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the lowdown on IUDs » Family Planning

the lowdown on IUDs

November 14th, 2008 by maggie chen Leave a reply »

Part of my goal for this blog was to profile longer-term birth control methods that have the potential to be effective for women in rural or isolated areas. One of these was Implanon, and I think it’s time to talk about IUDs. (Incidentally, I was at the teen clinic where I used to work today, and they said they were removing Implanons for a lot of the women who had just gotten them in recent months. Women were complaining about having prolonged spotting/bleeding…so we’ll see how this plays into the future acceptability of Implanon).

The IUD, or intrauterine device, has had a long and mixed history in the US, and is currently the world’s most widely used reversible birth control method. The basic concept of the IUD, a device that is inserted into the uterus to prevent the start of a pregnancy, is one of the oldest attempts at birth control. IUDs have taken many iterations and forms; check out this picture of all kinds of IUDs from the History of Contraception Museum.

The IUD got a bad rap among American women in the 1970’s when the Dalkon Shield, a faulty version, was put on the market and used by millions of women, many of whom were injured while using it. There were lots of negative aspects of the Dalkon Shield: it had extensions on each side that made insertion and removal painful, and the string was made of a porous material that sheparded bacteria into the uterus. This resulted in severe pelvic infections, which can cause infertility due to scarring. Turns out that little research was done on the Shield before it was released, and birth control devices were not as strictly regulated at the time.

Needless to say, the Dalkon Shield episode changed the way that the FDA treats birth control methods (restrictions are much tighter now). The positive news is that two forms of safe, effective IUDs are currently available in the US, and they provide a good option for women who desire long term, reversible birth control that usually requires no maintenance. These two IUDs are:

  • Mirena: contains a small dose of progestin, to reduce the heavy bleeding sometimes associated with IUDs, can be used for up to 5 years.
  • Copper-T (Paraguard): non-hormonal, has copper wrapped around the arms of the T, can be used for up to 10 years (some studies show it is effective for 12 years).
  • Both are small, with a basic structure made of plastic, and shaped like a T.

I’m hoping this entry will get the facts straight for us as young American women (and men), since I think some of the impressions from the Dalkon Shield era were transmitted to our generation. It’s important to keep in mind that IUDs play a much bigger role in other countries and are just starting to gain popularity in the US again.

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5 comments

  1. mjromano says:

    Thanks for the info. I definitely qualify as one of the “young American women (and men)” that is skeptical about the use of IUDs. I have heard concerns about pain, scarring, and infection risk that made IUDs seem impractical. I really like the idea of non-hormonal birth control methods, and the Paraguard seems like a great option. I would be curious to know what kind of reputation IUDs have in parts of the world where they dominate the birth control market.

  2. jliebner@stanford.edu says:

    I would be extremely hesitant to ever have an IUD inserted, and the idea that it can remain inserted for 5 years and not cause any health concerns just seems a little questionable. I’m also still a little uncertain about how such a device is inserted – are the arms retractable? I also wonder which (hormonal vs nonhormonal) method is more popular. Unlike Max, I like the idea of hormonal based therapies because I feel that they are more effective (gooo the pill!).

  3. cmccourt@stanford.edu says:

    Thanks for clearing things up, Maggie. I think you’re right that IUDs have gotten a bad rap in the U.S., because I (for one) have little education on them other than knowing that they exist as an option, and some of their very basic functioning. I am curious if the cost of IUDs would be prohibitive for many people living in rural areas. According to WebMD the Paragard costs about $500 (and I don’t think this includes the cost of insertion and removal by the doctor).

  4. Maggie Chen says:

    Just wanted to reply to the questions that were asked in the comments. You brought up some important points that should be addressed–thanks for your thoughtfulness!
    Each IUD comes packaged in an insertion tube. The arms are flexible, and are folded down so that it fits into the tube. The tube containing the compressed IUD at the end is inserted into the cervix (sometimes the cervix is dilated a bit first), then the IUD is essentially pushed out of the tube and into the uterus, and the tube is removed. Sounds complicated, but it can be very quick with minimal discomfort with the right practitioner. As you can imagine, IUD insertions work better for women who have had babies because their os (cervical opening) is slightly wider. IUD insertions are often scheduled for when a woman is menstruating, because her os is slightly more dilated then.
    In terms of popularity, from what I’ve seen, IUD choice is based on the woman’s primary concerns. If the woman feels strongly about not using hormones, she will likely go for the Paraguard. If she is concerned about bleeding due to the IUD and is ok with low-dose hormones, she’ll go for the Mirena.
    On efficacy: IUDs are actually MORE effective than hormonal methods, by a slight margin. With perfect use, IUDs are 99.99% effective, while the pill is quoted at 99 to 99.9% effective.
    As a quick response to Max’s question, from what I’ve heard, most women in IUD-dominant countries are quite satisfied with them. In Europe, IUDs are used widely and since European women are more likely to have multiple BC options, this might say something about IUDs. In Africa and Asia, IUDs are also widely used. But options may be more limited in some regions of these continents, so it’s hard to say whether women are happy with the IUD or just happy to have contraception.
    Lastly, good point Casey. That’s the sticker price for a Paraguard (which should be amortized over up to 10 years, making it more cost-effective than monthly hormonal methods). Many health insurance companies cover IUDs and insertion. From the insurance perspective, paying for a woman’s IUD over a number of years is cheaper than paying for a pregnancy or abortion. The program in CA that provides free reproductive health care (Family PACT) covers IUDs. And finally, I’ve heard there’s some sweet deal for women on Cardinal Care where they can get an IUD for some very low co-pay fee like $5. This may have changed when funding for birth control at college health centers was cut about 2 years ago.
    Thanks for reading!

  5. Maggie Chen says:

    and this photo demonstrates how the insertion works:
    http://www.fhi.org/training/en/modules/iud/slidepics/slide35.jpg

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