IUD (Intrauterine Device): Another birth control option

Originally Published: April 6, 2001 - Last Updated / Reviewed On: May 1, 2009
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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."

Today, two types of IUDs are used in the States. Both are approved by the U.S. Food and Drug Administration (FDA). In the past, before the approval of today's IUDs, some women experienced severe complications from certain IUDs. The 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 commonly used among U.S. women as it is among women living elsewhere, especially in Europe. More than 85 million women worldwide use IUDs.

While some IUDs are effective for a year, others can last up to twelve years. Depending on the type of IUD, either copper ions or the hormone progestin is released. Copper ions prevent fertilization by immobilizing sperm. Hormonal IUDs not only impair sperm mobility, they also thicken the cervical mucus to help keep sperm from entering the uterus. Both kinds of IUDs change the uterine lining to prevent implantation if an egg is fertilized.

All IUDs 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. It's especially important to feel for the strings every so often 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

  • High level of protection against pregnancy — both types of IUDs are over 99 percent effective
  • Long-term protection
  • Cost-effective — according to Planned Parenthood, IUDs are "the most inexpensive long-term reversible method of contraception available in the world"
  • Allows women to be more spontaneous — there's nothing to insert or put in place before sex
  • Privacy — no pills or packaging that can embarrass some women
  • Doesn't interfere with sex — neither a woman nor her partner will feel an IUD during sex
  • Can be removed at any time by a health care provider
  • The copper IUD can be used by women who cannot use hormonal methods of birth control
  • Fertility resumes when it is removed, if a woman does not experience certain serious complications from the IUD
  • The copper IUD can be inserted for emergency contraception within five days of unprotected sex

Disadvantages

  • Needs to visit a health care provider for insertion, follow-up exams (including yearly Pap smears as part of a regular gyn exam), and removal
  • Does not protect against sexually transmitted infections (STIs)
  • Some women may need to use a back-up method of birth control at first. Copper IUDs are effective right away, but hormonal IUDs are only effective immediately if they're inserted during a woman's period. If they're inserted at any other point during her cycle, it's recommended that she also uses another form of birth control, such as the contraceptive foam, spermicidal jelly, or a condom, if she has vaginal sex in the first seven days after insertion. (Regardless of the kind of IUD used, some women choose to use a back-up method for the first few months in case the IUD accidentally comes out without being noticed.)  
  • Some women, especially those who have never given birth, who have heavy periods, or who experience severe menstrual pain, expel the IUD in the first few months. In addition, a woman who has expelled an IUD is more likely to expel it again than a woman who has never expelled an IUD.
  • Some women experience complications during and shortly after insertion, including cramping, dizziness, backache, and spotting between periods
  • Possible change in menstrual flow, pelvic inflammatory disease (PID), perforation of the uterus, or embedding of the IUD in the uterine lining
  • If pregnancy occurs, the IUD must be removed to prevent pelvic infection or miscarriage

The IUD is primarily recommended for women who are in mutually monogamous relationships and at low risk for STIs. While serious complications from IUD use are rare, certain STIs will increase the risk for PID, which, if untreated, can lead to infertility. In particular, women who've had gonorrhea, chlamydia, or PID in the past twelve months shouldn't get an IUD.

If a woman is considering the IUD, and wonders if it's right for her, discussing her and her family's medical history with a health care provider is a good first step. It's also important to read the informational brochure from the IUD manufacturer and talk about the benefits and risks associated with the specific type of IUD that is recommended.

Alice

March 20, 2012

508885
I've had my copper IUD for 8 months now and I love it. Everything about sex feels completely natural now and my body is cycling as it would normally. Two things Alice didn't mention: - Copper IUDs...
I've had my copper IUD for 8 months now and I love it. Everything about sex feels completely natural now and my body is cycling as it would normally. Two things Alice didn't mention: - Copper IUDs can be inserted almost immediately after giving birth and are safe for breast-feeding mothers. -IUDs are useful for women with partners who forbid them to use contraception or refuse to use it themselves. Studies have shown that refusal to allow birth control is commonly associated with abusive relationships. Any woman seeking to prevent pregnancy without angering her partner or making him suspicious could use an IUD (circumstances permitting). This could also be useful for members of strictly conservative or religious communities. There are some downsides: the actual insertion hurts for a few minutes and I had heavier periods and funky discharge for a few months afterward, but all those symptoms are gone. If you can afford the upfront cost of an IUD I'd say it's the best option by far(if you're not at high risk for STDs).

April 24, 2009

21538

Dear Alice,

I've had my copper IUD since 2000, and I love it. It is literally the only birth control that requires no maintenance whatsoever. Cost-wise, you can't beat it - it cost $400 to...

Dear Alice,

I've had my copper IUD since 2000, and I love it. It is literally the only birth control that requires no maintenance whatsoever. Cost-wise, you can't beat it - it cost $400 to insert, and it's good for 10 years. Compare that to the $30-40/month of hormones, or the shot. No wonder almost no one knows about it - the drug companies lose money on IUDs! Plus, with no maintenance, there's nothing to mess up; that is, there's no worry about forgetting a pill.

October 31, 2008

21483

Dear Alice,

I've had an IUD for about a year, and I'm thrilled with it in general. However, there has been one unforeseen consequence that I'd never heard anyone else talk about before: the...

Dear Alice,

I've had an IUD for about a year, and I'm thrilled with it in general. However, there has been one unforeseen consequence that I'd never heard anyone else talk about before: the IUD string pokes my boyfriend at unpredictable times during sex and causes him a lot of pain. I can't feel it at all, but it's made him bleed a couple times. I've been back to my gynecologist about it twice, and she has trimmed the string so that it's flush with my cervix. Apparently the IUD strings are supposed to curl up on themselves after they're inserted, but mine never did. The trimming hasn't completely eliminated the problem, but we've learned to work around it by not having sex around my period (when my cervix is open). I've never heard of anyone else experiencing this issue with an IUD before, but thought I'd let people know that it is possible.