Intrauterine devices (IUDs) are small, flexible, T-shaped plastic devices that are inserted into the uterus.
An IUD is left in place for 3, 5, or 10 years, depending on the type, or until the woman wants the device removed. IUDs must be inserted and removed by a doctor or other health care practitioner. Insertion takes only a few minutes. Removal is also quick and usually causes minimal discomfort.
IUDs prevent pregnancy by
- Killing or immobilizing sperm
- Preventing sperm from fertilizing the egg
- Creating an inflammatory reaction inside the uterus that is toxic to sperm
Understanding Intrauterine Devices
Intrauterine devices (IUDs) are inserted by a doctor into a woman’s uterus through the vagina. IUDs are T-shaped and made of molded plastic. Some types of IUDs release a progestin called levonorgestrel. Another type has a copper wire wrapped around the base and on the arms of the T. Plastic strings are attached to the IUD. The strings enable a woman to make sure the device is still in place and a doctor to easily remove it.
In the United States, about 12% of women who use contraception use IUDs. More and more women are using them because of their advantages over oral contraceptives:
- IUDs are very effective.
- IUDs have no general, bodywide (systemic) effects.
- Women need to make only one contraceptive decision every 3, 5, or 10 years.
Five types of IUDs are currently available in the United States.
Four of them release a progestin (levonorgestrel). One of these is effective for 3 years, and the others are effective for at least 5 years. During that time, only about 0.9% of women become pregnant with the 3-year IUD, and about 0.7 to 1.5% of women become pregnant with the 5-year IUDs.
The fifth type, which contains copper, is effective for at least 10 years. When it is left in place for 12 years, fewer than 2% of women become pregnant.
One year after removal of an IUD, 80 to 90% of women who try to conceive do so.
Most women, including those who have not had children, and adolescent girls, can use IUDs. However, IUDs should not be used when the following conditions are present:
- A pelvic infection, such as a sexually transmitted disease or pelvic inflammatory disease
- A structural abnormality that distorts the uterus
- Unexplained bleeding from the vagina
- Gestational trophoblastic disease
- Cancer of the cervix or cancer of the lining of the uterus (endometrium)
- For levonorgestrel-releasing IUDs, breast cancer or an allergy to levonorgestrel
- For copper IUDs, Wilson disease or an allergy to copper
Having had a sexually transmitted disease, pelvic inflammatory disease, or a mislocated (ectopic) pregnancy in the past does not prevent women from using an IUD.
Religious beliefs that prohibit abortion do not prohibit the use of IUDs because IUDs do not prevent conception by causing a fertilized egg to be aborted. However, when used for emergency contraception after unprotected sex, a copper IUD may prevent a fertilized egg from becoming implanted in the uterus.
An IUD may be inserted at any time during the menstrual cycle if women have not had unprotected sex since their last period. If they have had unprotected sex, a pregnancy test must be done before an IUD is inserted, and women are advised to use another method of contraception until the test is done. Pregnancy must be ruled out before the IUD is inserted unless women wish to use an IUD as emergency contraception after unprotected sex. In such cases, a copper IUD may be inserted to prevent unwanted pregnancy. If inserted within 5 days of one act of unprotected sex, a copper IUD is nearly 100% effective as emergency contraception. Then, if the woman wishes, it may be left in place for long-term birth control. A levonorgestrel-releasing IUD is not used for emergency contraception, and pregnancy must be ruled out before it is inserted.
Before the IUD is inserted, doctors may recommend testing for sexually transmitted diseases (STDs) based on a woman's risk factors. However, doctors do not need to wait for STD test results before inserting the IUD. If results are positive, the STD is treated, and the IUD is left in place. If women have a discharge that contains pus, an IUD is not inserted. In such cases, STD testing is done, and antibiotics are started immediately, without waiting for test results.
An IUD may be inserted immediately after a miscarriage or an abortion that occurs during the 1st or 2nd trimester and immediately after the placenta is delivered after a cesarean delivery.
The uterus is briefly contaminated with bacteria at the time of insertion, but an infection rarely results. IUD strings do not provide access for bacteria. An IUD increases the risk of a pelvic infection only during the first month of use. If an infection develops, it is treated with antibiotics. The IUD can be left in place unless the infection persists after treatment.
Bleeding and pain are the main reasons that women have an IUD removed, accounting for more than half of all removals before the usual replacement time. The copper IUD increases the amount of menstrual bleeding and may cause cramps. NSAIDs can usually relieve the cramps. Levonorgestrel-releasing IUDs reduce the amount of menstrual bleeding, and after 1 year, menstrual bleeding stops completely in about 6% of women who use the 3-year IUD and in 20% of women who use a 5-year IUD.
Typically, IUDs are expelled in fewer than 5% of women during the first year after insertion, often during the first few weeks. Sometimes a woman does not notice the expulsion. Plastic strings are attached to the IUD so that if she wishes, a woman can check every so often to make sure that the IUD is still in place. However, a woman typically has bleeding or pain if an IUD is expelled or is in the wrong position. If another IUD is inserted after one has been expelled, it usually stays in place. If doctors suspect that the IUD has been expelled, women must use another form of birth control until the problem is resolved.
Rarely, the uterus is torn (perforated) during insertion. Usually, perforation does not cause symptoms. It is discovered when a woman cannot find the plastic strings and ultrasonography or an x-ray shows the IUD located outside the uterus. An IUD that perforates the uterus and passes into the abdominal cavity must be surgically removed, usually using laparoscopy, to prevent it from injuring and scarring the intestine.
If women conceive with an IUD in place, they are more likely to have a mislocated (ectopic) pregnancy. Nonetheless, the overall risk of an ectopic pregnancy is much lower for women using IUDs than for those not using a contraceptive method because IUDs prevent pregnancy effectively.
In addition to providing effective birth control, all types of IUDs may reduce the risk of uterine (endometrial) cancer.
The 5-year levonorgestrel-releasing IUDs are also effective treatment for women who have heavy menstrual cycles.
The copper IUD can provide effective contraception for women who cannot use hormonal methods.
Drugs Mentioned In This Article
|Generic Name||Select Brand Names|
|levonorgestrel||MIRENA, PLAN B|