Intrauterine devices (IUDs)

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Intrauterine device
Intrauterine devices (IUDs) are among the most commonly used and
safest contraceptive devices worldwide. They were used extensively
in the United States until the 1980s, when a significant number of
pelvic infections were observed in women using a specific IUD called
the Dalkon Shield. The tail of that particular device was designed
in a way that increased the risk of infection. This led to a
rejection of all IUDs by women and their doctors. But other IUDs
were actually safe then and remain safe and effective today, as
demonstrated by extensive research.

Two IUDs are available in the United States:
Copper (ParaGard)
Hormonal (Mirena)

Copper IUD
The copper IUD (ParaGard) is a T-shaped plastic frame with two
threads attached. It's inserted into the uterus to prevent
pregnancy. Once in place, it inhibits fertilization, as the IUD
impedes the sperm's journey to the fallopian tubes. If fertilization
occurs, the device prevents the embryo from attaching to the uterine
wall. ParaGard also slowly releases copper, which inactivates the
sperm in the cervical mucus.

Named after the contraceptive substance released, the copper IUD is
highly effective at preventing pregnancy.

Effectiveness rate. The effectiveness rate for the copper IUD is
between 99.2 percent and 99.4 percent, meaning that six to eight
women out of 1,000 who use it for one year will get pregnant. The
copper IUD may remain in place for up to 10 years.

Side effects and health risks. Common side effects associated with
the copper IUD are increased vaginal bleeding and menstrual pain.
Taking nonsteroidal anti-inflammatory drugs (Advil, Motrin, others)
helps with these symptoms. Some women may also experience a pelvic
infection within the first three weeks of placement, as the
insertion process may introduce bacteria into the uterus. Your
doctor may prescribe antibiotics before insertion to reduce the risk
of such infections. The copper IUD doesn't protect against STDs.
IUDs also carry a risk of spontaneous expulsion - which leaves you
unprotected against pregnancy - or piercing (perforation) of the
uterine wall during insertion.

How to use the copper IUD. If you decide on the copper IUD, your
doctor will insert the device and give you information on its use.
When ParaGard needs to be removed, your doctor gently withdraws it
by pulling on the IUD string. In rare instances the strings on the
device may break, making IUD removal a more complicated procedure.
After removal, normal fertility returns promptly.

Cost and availability. The copper IUD costs $200 to $300 every ten
years plus the cost of an office visit for insertion and a follow-up
appointment.

Hormonal IUD
The hormonal IUD (Mirena) is a T-shaped plastic frame with thread
attached. The IUD is inserted into the uterus to prevent pregnancy.
Once in place, it inhibits fertilization, as the IUD impedes the
sperm's journey to the fallopian tubes. If fertilization occurs, the
device prevents the embryo from attaching to the uterine wall. The
hormonal IUD also releases progestin, which inhibits sperm mobility
and makes the uterus unsuitable for a pregnancy.

Effectiveness rate. The effectiveness rate for Mirena is 99.9
percent, so one woman out of 1,000 using the device for one year
will get pregnant. Mirena must be replaced every five years.

Side effects and health risks. Unlike the copper IUD, the hormonal
IUD decreases the amount of menstrual blood flow and menstrual
cramping. The major side effect of hormonal IUD use is abnormal
vaginal bleeding. Some women have unpredictable, light menstrual
flow, while many may have no flow at all. Some users may experience
a pelvic infection within the first three weeks of placement, as the
insertion process can introduce bacteria into the uterus. Your
doctor may prescribe antibiotics before insertion to reduce the risk
of such infections. Hormonal IUDs don't protect against STDs. IUDs
also carry a risk of spontaneous expulsion - which leaves you
unprotected against pregnancy - or piercing (perforation) of the
uterine wall during insertion.

How to use the hormonal IUD. If you and your doctor decide on the
hormonal IUD, he or she inserts the device and gives you information
on its use. When the IUD needs to be removed, your doctor gently
withdraws it by pulling on the IUD string. In rare instances, the
device may need to be removed surgically. After removal, normal
fertility returns promptly.

Cost and availability. Mirena costs between $300 and $400 every five
years plus the cost of an office visit for insertion and a follow-up
appointment.

Pros and cons
The IUD is a long-lasting, safe and reversible means of birth
control, yet there are downsides. To help you decide if it's right
for you, keep the following points in mind:

Pros
* The IUD is highly effective.
* Women who are breast-feeding can use an IUD.
* It is easy to use and is cost-effective if used for its full term
of effectiveness.

Cons
*Placement of an IUD carries a small risk of pelvic infection during
the first few weeks after device insertion.
*In rare circumstances, the device is spontaneously expelled.
*It offers no protection against STDs, including HIV.
* It's expensive if used for only a short time.