What is “the IUD”?
The IUD is a small, plastic device that is inserted and left inside the uterus. Although there have been several types of IUDs, currently only two categories are available in the United States, either containing copper or progesterone. Both are T-shaped and have a string at the base of the T that will extend through the cervix and lie in the vagina. The string remains inside your body. You will not see the string, and you and your partner should not feel the string during intercourse. IUDs can be removed at any time if not tolerated or if you decide to get pregnant.
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Mirena, a hormonal IUD, releases a small amount of the progesterone called levonorgestrel into the uterus every day. The effect of the hormone thickens the mucous around the cervix preventing sperm from entering as well as slowing down the movement of sperm. Also the progesterone keeps the lining of the uterine wall very thin resulting in less overall menstrual bleeding. The FDA has also approved Mirena for the treatment of heavy uterine bleeding.
The Mirena is effective for 5 years, but can be removed at anytime prior to that to resume childbearing or if you are dissatisfied with it. After the 5 years are up, if you love it and still need birth control, we can remove the old one and replace it with a new one during one office visit.
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| Mirena IUD |
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For more information visit their website at
www. mirena-us.com
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Kyleena is simply a smaller version of Mirena. It was designed for women who have not had children yet. It is smaller. The uterus is smaller before we have children and the device is narrower making the insertion process a little easier. Just like Mirena, it is a hormonal IUD, releasing an even smaller amount of the progesterone called levonorgestrel into the uterus every day. It has the same effect of the hormone thickening the mucous around the cervix preventing sperm from entering as well as slowing down the movement of sperm. Also the progesterone keeps the lining of the uterine wall very thin resulting in less overall menstrual bleeding.
Kyleena is effective for 5 years, but can be removed at anytime prior to that to resume childbearing or if you are dissatisfied with it. After the 5 years are up, if you love it and still need birth control, we can remove the old one and replace it with a new one during one office visit.
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For more information visit their website at
www. kyleena-us.com
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Mirena
- 5 years
- 32 mm "wingspan"
- 4.8 mm diameter of inserter
- usually no period
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Kyleena
- 5 years
- 28 mm "wingspan"
- 3.8 mm diameter of inserter
- usually light period
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Paragard, the Copper IUD, releases a small amount of copper into the uterus. This IUD does NOT contain any hormones. The copper acts as an irritant and prevents conception. By interfering with the number and transport of sperm, it is difficult for the egg to move through the fallopian tube thus preventing conception also know as fertilization. IUDs do not prevent ovulation and do NOT cause abortion. The Copper IUD also contains NO hormones. It is effective for 10 years, but also can be removed at any time prior for childbearing or if you simply do not want to use it as birth control anymore.
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| Paragard IUD |
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For more information, visit their website at
www.paragard.com
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How effective is the IUD?
The IUD is extremely effective. During the first year of use, only 2 out of 1000 women will become pregnant with Mirena and during the 5-year period with Mirena, only 1 out of 100 will become pregnant. With the Copper T, 8 out of 1000 women will become pregnant with the first year of use.
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Am I a good candidate for the IUD?
The IUD is best suited for women who want convenient, effective, reversible contraception. Once it is placed neither you nor your partner will know it is there.
Traditionally, it had been recommended only for women who have at least one child, are in a stable, mutually faithful relationship. However, recently these recommendations have been extended to young women who have not yet had children but desire to in the furture. It is an excellent alternative to tubal ligation in a woman who wants effective birth control but does not want to undergo surgery. IUDs provide a long-term, highly effective, easily reversible form of birth control.
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It's not your mother's IUD!
In the 1970's, there was a particular IUD known as the Dalkon Shield. This IUD had a "multifilamentous" string. Our current IUDs all use a single filament string. The multiple fibers of the Dalkon Shield's string enabled bacteria to adhere to the string causing infection and often infected pregnancies leading to subsequent infertility. The medical-legal response was to remove all IUDs from the US market except for the Copper IUD, as it was deemed safe. IUDs were then only recommended to women who had at least one child (thus proved their fertility). And it was best for women in a "mutually faithful" relationship to minimize the chance of exposure to sexually transmitted diseases that might cause pelvic inflammatory disease and infertility. As well as women with no prior history or suspicion of pelvic infection.
However, over the past forty years, IUDs have been used safely in all women regardless of childbearing status in Europe, Asia and Latin America. Thus, the recommendations have been extended and we can now offer young women as well as mothers a reliable, long-term, reversible form of birth control.
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| Are there any reasons why I shouldn’t use the IUD?
The IUD is probably NOT a good choice for you if you have:
- recent history of pelvic infection (in previous 3 months)
- current sexually transmitted infection
- postpartum or postabortion sepsis
- unexplained abnormal vaginal bleeding
- genital tract malignancy
- uterine anomalies or fibroids that distort the uterine cavity
- allergy to copper (Copper T only)
- personal history of breast cancer (Mirena only)
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What are the common side effects of the IUD?
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Irregular bleeding. Bleeding problems constitute one of the more common IUD complications. Some women have cramping and spotting during the first few weeks after the IUD is placed. These should disappear within a month or so. The Copper T causes slightly crampier and longer menstrual periods. These symptoms can be treated with Motrin or Advil. Whereas Mirena will cause your period to be lighter and less crampy. For the first 3 to 6 months after Mirena is placed you may experience frequent spotting. A few women may have heavy or prolonged bleeding during this time. After your body adjusts, the number of days of bleeding is likely to decrease, and you may even find that your periods stop altogether.
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Pelvic infection. The risk of developing a pelvic infection associated with the IUD is attributable to insertion of the device and exposure to sexually transmitted infection. The greatest risk occurs during the first few weeks following insertion. Women who have more than one sexual partner or whose partner has other sexual partners are at high risk for acquiring a sexually transmitted disease.
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Expulsion. Between 2 and 10% of IUD users spontaneously expel their IUD within the first year. Expulsion, though infrequent, is more likely to occur during the first 3 months of use. An IUD expulsion can occur without a woman knowing it.
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Other side effects. Other side effects include lower abdominal pain, reported by 10% during the first 3 months. Side effects occurring in fewer than 5% of women include acne or other skin problems, back pain, breast tenderness, mood changes, and nausea.
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What are the benefits of the IUD?
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| Highly effective |
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| Easy to use |
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| Easily reversible |
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| No adverse effects on breast feeding |
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| Cost effective |
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| Comfortable |
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When can the IUD be inserted?
Ideally, the insertion should be scheduled within the first 5 days of your next menstrual period; this ensures that you are not pregnant at the time of insertion and the method is effective immediately for birth control.
Next best is any time during your cycle. In this case, we would do our best to rule out pregnancy (perform a pregnancy test) and then advise that you do not rely on it for birth control for the next 2 weeks (use a back-up such as condoms!)
The IUD can also be placed after giving birth, as soon as your uterus has returned to its normal pre-pregnancy state, usually 6-8 weeks postpartum. It can be determined whether you are ready for IUD insertion at your postpartum check.
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| Call the office the first business day of your period to schedule an appointment for insertion |
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| How is the IUD inserted?
You may be given some antibiotics to take prior to insertion to protect from infection. Also, taking 3-4 Motrin or Advil an hour prior to insertion will minimize the discomfort of the insertion. Insertion of the IUD does not require anesthesia and only takes a few minutes. Immediately before the IUD is inserted, you will be asked to sign a consent form making sure you understand everything about the insertion and a pregnancy test will be checked. To insert the IUD, the arms of the T-shaped device are folded and the IUD is placed in a long, slender, plastic tube. The tube is then inserted into the vagina and guided through the cervix into the uterus. The IUD is then pushed out of the plastic tube into the uterus and the tube is withdrawn. Each IUD comes with a string or “tail” made of a thin plastic thread. After insertion the thread is trimmed to the proper length.
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What are the risks of IUD insertion?
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How can I check that the IUD is in place?
You will be able to tell about the placement of the IUD by the location of the string. But do not pull on the strings. The string will not bother you, but your partner may feel it with his penis. If he reports discomfort, the string may be further trimmed. It is helpful to check the string each month (but you do not have to check.) To do this, you must insert a finger into your vagina and feel around for the string. You can do this at any time, but doing it after your menstrual period is easier to remember. If you feel the string is shorter or longer than it used to be—or if you don’t feel the string at all—call your doctor. The IUD may have slipped out of place. Use another form of birth control until your IUD is checked.
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How is the IUD removed?
Your IUD can be removed at anytime by your health care provider during an office visit by placing a surgical clamp on the string and pulling on the IUD out. You might have it removed because you are planning another pregnancy. Or at the end of the 5 year (Mirena) or 10 year (Copper T) period the IUD should be removed but a new IUD can be placed at the same time if you choose to continue the IUD. You may become pregnant as soon as your IUD is removed. About 8 out of 10 women who want to become pregnant will become pregnant some time in the first year after the IUD is removed. If you remove your IUD and you are not planning pregnancy then you need to use an alternative form of birth control immediately.
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| What if I become pregnant while using the IUD?
Although the IUD is very effective, no form of birth control (other than abstinence) is 100%. Call your health care provider right away if you think you are pregnant. If you get pregnant with the IUD in place, you may have an ectopic pregnancy. This means that the pregnancy is not in the uterus. Unusual vaginal bleeding or abdominal pain may be a sign of an ectopic pregnancy. An ectopic pregnancy can cause internal bleeding, infertility, and even death. There are also risks if you get pregnant while using the IUD and the pregnancy is inside the uterus. Severe infection, miscarriage, premature delivery, and even death can occur with pregnancies that continue with the IUD. In this case the IUD should be removed immediately.
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Are there any warning signs I should look for after the IUD is inserted?
Pain. Cramping along with dizziness and faintness may occur while the IUD is being inserted. Pain can be minimized by taking pain relievers such as Motrin, Advil, or Aleve prior to the procedure.
Pelvic infection. Infections in the uterus or fallopian tubes may occur after insertion. This may cause scarring in the reproductive organs, making it harder to become pregnant at a later date. This risk is increased when a woman has been exposed to sexually transmitted infections.
Uterine perforation. The IUD may perforate (or pierce) the wall of the uterus during insertion. Perforation may cause internal scarring, infection, or damage to other organs. This is very rare and occurs in about 2 out of every 1,000 insertions.
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Call your doctor if you have any of the following problems:
·severe abdominal pain
·pain during intercourse
·bleeding that occurs between periods or that lasts more than a few months
·bleeding or spotting after intercourse
·missed period or other signs of pregnancy
·unusual vaginal discharge
·a change in length or position of the string
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