By Heather Shannon, MS, CNM, NP, MPH
Most of us know about intrauterine devices (IUD) and most of us have heard the horror stories surrounding IUDs. Many years ago, there was only one type of IUD, which did come with problems. However, over the years, IUDs have been improved and are safer than ever. Did you know there are five types of IUDs on the market today? They last from three years up to 10 years, offer excellent pregnancy prevention, and help with menstrual problems.
Let us talk about the basics. An IUD is a small T-shaped device that is inserted into the uterus and left there for a number of years. There are two types of IUDs. The first is a hormonal IUD, which releases the hormone progestin (a progesterone) into the uterus to prevent ovulation and fertilization. These last three to five years and there are four types. The differences are size, amount of hormone and length of use. Hormonal IUDs are classified as Long Acting Reversible Contraception (LARC), which means fertility resumes shortly after its removal. The second is a non-hormonal IUD that is made with copper, no hormones, and lasts for up to 10 years. It works by preventing fertilization (union of egg and sperm). With the hormonal IUD, the progestin thins the lining of the uterus and thickens cervical mucus making it more difficult for the sperm to enter the uterus. With the non-hormonal IUD, copper affects the sperms ability to move and is very toxic to the sperm, therefore, making it difficult to reach the egg. Both types of IUD are over 99 copper effective in pregnancy prevention, making it extremely reliable.
Possible side effects of the hormonal IUD are changes in menstrual bleeding. You may experience absent bleeding, regular bleeding that is lighter and less painful or frequent bleeding. Rest assured this is normal and not harmful. Unfortunately, there is no way of predicting your bleeding profile until three months post placement. There are medicines that can help with frequent bleeding and you can talk to your health care provider about these options. In most cases, the bleeding will improve over time.
Benefits of an IUD are numerous. The biggest benefit is its ease of use. Once it is placed, there is nothing more you need to do to prevent pregnancy. The IUD is placed at any time, even post or immediately after pregnancy. The procedure is conveniently performed in your provider’s office as a minor procedure. The IUD is discrete. No one knows you are using it and it does not interfere with your daily or sexual activities. For those women who have painful periods or a heavy menstrual flow, the hormonal IUD helps reduce these symptoms. This is especially true for perimenopausal women dealing with difficult menses while they are transitioning into menopause. Talk to your provider to see if this is an option for you.
The placement is a minor office procedure. Your provider will counsel you on IUD options and the risks and benefits of use and placement. The IUD is placed through the vagina and cervix and rests in the uterus. You may experience minor cramping that is temporary and usually treated with over-the-counter pain relievers (ibuprofen, Advil or Aleve, etc.). You may need to continue the pain relievers for the next several hours and limit any extraneous activity, but in most cases, you can resume normal activity 24 hours after placement.
You can have the IUD removed at any time and it is completely reversible. The IUD removal is very simple with very little discomfort and done in the office. It was once thought that IUDs affect your ability to get pregnant after its use. That is a myth and is proven to not affect fertility. Most women will resume normal menstruation four to six weeks after removal. In cases where menses does not return, further evaluation by your provider is necessary. There may be an underlying hormonal imbalance as the cause of delay or irregular menses.
Potential risks during or shortly after the placement of an IUD are few, but important to understand. A small number of women may experience the IUD expulsion, or falling out. It can happen with teenagers, as the uterus is a smaller muscle. It responds to the IUD by contracting (cramping) and works to push it out. Another very uncommon risk factor is the potential risk of the IUD going through the wall of the uterus during placement. This does not cause any major health problems, but the IUD will need to be removed. Pelvic Inflammatory Disease (PID) is a serious pelvic infection that requires treatment. If a woman has a sexually transmitted infection (STI) at the time of insertion, she is at risk of developing PID. Screening for STI’s is recommended before IUD placement. Because the IUD is more than 99 percent effective in preventing pregnancy, it is rare to become pregnant. However, if pregnancy does occur, you will need to talk with your OB/GYN provider about your options and whether the IUD should be removed or not.
So, the next time you are thinking about birth control options or is having menstrual problems, consider using the IUD. There are many great benefits to its use and convenience. Talk to your women’s health care provider for more information.