Dear Alice,

As I looked in your list for contraception methods, I couldn't find a thing called "Intrauterinpessar," or maybe it's a bad translation of the popular German word, "coil." Isn't that used in the U.S.? Are there reasons for not using them? Thank you for answering.

— A European Woman

Dear A European Woman,

You're probably referring to a method of contraception known in the United States as the intrauterine device, or IUD for short. An IUD is a small device that a health care provider inserts into a uterus, through the cervix, as long as a woman isn't pregnant. Some IUDs have a coiled shape, which may explain the German translation that you mentioned. Others, such as the ones available in the U.S., resemble the letter "T." To answer your question, before the approval of the current generation of IUDs, some women experienced severe complications from certain IUDs. The specific devices that caused these problems have since been taken off the market. Partly due to its past negative image — and despite its advantages — the IUD is still not as common among women in the U.S. as it is among women living elsewhere, especially in China and Europe.

Currently, two types of IUDs are approved by the U.S. Food and Drug Administration (FDA) and used in the States:

  • Copper – This type of IUD prevents pregnancy by releasing cooper ions which then prevent fertilization by immobilizing sperm. It has been found to be effective for up to 12 years.
  • Hormonal – These types of IUDs not only impair sperm mobility, they also thicken the cervical mucus to help keep sperm from entering the uterus. They have been found to be effective for up to 3 to 5 years depending upon the brand.   

Despite these differences, both types of IUDs change the uterine lining to prevent implantation if an egg is fertilized. All IUDs also have one or more plastic strings at the base that hang down through the opening of the cervix into the vaginal canal. The string(s) need to be checked after each period to be sure that the IUD is in place. As such, you may also want to keep an eye on your pads, tampons, or cups to see if the IUD has fallen out. Feel for the strings every so often, especially during the first few months after insertion — this is when the IUD is most likely to be expelled. If it does come out, contact a health care provider as soon as possible.

As with any method of birth control, the IUD has its advantages and disadvantages.

Advantages of the IUD include:

  • A high-level of protection: Both types of IUDs are over 99 percent effective over a long period of time.
  • Cost effectiveness: You pay for them once rather than each month or so for years of pregnancy prevention.
  • Allowing for spontaneity: There’s nothing to remember daily and the device is usually not felt by partners during sex.
  • Privacy: There are no pills or packaging that might be embarrassing.
  • Being reversible: Fertility resumes quickly after the removal of the device (assuming that there were no serious complications — more on that in a bit), which can be done at any time by a health care provider.
  • Immediate effectiveness: The only exception is if you have the hormonal IUD inserted at a time other than the first seven days of your menstrual period. In that case, you’d just want to use another form of birth control (such as female or male condoms) for the first seven days following insertion.

There are also a few advantages specific to the IUD type:

  • Copper IUDs can be used by women who cannot use hormonal methods of birth control and can be used as a method of emergency contraception (EC) if inserted within five days of sex.
  • Hormonal IUDs may reduce menstrual cramps and make your flow lighter (sometimes they stop menstruation altogether).

It’s also good to be aware of the possible disadvantages with IUDs, including:

  • Medical visits for insertion, follow-up exams (including yearly Pap smears as part of a regular gynecological exam), and removal
  • No protection against sexually transmitted infections (STIs)
  • Risk of device expulsion from the uterus within the first few months, especially in those who have never given birth, who have heavy periods, or who experience severe menstrual pain (A woman who has expelled an IUD is more likely to expel it again).
  • Cramping, dizziness, backache, changes in menstrual flow, and spotting between periods, which can occur during and after insertion
  • The risk of slipping out of the uterus – either a little or all the way (If this happens, pregnancy could occur)

Though rare, there are a few potentially severe complications associated with IUDs. There is a risk of infection and uterine perforation (when the IUD pushes through the wall of the uterus). Additionally, though the risk of pregnancy is low, if it does occur, it can be dangerous and result in infection, miscarriage, ectopic pregnancy, or early labor and delivery. If at any time while using an IUD you suspect that you might be pregnant, have an infection, or experience pain, seek medical attention immediately.

The FDA states that the copper IUD is safe enough to be used by women who had never had a child and who had more than one sexual partner. In 2012, the American Congress of Obstetricians and Gynecologists (ACOG) stated that both hormonal and copper IUDs are safe enough to be used by teens, (unless the teen had a pelvic infection in the past). It’s best to speak with your health care provider to talk through the pros and cons and whether this type of birth control method will work well for you.

Alice!
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