|What Is An IUD Device?
An intrauterine device (IUD) is a small plastic or metal object that is placed into the uterus (womb) to prevent pregnancy. In the UK it is often referred to as 'the coil'. Once in place it can remain there for years. It is a reversible contraceptive, which means once removed, the woman can become pregnant if she wishes. It is a highly effective form of birth control with a typical failure rate of 1 percent - after 7 years of use, only one woman in a hundred is expected to accidentally become pregnant. In the United States there are now two kinds of IUD's available:
Copper-Releasing Tcu-380A (ParaGard): This became available in 1988. It is a white plastic device coated in copper. It can remain in place for 10 years. Copper ions are released into the uterus. It is not fully understood how this prevents pregnancy, but it may be because copper is toxic to the sperm, or that it 'upsets' the lining of the womb making implantation more difficult.
Progestin-Releasing (Mirena): This is a more recently approved hormone releasing device (although it has been widely used in Europe for years). Mirena is also known as a levonorgestrel-releasing intrauterine system, or LNG-IUS. It secretes minuscule amounts of the hormone levonorgestrel (a form of progestin) providing safe contraception for up to 5 years. It may also help reduce heavy bleeding, menstrual cramps and shrink uterine fibroids.
How Is An IUD Inserted?
Copper IUD Device
Before inserting an IUD, a doctor will perform a physical examination to ensure you are a good candidate for the device. He will want to make sure you are not pregnant or have any infections. He will perform a pelvic examination, pregnancy test, Pap test and check for sexually transmitted diseases (STDs). If the test results are satisfactory he will proceed with inserting the IUD as follows:
1. The clinician takes a plastic tube (like a straw) which contains the IUD and slides it through the cervix and into the womb.
2. Both types of coils are made of plastic in the shape of a T which is flattened temporarily into a straight line during insertion.
3. Once in place, the device springs into shape.
4. The IUD has a plastic string attached which can be felt in the upper part of the vagina. When it is ready to be removed (a few years later) the doctor will pull on this string.
5. Some women feel uncomfortable cramping during insertion and spotting for a few days after. If cramping becomes worse talk to your doctor immediately. You may have an infection.
Who Is Not Eligible For An IUD?
No woman should have an IUD inserted if she has:
• Suffered an ectopic pregnancy in the past.
• An abnormal shaped uterus.
• A history of pelvic inflammatory disease (PID).
• A STD (it should be treated first).
• Uterine fibroids large enough to distort the shape of the womb.
• An active cervical infection (cervicitis).
• Acute recurrent vaginitis.
• An abnormal Pap smear test result.
• Cervical polyps.
• Suffers endometrial disorders such as uterine polyps, endometriosis or endometrial hyperplasia.
• Heart disease, sickle-cell disease, leukemia, diabetes, blood clotting disorders.
• An allergy to copper (but Mirena can be used instead).
Additionally doctors are reluctant to insert an IUD in women under 25 who statistically are more likely to contract an STD/infection because of multiple partners. Also, they are reluctant to insert an IUD in childless women because of the risk of PID-associated infertility. Better options may be birth control implants such as Implanon or birth control injections like Depo-Provera.
How Much Does An IUD Cost?
The total cost of an IUD, including the cost of two visits to the doctor and the required screening tests, is between $300 and $400.
What Are The Risks And Complications?
Periods: Although Mirena reduces menstrual flow, copper IUDs tend to make periods longer, heavier and cause cramps. This usually subsides after a few months.
Spotting: Mirena can cause spotting between periods for the first few months.
Ovarian Cysts: Progestin releasing IUDs (Mirena) increase the risk of benign ovarian cysts. Read more: Does the coil increase the risk of ovarian cysts?
Expulsion: Between 2 and 8 percent of IUDs are expelled by the body in the first year. It is most likely to occur in the first 3 months. One fifth of women fail to notice the expulsion and face the risk of unintended pregnancy. The risk of expulsion is highest during menstruation, so you should check the IUD is in place after your period has finished.
Perforation: A potentially serious complication of inserting an IUD is the accidental perforation of the womb during the insertion process - although if the doctor is experienced, this is a rare occurrence. Another rare occurrence is where the IUD perforates the uterus wall and travels to another part of the body such as the abdomen where it imbeds and causes problems.
A Brief History
When IUDs were first introduced in the 1970s they were marketed as the ideal form of birth control. But then quite quickly serious problems started to be reported. A number of women developed serious PID and suffered fatal septic abortions (became pregnant and miscarried due to infection) after using the IUD called Dalkon Shield. Dalkon Shield and many other IUDs were banned from the U.S. market in 1974 (although many countries, including Canada, did not ban them). Fortunately, the two new types of IUDs sold in the U.S. today do not carry the same level of risk.
Pelvic Infections: Using an IUD does appear to increase the risk of PID. Such infections can range from mild to severe and can become life-threatening. Studies show that such infections are more likely to occur soon after insertion. Taking an antibiotic at the time of insertion helps to prevent this from happening.
HIV Infection: There is no evidence that IUDs increase the risk of HIV infection in women.
Infertility: IUDs are considered a leading cause of infertility due to PID.
Ectopic Pregnancy: In the unlikely event that you conceive with an IUD in place, there IS a higher risk of an ectopic pregnancy or miscarriage. However, there is no evidence that the presence of an IUD in a pregnant women increases the risk of a birth defect in the baby.
When To Call A Doctor
• Miss a period.
• Start showing early signs of pregnancy. Read about the early signs of pregnancy before a missed period.
• Suffer severe abdominal pain or tenderness.
• Start feeling pain during intercourse.
• Feel feverish or chilled.
• Develop any unusual vaginal discharge or bleeding.
Fact: Nearly 50 percent of women who have IUDs have them removed within 2 years of insertion.
How Are IUDS Removed?
An IUD can be removed at any time although it may be slightly easier to remove during your period when the cervix is softer. Removal is far quicker and less painful than insertion. Your doctor will use a type of tweezers to grasp the string and slowly pull out the IUD. The flexible arms of the device will fold up as it is pulled through the cervix. It is recommended to avoid sexual intercourse for one week before removing the device if pregnancy is not desired. Sperm can live inside the female body for up to 5 days, so if the device is removed an egg can still be fertilized and imbed in the womb.