IUD for the WIN

In today’s post I am going to provide a nice introduction to a type of birth control that, although it has been around for years, common misconceptions about its safety have given the IUD a bad rep. Now with more recent research revealing the safety, and superior efficacy, in most women, I am really hoping to see IUDs make a come back in today’s female population.

First…lets start off with a brief introduction. An intrauterine device (IUD) is a type of contraceptive that provides top tier protection against pregnancy, second in effectiveness to getting your tubes tied. It is a small device that is inserted into your uterus by a healthcare provider, and depending on the type of IUD, its mechanisms of action works directly on the target site. This is a tremendous advantage to other methods, especially hormonal contraceptives, which use a systemic approach, and affect multiple body sites and systems. There are two different types of IUDs, each one having its own way of working.

The first, the Copper IUD, known as the Paraguard, is a small T-shaped device made with copper wiring. It is inserted into the uterus, and can be left in to prevent pregnancy for up to 10 years! This device does not contain any hormones at all, so it is a great option for women who do not want to take hormones or are at risk for adverse effects of hormones. It works by causing impaired sperm function and “confusion” with the presence of copper ions and inflammatory mediators in the upper reproductive tract (Hatcher et al., 2009). Because there are no hormones in this device, a woman typically retains her normal menstrual cycle, although it is not unusual to experience more bleeding with each period.

The second type of IUD is the levonorgestrel system, also known as the Mirena IUD. Instead of copper wiring, this device contains a type of progesterone that is secreted in tiny amounts into the endometrial tissue daily. The hormone in this system is the same as the hormone in Depo-provera, and its actions are very similar: it causes thickening of cervical mucus, preventing sperm transport into the uterus and supressing the endometrium, often inhibiting ovulation and fertilization. Local inflammatory effects (similar to those described in the Paraguard) also create a hostile environment for sperm survival. The added benefit of the IUD, however, is that it works directly on the target site in the uterus, and thus does not produce as many side effects as the other hormonal methods. Additionally, it can be left in place for up to five years without every having to worry about it! Another advantage to this type of IUD is a result of the endometrial suppression it causes. By inhibiting build up of the uterine lining, most women experience lighter periods, and at least 20% of women will stop bleeding altogether (Hatcher, 2009). This makes it a great option for women suffering from severe menstrual symptoms and anemia from heavy bleeding, has been found to be the superior method of treating and preventing heavy menses. Further, the Mirena has received much recognition in perimenopausal women on hormone replacement therapy. Because of the cancer risks of taking estrogen supplements alone, progesterone is added to the regimen, but can cause undesirable spotting and break through bleeding. For the woman enjoying the lack of periods from menopause, this new bleeding can serve as a major nuisance, and lead to discontinuation of the hormone therapy altogether. With the Mirena IUD, the endometrial suppression is much greater, and there is less likelihood of  unpleasant bleeding.

When really looking at the beneficial aspects of the IUD, much research is pointing to its use as a potential cancer prophylactic. Because of its ability to suppress build up of the uterine lining, the Mirena has frequently been used to treat and prevent endometrial hyperplasia and adenocarcinoma (Hatcher et al., 2009). Additionally, the inflammatory response that occurs with both the Mirena and the Paraguard have been proposed as a possible protective factor against cancer development.

I like to think of one of the best aspects of having the IUD is the relief from having to be on a strict daily pill requirement to avoid consequences. Ever wonder why the medication label says to take the pill at the same time every day? This is because the levels of hormone required to be effective are only maintained in our bodies for about 24 hours. After that, our body clears out most of it, and the levels are below the threshold to be effective and thus our bodies respond by ovulating, or in most cases, with break-through bleeding. With the IUD, remembering to take the pill on time is never an issue. Even better, because there is no estrogen in either of the IUDs, this method is free from most of the annoying side effects of the pill like weight gain, mood swings, blood clots, etc.

When looking at today’s female population using birth control, one must wonder who would get the most benefit out of the IUD? If you ask me, I truly believe that every woman (given they have no medical contraindications) can have outstanding success with this method. In the older female population, or rather in those mothers that do not want any more kids, the IUD is a great alternative to sterilization. Many people have been entertaining the  idea that these procedures can be reversed if they change their mind later, and although it is not impossible, it is not likely. There is a reason why these procedures are called permanent. The IUD offers an alternative method of  nearly equal effectiveness without having the risk of regret. You just never know. From my research, I have come to the conclusion that the younger female population (teens and early 20’s) would have exceptional benefit from the IUD. I mean, when you think about it, these age groups are the most likely to have poor compliance with other contraceptive methods. Especially when considering teenagers have a hard enough time trying to even acquire the pill, let alone expecting them to comply with the daily requirements, the IUD can provide relief from much of the obligation that comes with other methods. By giving these girls the option of the IUD, they can still get the best effectiveness without all the responsibility it takes to prevent a pregnancy. Same concept applies to women in their early 20’s. Being in college or working to build a career can come with unpredictable schedules (and sexual activity) that can make it hard to properly maintain a method of birth control. Think about how many unplanned pregnancies (and abortions!) can be prevented!!

OK so after giving you all the awesome aspects of the IUD. Here are the downers…

1. Menstrual disturbances. This is one of the most common reasons for IUD discontinuation. Although the IUD does decrease/stop your periods, it does take a couple months for that to happen. In the meantime, you can expect to have unpredictable spotting until everything adjusts. It does take time and patience for things to balance out so expect some irregular periods and spotting for up to 6 months. Additionally, the loss of a period can be very bothersome for some people who like the reassurance that a monthly period gives them.

2. Cramps/pain. OK not going to lie here, the insertion can be pretty uncomfortable, especially in the never-had-kids population. This is pretty much the worst of it, and it is over before you know it. Once in a while, there may be some discomfort as your body adapts to the device, and taking some OTC pain relievers seems to work just fine. As with the bleeding irregularities, it does take time for everything to adjust, so its not uncommon to get mild cramps in the first 6 months of having it.

3. Infection. Early school of thought suggested the IUD was a contributor to increased risk of pelvic infections. Recent research has disproved this theory, and found that risk of infection was attributable to insertion technique, and significantly declined in the days following insertion. Sterile instruments and aseptic technique is a standard approach for inserting the IUD, and many providers opt to implement antibiotic prophylaxis to further reduce risk of infection.

4. Perforation. One of the rare possibilities is uterine perforation as the IUD is inserted into the uterus. As a precaution, the provider will measure the depth of the uterus before insertion to avoid putting it too far, and using this approach makes the chances of perforation very unlikely.

5. String problems. Attached to the end of the IUD are two strings that will extend out of the the uterus and into the vagina. These strings are necessary to ensure the IUD is in the right place over time, and the provider will usually cut these strings nice and short so that they hang just outside the cervix. Periodically, you should feel inside for these strings to make sure the IUD stays in place, but they should typically go unnoticed otherwise. A common complaint, especially in the first few weeks, is discomfort from the strings during intercourse—from the guy. Initially, the strings may “poke” your partner, but should quickly soften and curl under with time.

The IUD is a great method of contraception that has received a bad reputation over the past years. Coming from someone that has an IUD, and has hands on experience with them as a provider, get it! Even with the few negative aspects, most are self limiting, and are not an issue after the first couple months. I have no complaints with mine. If you are on birth control pills, get it. If you dont want kids right now, get it. If you want lighter/no periods, get it. This system really is great for anyone looking for an effective and convenient method of contraception that has few side effects and is highly cost-effective. Talk to your GYN about it to see if you are a good candidate, just like the pill, its not for everyone. But it has been proven to be safe and effective regardless of age, so I absolutely recommend it!

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