Frequent Questions about IUDs (Intrauterine Devices)
Many women would like to find a method of birth control that they do not have to think about every day or even monthly. An IUD (intrauterine device) may sometimes be referred to as an IUC (intrauterine contraception). IUDs are small plastic devices shaped like Ts that are placed within the uterus. An IUD can provide effective birth control for up to 5 or 10 years. And yet, it is usually quick and easy to remove an IUD when pregnancy is desired.
What are my choices of IUDs?
The two commonly used IUD in the US are Mirena and ParaGard. Each of these IUDs has different benefits. A comparison table is shown below.
Mirena contains levonorgestrel (a type of progesterone) in the neck of the T shape. This hormone is slowly released over 5 years which cause the lining of the uterus to become thin. It is thought that Mirena prevents pregnancy by thickening the mucus covering the cervix to slow or prevent entrance of sperm in to the uterus. The thinning of the uterine lining (or endometrium) also disrupts implantation.
Because the progesterone thins the endometrium, during the first 3 to 6 months of Mirena a woman may experience irregular bleeding or spotting. Once the thinning has been completed, a woman usually has very light to no period. Mirena has also been approved by the FDA as a treatment for heavy period.
ParaGard contains no hormones. Copper wire surrounds both the neck and two top sides of the T shape. It is thought that ParaGard works by slowing sperm motility to prevent it from reaching the egg. It may also irritate the uterine lining to prevent egg implantation.
Do IUDs prevent sexually transmitted infections?
No. It is important to note that IUDs do not prevent transmission of STIs (sexually transmitted infections). Therefore, it is important for women to continue safe sex practices and condom use.
How are IUDs placed?
An IUD is placed during an office visit by your healthcare provider. It is easiest to insert an IUD when a woman is on her period. This is because the cervix or opening of the uterus is slightly dilated during this time. The actual insertion time is usually about five minutes from start to finish.
Can I still use tampons?
Yes, there is no need to stop using tampons.
Can it be felt during sex?
You should not be able to feel the IUD during sex. Sometimes partners have been able to feel the strings. If this is bothersome, it may be possible to trim your IUD strings shorter. Call your healthcare provider.
How do I know it is in the right place?
You should check for the strings each month after your period. With clean hands, place 1 or 2 fingers into your vagina to feel for the strings. Some women have their sex partner check for them.
What if I don’t feel the strings?
Call your healthcare provider. Sometimes the strings will move making them difficult to feel. Your healthcare provider can look for the strings and/or order an ultrasound to check the placement of the IUD.
Can an IUD move or fall out?
Although it is not common, it is possible for an IUD to migrate or be expelled by the uterus. Migration occurs if the IUD moves out of the uterus and into the pelvic or abdominal cavity. Thankfully, this does not happen often. If the IUD has migrated, it may be necessary to remove the IUD with laprascopic or open incision surgery. If the IUD falls out, call your healthcare provider to discuss replacement or other birth control options.
What are the risks of IUD insertion?
Infection, expulsion, embedment and uterine perforation.
o Infection is most commonly cause by STIs. If undetected, these can progress to PID (pelvic inflammatory disease). Infections may also occur during the placement of the IUD. During insertion, the cervix is cleansed to reduce the risk of uterine infection. If you experience any pelvic pain or foul smelling discharge, call your healthcare provider.
o Expulsion occurs when the uterus pushes the IUD out through the vagina. If this occurs, call your healthcare provider to discuss birth control options and use condoms until a new birth control choice has been established.
o Embedment occurs when the IUD becomes attached to the uterine wall making it difficulty to remove. If this occurs, it may be necessary to surgically remove the IUD.
o Uterine perforation may refers to a break in the uterine wall and may occur during insertion. If this happens, the IUD may migrate out of the uterus into the pelvic or abdominal cavity. It will be surgically necessary to remove the IUD.
It should be noted that the above side effects can occur but not on a regular basis.
Who should get an IUD?
o Women that are in a monogamous (1 partner) relationship.
o Women that desire long term birth control or non-hormonal birth control.
o Women that desire treatment for heavy periods.
o It is easier to place an IUD in a woman that has had prior vaginal deliveries. However, it may still be possible to perform an IUD insertion if you have not had children before.
Who should not get an IUD?
o Women who are pregnant or want to become pregnant.
o Women in early postpartum stage (6-12 weeks).
o Women with current sexually transmitted infections or at risk for infections.
o Women with suppressed immune systems (i.e. HIV, leukemia).
o Women with unexplained pelvic pain or abnormal bleeding.
Speak with your healthcare provider about your personal risks, benefits and options.