 
What is an IUD?
An Intrauterine Device (IUD) is a small object that is inserted through the cervix and placed in the uterus to prevent pregnancy. A small string hangs down from the IUD into the upper part of the vagina. The IUD is not noticeable during intercourse. IUDs can last 1-10 years. They work by changing the the the lining of the uterus and fallopian tubes affecting the movements of eggs and sperm and so that fertilization does not occur. IUDs are 99.2-99.9% effective as birth control. They do not protect against sexually transmitted infections, including HIV/AIDS.
Use • Cautions • Side Effects • Future Fertility
Advantages • Disadvantages • Emergency
Contraception
Your Cervix • PDF
Version
Use
Getting
an IUD involves a clinic visit. To prevent infection, clinics require women to
have check-ups prior to insertion. This can include a full medical, pelvic, and
breast exam, with a Pap smear, STI check, and
pregnancy test. If anything unusual is found, it is addressed before the IUD is
inserted. After insertion, an IUD is effective immediately.
Insertion:
An IUD is usually inserted during a menstrual
period when the cervix is slightly open and pregnancy is least likely. It
may be inserted at any time, however. The procedure for insertion takes about
5-15 minutes. Most women feel cramping during and after insertion. Ibuprofen can
help relieve cramping.
Awareness:
You can keep track of your IUD by checking its strings. You
can feel for the string by putting a finger into your vagina. Some women prefer
to look at the string using a speculum, mirror,
and flashlight.
It is recommended that women check their IUD after each
period. A shorter than normal string can be a warning sign of an imbedded IUD.
Missing strings may mean that the IUD was expelled. If the string is missing,
call the clinic and use a backup method of birth control.
If you miss a
period while on an IUD, you may want to take a pregnancy test. If you have any
concerns about your IUD, call the clinic.
If you have any concerns about your IUD, call the clinic where you got it.
The longer the IUD remains in place,
the less likely it is that the uterus will reject the IUD and expel it.
Removal:
An IUD can be removed at any time and the procedure is quicker
and easier than insertion. If it is removed near ovulation, a woman may become
pregnant from recent intercourse before IUD removal.
Types
of IUDs
There are two types of IUDs available: ParaGard
and Mirena. The ParaGard has a tiny copper wire wrapped around the plastic body
and should not be used by anyone who is allergic to copper. The Mirena releases
small amounts of a synthetic progesterone hormone. The hormone was added to attempt to decrease the bleeding and cramping that some women have with the IUD.
Every
woman is different and IUDs are not recommended for all women. Due to the risk
of serious health problems, women with the following conditions should not use
IUDs:
- Recent or repeated pelvic infection
- Known or suspected
pregnancy
- Severe cervicitis
- Salpingitis
- Malignant lesions
in the genital tract
- Unexplained vaginal bleeding
- HIV/AIDS
- History
of ectopic pregnancy
- History of Toxic Shock Syndrome
- Physical
inability to check IUD
IUDs are not recommended for women who are
at risk for PID (Pelvic Inflammatory Disease), have lower immune response, abnormal pap smear, heart disease,
anemia, a history of severe menstrual cramping and heavy flow, a history of ectopic
pregnancy, or previous problems with an IUD.
Copper IUDs are not recommended
for women with Wilson's disease or allergies to copper.
- Women with a history
of breast cancer cannot use the Mirena IUD.
- Women with diabetes should be monitored
carefully if they use the Mirena IUD.
- Breastfeeding women should be aware the
synthetic hormone in the Mirena IUD will be passed to the baby in her breast milk.
Health
Risks:
Getting any vaginal infection while using an
IUD can increase the risk of developing a serious pelvic infection. This can result
in a loss of fertility. For this reason, women need to assess their own risk for
infection. If you have multiple partners or if your partner has multiple partners,
your chance of infection is much higher.
Piercing or perforation of the
uterine wall may occur during insertion of the IUD. Over time, an IUD may become
imbedded in the uterine wall. An Imbedded IUD is still effective, but it can be
painful and may need to be removed. There is a risk of surgery and/or sterility
if an IUD becomes imbedded.
If a woman becomes pregnant while using an
IUD, it is highly recommended that she have the IUD removed, whether or not she
wants to carry the pregnancy to term. An IUD increases the risk of having a miscarriage
or premature birth.
A woman who becomes pregnant while using an IUD is
also more likely to have an ectopic pregnancy. An ectopic pregnancy occurs when
a fertilized egg attaches and grows outside the uterus. This can be very dangerous
and requires emergency medical attention.
Both the ParaGard and the
Mirena IUDs can cause longer, heavier, and more painful menstrual periods, but
this is much less common with the Mirena. The increased blood flow may cause anemia.
Spotting may occur without serious cause or as a sign of infection.
The
Mirena IUD can cause ovarian cysts. Some women using the Mirena stop bleeding
altogether. Usually their menstrual periods return when the IUD is removed. Mirena
can cause weight gain, headaches, increased blood pressure, acne, depression,
and decrease in sex drive.
Future Fertility
Women who want to become pregnant
may have their IUD removed at any time. While most women who stop using IUDs are
able to become pregnant, IUDs can have negative effects on a woman's fertility.
If perforation, embedding, or pelvic infection occurs, the uterus or tubes may
become damaged and lower the chance of pregnancy. In cases of severe damage or
infection of the uterus, a hysterectomy (removal of the uterus) may be required,
resulting in permanent sterility. The synthetic hormone in the Mirena IUD can
cause a delay in return of menstruation and fertility after it is removed.
- Allows sexual spontaneity.
- Requires
no daily attention.
- Immediately effective.
- Long-lasting.
- Not
messy.
Disadvantages
- Does not protect against sexually transmitted infections,
including HIV/AIDS.
- Insertion and removal require clinic visits.
- Can
be expelled.
- Can cause more difficult menstrual periods.
- Possible
risk to future fertility.
Emergency Contraception
You can prevent pregnancy
after unprotected intercourse by having a copper IUD inserted. Within one week
of unprotected intercourse, copper IUDs can be used as Emergency Contraception.
The
cervix is the opening to the uterus where menstrual blood, babies, and sperm pass.
It is the opening through which abortions are performed. IUDs are inserted through
the cervix into the uterus.
Barrier methods of birth control, including
the cervical cap, diaphragm,
and female condom, work by covering the cervix
and preventing sperm from entering the uterus. Hormonal methods of birth control,
including oral contraceptives, Norplant, and Depo Provera affect the mucus around the
cervix and make the opening more resistant to sperm.
Women's bodies also
naturally produce hormones that change the cervix during a menstrual cycle. You
can learn more about your cervix using a speculum to perform a self-exam.
Further
References
March 3, 2008
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