All of the practitioners within our office frequently place IUD’s. They are now more commonly used and are generally well tolerated. We insert the IUDs with or without local anesthetic after cleansing the cervix (to reduce the chance of infection) with an Iodine based solution. Most women who have had vaginal deliveries tolerate the insertion very well even without local anesthetic because the cervix is slightly more dilated compared to women who have had cesarean sections or no prior deliveries at all. The actual insertion itself takes less than 15 seconds, and removal of the device when pregnancy is desired takes 1 second. You may experience some mild cramping following the procedure that Advil should treat very effectively.

Following are comments I’ve heard from many patients, and facts that will hopefully make you feel more comfortable with choosing an IUD for contraception:

I heard IUD’s were dangerous!

As you consider the possibility of choosing the intrauterine device for contraception, you should understand its history as well. The rise in popularity of the IUD has occurred in the face of great conflict. There have been many myths and misconceptions associated with today’s IUD. In the 1970s, an IUD called the Dalkon shield was manufactured and subsequently taken off the market due to its contribution to a huge increase in pelvic infections that sometimes resulted in permanent infertility. As it turned out, a manufacturing flaw caused these infections.

The Dalkon shield consisted of main circular part that rested in the uterus. Like most other IUD’s, a thread was attached to this main part. This “tail” ran through the cervix and protruded slightly into the vagina. The purpose of this thread was simply to provide a means of confirming its presence and to facilitate an easy removal. For this particular IUD, however, a braided multi-filament thread was used. This gave bacteria in the vagina an opportunity to “wick” (climb) up the thread in all of its cracks and crevices into the uterus. After this was discovered, the Dalkon shield was taken off the market, and all subsequent IUDs were manufactured with a monofilament thread. The monofilament tail prevents bacteria from gaining access into the intrauterine cavity, thus virtually eliminating the opportunity for developing an infection.

Doesn’t it work by causing abortion?

Previously it had been thought that the IUD worked by preventing implantation of fertilized eggs. Having studied this issue in depth, we now know that the mechanism of action of an IUD is almost completely spermicidal. The way this was discovered is very interesting. Researchers took a group of women desiring permanent sterilization by tubal ligation, and divided them into two groups. In one group, IUD’s were placed for a time prior to the surgical sterilization procedure. On the morning of their tubal ligation procedure, the women in both groups had “unprotected” intercourse. During the actual sterilization procedure, physicians irrigated the intrauterine cavity and the contents of the irrigant were studied microscopically. In addition, the contents within the resected segments of fallopian tubes were inspected microscopically, as well. What they discovered was interesting. In the group that did not have the IUD, they found living, motile (moving) sperm in both the uterine cavity irrigant and the fallopian tube segment, just as one would expect. In the group that did have the IUD, they found dead sperm in the uterine cavity irrigant, and NO sperm in the fallopian tube segment. Upon further research, they discovered that the device causes swelling in the endometrial cells lining the uterus. This sterile inflammatory reaction causes these cells to burst and release lysozymes, a spermicidal substance.

What about the risk of infection?

The risk of infection related to IUD use is most prominent within the first 20 days and usually associated with contamination during the insertion process. Following the first twenty days, the risk of infection is limited so long as patients who utilize this form of contraception are monogamous. In women with multiple sexual partners, it has been found that there is an increased risk of infection . As a result, we typically reserve the IUDs for women in stable, monogamous relationships.

What are side effects of the Two different IUDs?

Some side effects associated with the IUD depend on what type is used. There are currently two different IUD devices marketed in the U.S. One is made of inert copper and plastic, and the other is made of plastic and a silastic capsule containing a progesterone hormone called levonorgestrel. Both types of IUDs may cause cramping for a variable amount of time. The biggest distinction between the two is regarding the impact on menstrual bleeding. The copper & plastic IUD, or Paraguard device is associated with heavier bleeding during menstrual cycles. However, this should be put into perspective. If a woman has previously been on birth control pills (which generally lighten flow) and then uses the Paraguard IUD, she may note that her periods are heavier. In women who use other non-hormonal types of contraception, they may not notice such a dramatic increase in flow. The bleeding side effects may be offset, somewhat, by knowing that the Paraguard device may be used for up to 10 years. The Mirena IUD in contrast, is associated with up to a 90% reduction in menstrual flow. In fact, 20% of users will completely stop having periods. We now know that having menses very light or absent in this situation is not harmful. The Mirena, unlike the Paraguard, is effective for 5 years, at which time it should be replaced.

How effective is the IUD in preventing pregnancy?

The IUD method of birth control is as effective in preventing pregnancy as birth control pills when used correctly, or tubal ligation, or vasectomy. The Paraguard IUD is FDA-approved to remain in the uterus for up to ten years before removal is mandated. The Mirena is FDA-approved for 5 years before removal is recommended. As soon as the device is removed, conception can take place as soon as the sterile inflammatory response resolves which is usually very quickly (a few days to weeks).

The one drawback to the IUD is its expense. Insurance companies oftentimes will cover either the device or the insertion, although sometimes they cover both the device and the insertion and sometimes they cover neither one. The fee for both the device and insertion can range from $450.00 to $500.00. Compared to the cost of birth control pills, the IUD would pay for itself in approximately 13 to 14 months. We have found more recently that most insurance companies are paying for the device and insertion. Nevertheless, please call your insurance company and inquire whether they reimburse for this service. If you have any questions regarding the IUD, please call our office.

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