You need an IUD

IUD pic 03-12 at 9.24.14 PM

You need an IUD. Trust me, I’m a doctor.

IUDS ARE 99% EFFECTIVE IN PREVENTING PREGNANCY, MORE EFFECTIVE THAN BIRTH CONTROL PILLS AND WAY, WAY MORE EFFECTIVE THAN CONDOMS. They are also very reversible: your hormones and fertility go back to baseline within a day or two.

Okay, obviously this post does not apply to all women, and definitely does not apply to men.* If you do not have a uterus or have completed menopause, you may skip this post. But if you are peri-menopausal or even have had your tubes tied and have heavy periods, read on. (*Exception: Transgender males with uteri can get an IUD.)

Back in the 1970s, there was the Dalkon Shield IUD. It was a nightmare. Almost 200,000 women were adversely affected. This particular IUD caused pelvic infections which often lead to infertility, and the A. H. Robins company had to award women 2.4 billion dollars in the late 1980s. I am sure that class action lawyers got the bulk of this money, but I digress.

It took a lot of chutzpah to introduce yet another IUD into the market place after that. But in 1988, the copper Paragard IUD was introduced to the U.S. market, which lead the way to other IUDs.

Sounds scary. Why should I get an IUD? 

–If you have been told that contraception is unsafe because you have high blood pressure or smoke or have other medical contraindications, you need an IUD.

–If you have had side effects from the pill or Depo Provera, you need an IUD.

–If you are tired of taking a pill every day, you need an IUD.

–If you are worried that contraception will no longer be covered by insurance, you need an IUD.

–If you are worried that you soon may not have insurance, you need an IUD.

–If you have very heavy or painful periods, you need an IUD. Even if you are not sexually-active, or have only female partners, or your partner is man who has been fixed. (Kudos to these men, seriously.)

Who should not get an IUD?

See above: if you do not have a uterus. The old exclusionary criteria no longer apply: If you have never had a kid or have a history of ectopic pregnancy or a history of chlamydia, you can still get an IUD.

There are a few women who will not be good candidates. If you have a uterine anomaly, like a bicornuate  uterus, IUD may not be a good option. Also, if you find pelvic exams to be the worst thing in the world, like you would rather have a root canal without novocaine, an IUD may not be a good choice.

What types of IUDs are out there?

IUDs can be divided into two main categories: those containing progesterone and those made with copper.

There is only one copper IUD in the U.S., Paragard, and this is FDA-approved for 10 years but likely effective for 12 years.

PROS: Ten years effective birth control!!! Do you even need to keep reading?! Yes, you do. It is also the only IUD that can be used for emergency contraception. If inserted within 5 days of unprotected sex, it is more effective than Plan B at preventing pregnancy.

CONS: It can make your periods heavier and more painful. But if your periods are naturally light and easy and no big deal, this may be a great option.

There are 4 progesterone IUDs available in the U.S. All have the same type of progesterone but in varying amounts:

  1. Mirena IUD which releases approximately 20 mcg levonorgestrel (a type of progesterone) each day. It is FDA-approved for 5 years but they are using it in Europe for 7 years and recent studies show it is effective for this duration.
  2. Liletta IUD is almost identical to Mirena but it has been approved for only 4 years, simply because it has not been around as long. It is not as widely available because it does not have the marketing behind it, but it works just as well.
  3. Kyleena IUD is smaller than Mirena and Liletta, but just by a few millimeters. It also has less progesterone, 17.5 mcg, but works for 5 years.
  4. Skyla IUD is the same size as Kyleena and releases even less progesterone–14 mcg –and is effective for 3 years.

Do IUDs cause abortions?

No, they work by several different mechanisms. The copper IUD works like a permanent spermicide and the progesterone IUDs both thicken cervical mucus which forms a plug and thin the uterine lining to prevent implantation. They often also (but not always) prevent ovulation.

Great, I want one! You are so helpful, Gyn Girl Next Door! Tell me more!

If you are planning on an IUD, schedule this on your period if possible. It tends to be easier because your cervix is more open. Sometimes, the insertion will be unsuccessful on the first attempt and a woman will need to return when she is on her period. (No, you will not gross-out your provider. We really are used to this.)

IUD insertion hurts like bad menstrual cramps. I tell my patients to take 600mg of Ibuprofen two hours before their appointments. The jury is still out on whether or not this makes a big difference, but I think it does. If a woman is very worried about the pain and has alternative transportation, I offer a small dose of narcotic, ie hydrocodone. If she is very anxious, I offer Valium, but this is up to your provider. Sometimes, we can numb your cervix and uterus with a paracervical block, but this adds considerable time to the procedure and quicker is usually better if you have a speculum inside of you.

If you have a history of heavy or painful periods, avoid the copper Paragard IUD. Some of you may not remember what your periods were like before hormonal birth control. I have many patients that like the idea of a hormone-free IUD, but the reality is not as pleasant.

If you are prone to hormonal acne, you may want to avoid the progesterone IUDs. My dermatology colleagues insist that all IUDs except Paragard cause acne, but let’s face it (pun intended!) that most women seeing a dermatologist have skin issues, so there is bias. Most women will not get acne from a Levonorgestrel-IUD, but some will.

Finally, it is important to understand that none of these have estrogen, which is a double-edged sword. This means that they are safe for women with a history of blood clots or high blood pressure, but they also do not have any of the benefits like clearer skin or decreased ovarian cysts.

 

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