Archive for June 25, 2010

The IUD 4 U! (An intro to the Intrauterine Device)

I think it’s time to introduce you, faithful reader, to the best contraceptive you’ve probably never used.  Yet.    

 An intrauterine device (IUD) is a small, flexible, “T”-shaped piece of plastic which is inserted into a woman’s uterus. Its job there is to prevent pregnancy. IUD’s are a very popular method of birth control throughout the world, but only 2% of women in the United States choose this method from among the many contraceptive choices we enjoy.    

There are two types of IUD approved by the FDA (the US Food and Drug Administration).    

The Mirena IUD is distinguished by its hormonal activity. The plastic in the device releases a small amount of levonorgestrel, which is a type of progesterone similar to those found in birth control pills. The amount of progesterone in the IUD is much much MUCH less than in a birth control pill. It only acts locally, on the uterus and cervix, as opposed to circulating around the body to be absorbed systemically.     

Mirena IUD

  

    

The progesterone in Mirena causes a number of changes in the uterus and cervix. First of all, it makes the cervical mucus thick and inhospitable to sperm. They can knock all they want, but they can’t get in. Sorry guys, you don’t have to go home but you can’t stay here.    

But your Mirena doesn’t stop there. It also affects the fallopian tubes. So, whereas the cells lining the fallopian tubes normally ferry the egg down toward the uterine cavity, these cells slow down under the influence of progesterone. The egg is delayed at the departure gate and never makes the flight to rendezvous with her awaiting sperm (assuming he somehow got past security). Honeymoon cancelled. No pregnancy.    

The lining of the uterus is also affected by progesterone. It thins out and becomes inhospitable to a pregnancy. So even if a fertilized egg were to arrive in the honeymoon suite, it would find a cruddy motel room it wouldn’t want to stay in anyway. This thinning of the uterine lining also has the added benefit of giving you shorter, lighter periods. Yay!    

The other kind of IUD is called Paragard. It does not contain ANY hormones. It has a copper coil around the shaft of the “T”. This coil slowly releases copper ions into the uterine cavity. This makes the womb inhospitable to both sperm and egg. It’s a toxic environment where fertilization is unlikely to occur and pregnancy can’t establish itself. Like your mother-in-law’s house.    

Paragard IUD

  

Both types of IUD have thin strings which pass through the cervix and allow the IUD to be easily checked (to see if it’s in place) or removed. A Mirena IUD lasts up to 5 years before it needs to be replaced. A Paragard lasts up to 10 years. Both can be removed anytime after placement if a woman changes her mind or if side effects (such as light bleeding between periods) are troublesome.     

On a serious note, I’d like to remind you that none of this represents an abortion.  If a fertilized egg never implants, it hasn’t established a pregnancy.  It passes with the next menstrual cycle.  You get a period.  Period.    

 So, why wouldn’t everyone want one of these?  Well, for starters, you can’t just pick one up at your local pharmacy. An IUD needs to be inserted in the uterus by a healthcare professional. This can be done during a woman’s peroid to minimize discomfort. It’s often easy to insert in a woman who has been pregnant in the past. It’s a little more tricky if a woman has never been pregnant, but obstacles can be overcome with a little medicine and proper counseling.    

The other reason an IUD requires careful consideration is that it’s not a great form of contraception in women who are not in a monogamous, trusting relationship. An IUD does not protect against sexually transmitted infections (but it doesn’t CAUSE them either). However, if you get a sexually transmitted infection, like gonorrhea or chlamydia, with an IUD in place, it can turn into a very serious medical condition called pelvic inflammatory disease. This may require hospitalization and DEFINITELY requires removal of your IUD.    

I think it’s also a good idea to address myths about the IUD.  The IUD does not cause ectopic (tubal) pregnancy.  A woman with an IUD in place is LESS likely to have an ectopic preganancy than either woman who is not using contraception or one using condoms.  However, in the unlikely event that a pregnancy occurs in woman who has an IUD in place, she needs prompt medical evaluation.      

A properly placed IUD is also very unlikely to ”slip out of place.”   Whereas an IUD can be lost (i.e. slip out of the uterus and into the vagina, from which it will inevitably fall out), it would be pretty obvious that your IUD isn’t protecting you anymore when it shows up in your panties or toilet.  If the IUD is put in place properly, it CAN NOT migrate up the uterus/tubes and into the abdominal/pelvic cavity.  But that’s why it’s important to have the IUD placed by a trained professional.    

In summary, an IUD is a great way to prevent pregnancy. They may be an especially good idea in women who have been pregnant in the past and are at minimal risk of contracting a sexually transmitted infection. They are placed by a healthcare provider and can stay in place for 5 to 10 years if desired.    

For more information, try this link to the American College of Obstetrics and Gynecology’s patient education materials on the intrauterine device.  Planned Parenthood also has a very informative site.    

And if you still have questions, you know who to ask!

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June 25, 2010 at 11:05 pm 25 comments


Linda M. Nicoll, MD

Welcome to my blog! Here you will find information about minimally invasive gynecologic surgery as well as some more general information about common gynecologic disorders such as endometriosis, ovarian cysts, fibroids, infertility, and pelvic pain.

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