What is an IUD?

What is an IUD?

An IUD (intrauterine device) is a small, usually plastic T-shaped object that is placed into the cavity of the uterus for the purpose of long-acting contraception.  The types available in the US are either hormonal or copper containing, and work by causing a reaction in the lining of the uterus to make it hostile to sperm so that fertilization (the combining of the women’s egg with the man’s sperm) does not occur, as well as affecting the cervical mucus which makes it more difficult for the sperm to get into the uterus.  They are highly effective, with fertility rates less than 1 in 100 women using the device, about the same rate as permanent sterilization.  Insertion of the device takes place in the office and usually takes just seconds (although insertion does cause some cramping for a short time – we usually recommend taking ibuprofen prior to insertion).

The hormone-containing IUDs include Mirena, Liletta and Skyla.  The Mirena has been around in the US for over 15 years, and is approved for 5 year use (although some studies suggest it remains an effective contraceptive for up to seven years).  The Liletta has the same progestin (Levonorgestrel, a chemical derivative of progesterone) dose as the Mirena, but, because it is newer, the FDA has approved it for only 3 years so far. The manufacturer continues to submit data to the FDA to get longer approval times in the future.  Skyla is a slightly smaller IUD, and is FDA approved for 3 years. 

The progestin in these IUDs has the effect of thinning the lining of the uterus as well as thickening the cervical mucus, thus preventing a good milieu for the sperm to travel to on its search for an egg.  A wonderful side effect of this thinning process is that the menstrual periods tend to be much lighter and menstrual cramps tend to be much less intense – many women, over time, have mild spotting or no bleeding at all at the time of their period.  For this reason, the progestin IUD is also indicated for treatment of heavy menstrual periods!  Your body and your ovaries usually are not much affected by the hormones from the IUD, so hormonally you still “cycle” (not great for those who need concomitant treatment for PMS along with need for contraception).  Some women worry about not having a period and if that causes problems in the future.  In reality, before effective contraception was available, many women had 4 or more children and therefore did not have periods for long a time when they were pregnant and breastfeeding, so the lack of bleeding and cramping is really a great plus.

The copper containing IUD, Paragard, has been around for over 25 years.  It is FDA approved for 10 years of contraception.  It works because the copper acts as a spermicide within the uterus and it also affects the cervical mucus, thus inhibiting the motility of the sperm.  It also can be used as emergency contraception for up to 5 days after unprotected sex.  This IUD is as effective as the hormonal IUDs, but the copper can irritate the lining of the uterus such that the periods can be somewhat heavier than usual.

IUDs are contraceptives that are long acting, but reversible.  Although the FDA-approved times note how long an IUD can be in place for effective contraception, the IUD can be removed at any time if one desires return of fertility.  There is no protection for sexually transmitted infections, however, so one should use a condom in to prevent STI’s.  The rate of pelvic inflammatory disease in a woman who has an IUD is similar to one without an IUD, but she should be free of infection prior to insertion.  Rarely, there can be complications from insertion which may require the IUD to be surgically removed, but this occurs < 1 in 1000. 

Should you have further questions regarding IUD use, please contact our office at 714-378-5606.  More information can be obtained at:  http://www.thewomenshealthcenter.com/services/contraception or http://www.acog.org/Patients/FAQs/Long-Acting-Reversible-Contraception-LARC-IUD-and-Implant


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