDs (Mirena, Skyla)
The Mirena or Skyla IUDs contain progesterone hormones, which cause cervical mucus to thicken to prevent sperm from entering the cervix and reaching the egg. Hormonal IUDs reduce the risk of tubal pregnancies and pelvic inflammatory disease. They also dramatically decrease menstrual blood loss. Mirena is approved for up to five years of use, and Skyla for up to three years.
- They can be removed at any time if a woman decides she wishes to become pregnant or if she does not want to use it anymore.
- Hormones are in the main stem of the IUD and are released slowly into the uterus.
- Side effects of hormonal IUDs can include irregular periods for 3-6 months after insertion.
- Hormonal IUDs tend to reduce menstrual flow by up to 90% and may stop periods altogether in some cases.
What Are the Disadvantages of 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 may wish to 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%. 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 in women using no birth control. Ectopic pregnancies are less likely to occur with hormonal IUDs. Women using IUDs who suspect they may be pregnant should contact their health-care professional 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), though hormonal IUDs appear to protect against pelvic inflammatory disease.
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.
How Much Does an IUD Cost?
Please inquire about cost and insurance coverage. At some clinics, price may be based on income. Medicaid covers these services. The out-of-pocket cost for the exam and insertion of the IUD can range from $0 to $1000, depending upon your insurance coverage. Hormonal IUDs tend to cost more than the copper IUD. The costs are less per year than many other forms of reversible birth control.
When Should I Call the Doctor if I'm Concerned About My IUD?
Women using IUDs should have regular medical examinations every year.
- You may wish to check to be sure that they feel the string coming out of the cervix to make sure the IUD remains properly in place. To check for the string, sit or squat and with clean hands, insert your index or middle finger into the vagina until the vagina is felt. Do not pull the string. This may cause it to come out of place. If you do not feel the string, if the string feels too short or long, or if you feel the IUD itself, you should call the doctor.
- Women who miss their periods or who notice unusual vaginal fluid or odor should call the doctor.
- Women who have severe abdominal pain or cramps, pain or bleeding with sex, unexplained fever and chills, or unexplained bleeding after the adjustment phase should call their health-care professional immediately.
- Any you are using an IUD you suspects that you are pregnant, contact your health-care professional immediately.
What Are the Complications and Risks of IUDs?
Complications and risk include the possibility of puncture of the wall of the uterus during insertion; this is uncommon and happens in 1-3 out of every 1,000 cases. If a woman becomes pregnant with an IUD in place, there is a 50% likelihood that the pregnancy will end in miscarriage. Another potential risk is that the IUD will be expelled from the uterus.
Who Should Not Use an IUD?
- Women who are pregnant or who have abnormal bleeding or cervical cancer or uterine cancer should not use IUDs.
- Women who have pelvic inflammatory disease, gonorrhea, or Chlamydia or a recent history of these infections should 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.
- 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 or who have Wilson disease (a rare disease in which copper accumulates in body tissues) should not use the copper IUD.
Which of the following are methods for contraception?
Reviewed on 10/17/2018
REFERENCE: Casey, FE, MD, et al. What are contraceptive intrauterine devices (IUDs)? Medscape. Updated: May 16, 2018