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Intrauterine Device (IUD): Dispelling the myths and answering common questions

“In the past, I heard that IUDs weren’t safe. Now I’m hearing more women talking about IUDs. Can you tell me a little about the newer IUDs? Are they safe? How do they work? Am I a good candidate to use an IUD?”


  1. Myth: IUDs are not safe

    Fact: Almost 160 million women across the globe (15% of all child-bearing age women) successfully use an intrauterine contraceptive with few complications.

    IUDs were first introduced in the 1920’s. Fear about the safety of IUDs is a more recent phenomena, traced back to an IUD used in the 1970’s called the Dalkon Shield. Due to higher rates of infection and complications with this one particular model of IUD, the popularity of this form of contraception declined in the United States. In 1970, approximately 10% of all American women using contraception used IUDs. By 1988, this rate had dropped to about 2%. 1

    Another contributing factor to the decline in popularity of IUDs in the U.S. was a misconception about how IUDs work (discussed next). This decline in use, however, was in contrast to the IUD’s popularity worldwide. Today it is estimated that approximately 160 million women use an intrauterine contraceptive device successfully and with few complications.3

  2. MYTH: IUDs work as an abortifacient… (i.e., conception occurs)
  3. Fact: IUDs prevent conception

    Early in the development of the IUD, its mechanism of action was not well understood. Developers of the older devices believed that the IUD prevented implantation of a fertilized egg or that it dislodged the recently implanted fertilized egg. It was believed to work as an “abortifacient.” It is now known that IUDs DO NOT function in this capacity.1,2

    While mechanism of action may vary somewhat depending on the model used, in general it is understood that:
    1. IUDs help to modify cervical mucus retarding the mobility and function of sperm.
    2. IUD models with progesterone also may prevent ovulation or slow the transport of the egg if it is released and cause some changes to the uterine lining.
    3. IUD models with copper may also interfere with sperm transport and/or work as a spermicide, decreasing the number of viable sperm.

  4. MYTH: IUDs are not very effective at preventing pregnancy

    FACT: IUDs are over 99% effective at preventing pregnancy. The prevention rate is comparable to surgical sterilization.

    METHOD - EFFECTIVENESS*
    Male condom 85%
    Female condom 79%
    Spermicide 71%
    Mirena IUD (5 year) 99.9%
    ParaGuard IUD (10 year) 99.2%
    Depo-Provera (“the shot”) 97%
    Oral Contraceptives (“the pill”) 92%
    Male Sterilization 99.85%
    Female Sterilization 99.5%

    *Within the first year of use; among typical couples who initiate use of a method, the percentage who do not experience an accidental pregnancy. 2

Answers to Common Questions about IUDs

  1. What is the IUD?
    The IUD is a small, flexible plastic T-shaped device. It is placed in the uterus to prevent pregnancy. It is placed by your midwife or doctor during an office visit. The 2 models of IUDs used most often are the Mirena IUD, which delivers progesterone locally to the uterus and is effective for 5 years; and the ParaGuard IUD, a copper intrauterine contraceptive that is effective for 10 years. While both IUDs are effective for long periods of time, they are easily reversible. If you desire to get pregnant any time after having an IUD placed, simply make an office appointment and the IUD can be easily removed. As with any hormonal method of contraception, return to ovulation may vary among women.

  2. Which women are good candidates for an IUD?
    • Women who have never experienced pelvic infection
    • Women who are sexually active with one partner
    • Women who have had a baby
    • Women who desire long-term birth control but do not wish for permanent sterilization
    • Women who cannot tolerate estrogen containing products
    • Women who are breastfeeding
      Before insertion, you will have an exam to determine if an IUD is right for you.
  3. What are the risks?
    While complications are rare, two that may occur are injury to the uterus during insertion and infection.

    Anytime an instrument is placed through the cervix and into the uterus, there is a risk of tearing or perforation of the uterus. In practice however, this is a minimal risk. IUDs are inserted during an office visit and the procedure usually takes about 15 – 20 minutes. Some women experience cramping during or immediately after the procedure. You can take ibuprofen and use a heating pad on the abdomen to ease the cramps.

    Anytime a foreign object is placed in the body there is an increased risk of infection. To minimize this risk, your provider will test you for vaginal infections prior to insertion of the IUD. Strict sterile technique also minimizes this risk. The risk for infection is greatest during the first 20 days following insertion after which the risk drops dramatically.

    It is important to note that IUDs do not protect a woman against sexually transmitted infections. If a woman has an IUD in place and is exposed to a sexually transmitted infection she is at risk for having a more dramatic infection. Therefore it is important for women who choose to use an IUD to practice safe sex.


  4. What are some benefits of having an IUD?
    • Long-term contraception
    • Low maintenance/ allows for spontaneity
    • Mirena users have a 90% reduction in menstrual bleeding. About 20% of users have no bleeding at all
    • ParaGuard is hormone-free, for women who either cannot tolerate or do not wish to use a hormonal contraceptive
    • Both methods are safe to use during breastfeeding and do not interfere with milk production
    • Over time, provides the most cost-effective contraception

Resources:

  1. Kimble-Haas S, The Intrauterine Device: Dispelling Myths, The Nurse Practitioner, vol. 23, No.11, pg 64, 1998
  2. Hatcher RA, Contraceptive Technology, 17th revised edition, NY, NY: ardent media 1998
  3. Patient information booklet, Mirena IUD, Berlex Laboratories, 2003
  4. Patient information booklet, ParaGuard IUD, Ortho-McNeil Pharmaceutical, inc, 2002