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

June 25, 2010 at 11:05 pm 24 comments

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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Progesterone In Your Pill: If the shoe fits, wear it! Whose advice are you taking anyway?

24 Comments Add your own

  • 1. bloomie  |  June 26, 2010 at 3:23 pm

    I’ve been considering an IUD for years as just back-up but there’s so much competing information out there and some gyno’s don’t even know about it or won’t insert it if you’ve never had children.

    You should send this along to Jezebel. They blog about IUD’s all the time.

    Reply
    • 2. drnicoll  |  June 27, 2010 at 5:40 am

      Thanks for the comment, Bloomie! Being knowledgable about your body and your contraceptive options is very empowering. And it’s important to have a doctor with whom you feel comfortable discussing your needs and expectations. But remember, every doctor has a different background and training. Some may be more or less comfortable with offering IUD’s to patients who have never been pregnant. If you have a good relationship with your healthcare provider, my best advice is to talk to him or her about the reasons why an IUD may be right or wrong for you. And remember you can always ask your doctor if they know someone who might be willing to offer a service which they don’t provide.

      Following your suggestion, I checked out the Jezebel.com site. I found the article about one patient’s experience with IUD insertion an interesting read (though I can’t endorse it as it is not quite medically accurate and I can’t speak to whether it is a particularly representative patient account). Nevertheless, I’ve included a link to the article if anyone else wants to take a look at it.

      Best regards,
      Dr Nicoll

      Reply
  • 3. Ann  |  October 5, 2010 at 1:49 pm

    Is there ANY association of weight gain with an IUD?? I have had mine for 2 1/2 months and feel very bloated in addition to a 10 lb. weight gain.

    Help!

    Reply
    • 4. drnicoll  |  October 19, 2010 at 6:06 pm

      Hi Ann,
      No, there isn’t an association between the IUD itself and weight gain. However, progesterone (in the Mirena IUD) may cause weight gain or bloating, as some people experience when they start or stop other kinds of hormonal contraception (the Pill, Nuvaring or the Patch). But the amount of progesterone in the Mirena IUD is very small and only locally (on the uterus) so it should not cause a large or sustained change in weight. The Paragard IUD doesn’t have any hormones at all. Even if the change was due to fluctuations in your hormones, 10 pounds may be more weight gain than would be expected from hormonal alteration alone.

      Other factors may be related to discontinuing whatever contraceptive (if any) you were using prior to the IUD. Childbirth, stress and other lifestyle factors can similarly cause weight gain especially when they usher in a change in diet or exercise patterns. You may want to take a look at what else is going on in your life to trace the origins of your recent weight gain. Then you’ll have the best chance of reversing it.

      Good luck!
      -Dr. Nicoll

      Reply
  • 5. Richard Semel  |  December 8, 2010 at 4:29 am

    Dr. Nicoll,

    I know you’ve already answered this question, but maybe you can give me a little clarification. My 20 year old daughter is in a monogomous sexually active relationship. She is currently on one of the low dose bcps, as well as condoms. We discussed her changing to an iud, which I like, because of the lower dose or no dose of hormones. She was interested and then said no she heard/read some negatives on th iud. Can you help?

    Reply
    • 6. drnicoll  |  December 10, 2010 at 3:07 am

      Hi Richard,
      IUD’s in genreral get a bad rap. But there are some valid concerns which must be considered if a woman is considering using one. While an IUD will not cause infection or pelvic inflammatory disease, contracting such an infection with an IUD in place can cause serious complications (as the IUD is a foreign body). A patient who gets pregnant with an IUD in place can also face a higher rate of ectopic pregnancy and miscarriage (although the chance of pregnancy with an IUD in place is exceedingly low).

      Other considerations with an IUD include pain during the insertion process (which can usually be managed with medications in an office setting), risk of injury to the uterus during insertion, midcycle spotting (which can be inconvenient), and loss of the menstrual cycle (which some women dislike, but which reverses when the IUD is removed). Some women are also turned off by the cost (which may or may not be covered by insurance) or by the idea of retaining a foreign body in the uterus.

      Many healthcare providers are also leery of placing an IUD in the uterus of a woman who has never been pregnant. The Copper IUD (Paragard) is approved for use in women who have never conceived (and many providers use the Progesterone IUD [Mirena] in these patients as well). Nevertheless, there are some healthcare providers who are (quite reasonably) hesitant. Concerns about infection, perforation, and patient discomfort are heightened by the fear that, if a patient experiences difficulty getting pregnant in the future, the IUD and/or the doctor may be blamed.

      There are also some noncontraceptive plus sides to low dose oral contraceptives. They may provide relief from menstrual cramps, heavy menses, and PMS symptoms. Taking a pill every day is easy. A woman can stop taking it or change her prescription at any time (with the help of her provider). Getting an IUD represents more of a commitment and can be a big step for a young woman to take.

      My suggestion is that you talk to your daughter. Make sure she has a healthcare provider who can be a source of good information (as opposed to the nightmares and horror stories many young people read on blogs). Then, hopefully, trust her to make smart, healthy choices for her body.

      I hope this was helpful!
      -Dr. N

      Reply
      • 7. Richard Semel  |  December 10, 2010 at 4:39 pm

        Dr. N

        Thank you for your quick response and thorough answer. I can see there is a bit more to think about. It is unfortuante that it is so difficult to find this complete information. One last thing. Are there any downsides to the daily low dose bcps?

      • 8. drnicoll  |  March 24, 2011 at 10:33 pm

        Hi Richard,
        There are many benefits to daily low-dose birth control pills. These include pregnancy prevention, predictable periods, reduced discomfort during menses, and (with prolonged use) a decrease in lifetime risk of ovarian and endometrial cancer in some patients. There is no known increase in risk of breast or other cancers. All birth control pills, including low dose pills, increase the risk of blood clots, heart disease, and cardiovascular disease. This is especially true in smokers over age 35. A quick review of the package insert of any new medication would reveal other possible side effects and risks. In most young women, the risks are relatively small and do not outweigh the benefit of reliable contraception. A discussion with your daughter’s OB/Gyn provider might provide further clarification and would potentially address specific concerns related to her medical history.
        Hope that helps!
        -Dr. N

  • 9. 2010 in review « The Gynecologist  |  January 3, 2011 at 12:22 am

    […] The IUD 4 U! (An intro to the Intrauterine Device) June 2010 7 comments 4 […]

    Reply
  • 10. Therese  |  March 23, 2011 at 8:43 pm

    I have a question, as a thirty year old with a history of migraines I have been told to try out non-estrogen birth control. Do these qualify? Also, I recently started taking Lamictal which is said to interact with birth control, would this be an option??

    Reply
    • 11. drnicoll  |  March 24, 2011 at 10:19 pm

      Hi Therese,
      The Mirena IUD contains progesterone. It does not contain estrogen. The Paragard IUD contains copper. It contains no hormones. Either could be appropriate for use in a patient who could not tolerate estrogen. Because both IUD’s act locally (on the uterus) for pregnancy prevention, neither is rendered less effective by the use of Lamictal.
      I hope that answers your question. However, I strongly encourage you to discuss any potential interventions or medications with your physician.
      Best of luck!
      -Dr. N

      Reply
  • 12. Therese  |  March 29, 2011 at 1:54 am

    Thank you!!

    Reply
  • 13. Nancy  |  August 1, 2011 at 7:52 pm

    What happens at the end of 10 years with the ParaGard IUD? Does the copper slowly stop releasing, leaving you vulnerable to pregnancy?

    Reply
    • 14. drnicoll  |  August 18, 2011 at 6:36 am

      Hi Nancy,
      The ParaGard IUD hasn’t been studied for efficacy at more than 10 years. Although the presence of any foreign body in the uterus does tend to render it hostile to pregnancy, I would never count on this (or any other) device for protection beyond the period for which use is recommended.
      -Dr. N

      Reply
  • 15. lewis  |  December 17, 2011 at 7:31 pm

    all your very interesting site with respect to gynecology

    Reply
  • 16. Katrina Fletcher  |  February 5, 2012 at 2:14 am

    Hello I had the paraguard for 5 years,got it remove 8 mths ago i got pregnant 2 months after removal had a blighten ovum,then got pregnant again 5 months later had a miscarriage is it possible my uterine lining is still to thin.

    Reply
    • 17. drnicoll  |  February 22, 2012 at 6:37 pm

      Hi Katrina,
      I do not dispense individual medical advice on my blog. This is something you need to discuss with your doctor. Wishing you the best of health,
      Dr. N

      Reply
  • 18. Shalina  |  February 21, 2012 at 1:50 pm

    I am a mom of a sixteen year old that has just become sexually active with her committed boyfriend. They are using condoms with sperm aside. I need some advice in helping her chose a better BC option. We considered the pill because she has acne trouble and terrible mood swings with her period. But now that I have read up on these two IUDS, I am wondering which one would be best for her. I could never take estrogen based bc pills they made me very sick. Only progesterone worked for me. So I am thinking she will be the same way, since all of our female family members are unable to take estrogen. First, which hormone helps with acne? Second, do you have a preference, from the two choices of IUD’s, for a young girl who has never had a child, miscarriage or abortion. Also, she suffers from a mood disorder and takes these medications. Vyvance 20 ml , Abilify, 5 ml day, and Zoloft 25 ml per day. Please give me your professional advice. Thank you

    Reply
    • 19. drnicoll  |  February 22, 2012 at 6:34 pm

      Hi Shalina,
      Again, I want to emphasize that I do not dispense individual medical advice through my blog. It’s an imperative to good medical care that your daughter see a healthcare provider (in person!) to guide her in choosing the best contraceptive method for her. She may wish to discuss this with her pediatrician, a doctor she knows well and hopefully trusts.

      If she needs a gynecologist, you can ask her doctor for a recommendation or you can take her to see your doctor. But remember, because she’s 16 and this visit will pertain to contraceptvies, you may be asked to wait outside so as to allow your daughter and her provider to abide by health information privacy laws (which vary locally).

      That being said, let me give you a little more information about IUD’s as it pertains to your question. Although oral contraceptives are used to treat acne, this is not a benefit of the progesterone-containing IUD (Mirena). That’s because the progesterone in an IUD is absorbed locally, by the reproductive organs, and only a very small amount is absorbed by the rest of the body.

      It is important have a discussion with your daughter’s doctor about the possible interactions of the medications she is taking with her choice of birth control method. In general, the effectiveness of the IUD is less likely to be reduced by psychiatric medications (as compared to the oral contraceptive, which can be rendered ineffective).

      Lastly, in any sixteen year old who is sexually active, it is important to emphasize that oral contraceptives or IUDs DO NOT PREVENT SEXUALLY TRANSMITTED DISEASES. Sexually transmitted infections which are acquired in the teenage years may have lifelong effects (infertility and an increased risk of cervical cancer are among the scariest). A healthcare provider can discuss STD prevention with your daughter and review the importance of condoms, regular STD-screening, and other risk-reducing habits.

      So my best advice is that you get your daughter to talk to a healthcare professional as soon as possible. I’m sure she’ll appreciate the love and care that you are showing by helping her make good health choices.
      Best of luck,
      Dr. N

      Reply
  • 20. bipolar one, real life two.  |  September 24, 2015 at 1:41 pm

    Good morning!

    I see above that in 2011 you said that, “because both IUD’s act locally (on the uterus) for pregnancy prevention, neither is rendered less effective by the use of Lamictal.”

    Is this still what the literature is saying? I was seen recently at a practice very close to yours (as in, you’re in the same brochure) and told that I would be going AMA if I got an IUD with hormones due to my Lamictal use.

    Thank you so much for your help!

    Reply
    • 21. drnicoll  |  September 24, 2015 at 8:53 pm

      Hi there,
      Medical information is always changing (it has been 5 years! there’s even a third type of IUD introduced to market since this was written!). The best bet is for each individual pateint to speak to her own doctor to determine the best course of action in any given situation. Blogs like this are for general information and are never a replacement for individual medical advice from a physician.
      Best of luck!
      -Dr N

      Reply
  • 22. Jeanneth  |  January 24, 2016 at 11:47 pm

    I just removed the paragard yesterday, and I am wondering if my cervix is somewhat thin or not ready to get pregnant right away, how long should I wait to prevent a miscarriage due to a non healthy cervix?

    Reply
    • 23. drnicoll  |  February 3, 2016 at 6:10 pm

      Hi Jeanneth,
      I do not dispense individual medical advice on this blog. Please contact your gynecologic care provider. That being said, in general, the copper IUD (Paragard) does not normally require a waiting period after removal before attempting to get pregnant.
      Best regards,
      Dr N

      Reply
  • 24. drnicoll  |  September 8, 2016 at 2:32 pm

    Hi Marta,
    I’m sorry but I don’t dispense individual advice on this site. Please call your doctor.
    -LN

    Reply

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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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