Intrauterine devices (IUDs) are one of the most effective forms of contraception from which a woman can choose. In fact, other than tubal ligation (having your tubes tied), there is not a more effective female birth control method than an IUD. In addition, an IUD can provide you with benefits, such as reversibility, long-term effectiveness, fewer side effects than other birth control methods and affordability. However, IUDs do not protect against sexually-transmitted diseases, and the devices can cause complications in very rare cases.
How do IUDs Work?
In the United States, two main types of IUDs are available; a copper IUD and a hormonal IUD. Both types have almost identical failure rates of less than 1%, meaning fewer than 1 in 100 women with an IUD will become pregnant. Both kinds of IUDs are small, T-shaped devices that are less than half the length of your index finger.
The copper IUD contains no hormones. Instead, the copper in the device produces an inflammatory response that kills both sperm and ova (eggs). A single copper IUD can stay in place and provide effective contraception for up to ten years after insertion.
On the other hand, the hormonal IUD slowly secretes the hormone progestin over time. This hormone release works to prevent pregnancy by either:
- Making you ovulate less often;
- Thickening the cervical mucus, which makes it harder for sperm to pass into your uterus; or
- Helping prevent sperm from binding to an egg.
There are several brand names of hormone-containing IUDs available in the US, all of which contain the same hormone, levonorgestrel, just in different quantities. The hormone-containing IUDs are effective for between three to six years depending on the amount of hormone contained in the IUD.
Is an IUD Right for Me?
Despite the convenience and affordability of IUDs, they are not the most popular form of female contraception. An IUD for contraception can be free or low-cost under most health insurance plans and Medicaid. Prices do vary depending on which type of IUD you select.
IUDs are considered to be one of the more convenient forms of birth control. It provides long-term yet reversible contraception and begins working immediately after insertion so it does not disrupt intimacy with your partner. In addition, unlike oral contraceptives, you do not have to remember to take a pill every day at the same time. Fertility also promptly returns after its discontinuation.
The Centers for Disease Control and Prevention (CDC) reports that more women use birth control pills or tubal ligations than IUDs. This fact may be because IUDs represent a “middle ground” between permanent surgical sterilization and more readily available contraception like birth control pills and condoms. Your IUD will certainly be removable, and the contraceptive effects reversible, but removal will require a trip to your OB-GYN’s office.
The majority of women who use IUDs are in long-term, monogamous relationships. However, IUDs can still be appropriate for women of other statuses. For example, the American College of Obstetricians and Gynecologists (ACOG) state that IUDs can be safe and effective birth control methods for adolescent females. However, having an IUD alone does not constitute safe sex for adolescents, since IUDs do not protect against STDs.
Most women can safely have an IUD, but barriers to IUD insertion include pregnancy, abnormal vaginal bleeding, an active pelvic infection, ongoing gynecologic cancer, or a misshapen uterus. Complications from IUDs are rare but can include:
- Lost IUD string: The IUD string is attached to the bottom of the IUD and hangs from the cervix to the vagina. On rare occasions, these strings can actually get inside the uterus and become lost. This is known as “nonvisualized strings.” If this happens, your healthcare provider will need to locate it during an exam, X-ray or ultrasound appointment.
- Expulsion: This occurs when the IUD has worked itself out from where it was originally inserted (at the top of the uterus). This is a rare complication that occurs in 2-3% of women using an IUD for birth control. To ensure the IUD has not gone through partial or complete expulsion, it is recommended that women check the IUD string to make sure it has not moved. Oftentimes, if an expulsion occurs, a woman may not know or sense that the IUD has moved.
Ectopic pregnancy is not more common with the IUD as compared to other methods of contraception. However, in the extremely unlikely event that you become pregnant with an IUD in place, you would have an elevated risk of ectopic pregnancy.
What to Expect During and After IUD Insertion
After you have been evaluated and approved for an IUD, the in-office procedure is scheduled. The “intrauterine” in an intrauterine device means that the device needs to be placed inside your uterus. This method is done through your vagina. No surgery is necessary, and the procedure is performed at Dr. Garofalo’s office.
We recommend trying to eat a little something on the day of your procedure to prevent lightheadedness. Also, speak with Dr. Garofalo about possibly taking some over-the-counter pain relievers for any soreness before your IUD insertion.
On the whole, the procedure itself will feel very similar to a pelvic exam, and it takes less than fifteen minutes to complete. Just like a pelvic exam, the doctor uses a speculum to see your cervix and then inserts the IUD with an applicator. A string attached to the IUD projects through the cervix into the upper vagina allowing for easy removal and as an indicator that the IUD is in the proper position.
Mild cramps and discomfort that may occur for a few days after IUD placement should respond to over-the-counter medications like ibuprofen. Depending on the type of IUD you received, you may also notice light and infrequent periods (with hormone-containing IUDs) or heavier and more colicky menstrual periods (with the copper IUD). You will need to wait a full 24 hours after IUD insertion before using a tampon, having sex or inserting anything into your vagina.
Our office will provide you with complete aftercare instructions, including methods to manage discomfort and what to do if problems appear. Always feel free to contact us with any questions or concerns post-IUD procedure.
About the Connecticut OBGYN Practice
Dr. John Garofalo, M.D., is a CT OBGYN based in Fairfield County, providing care for Norwalk, Darien, New Canaan, Weston, Rowayton and the surrounding areas. He has more than 20 years of practice and surgical experience covering many facets of obstetrics and gynecology.
Laury Berkwitt, APRN, is a nurse practitioner specializing in women’s health in Fairfield County, Connecticut. Women undergoing signs and symptoms of menopause can make an appointment with Laury for Hormone Replacement Therapy. Laury has a passion for providing quality women’s health care in a safe and comfortable manner by creating a trusting patient-practitioner relationship. She has been in practice for more than 10 years, caring for women of all ages.