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 type of contraceptive device that’s placed in the uterus by a health care provider and can prevent pregnancy for up to three to ten years. Because of its ability to protect against pregnancy for longer periods of time, it’s referred to as a long-acting reversible contraceptive (LARC). The IUDs available in the US are shaped like the letter "T" and are offered as non-hormonal or hormonal options. To answer your question, before the approval of the current generation, some people experienced severe complications from earlier generations of IUDs. However, with the advancement of technology and removal of previous generations from the market, IUDs are considered quite low-risk and effective. As a result, IUDs are becoming increasingly more popular among individuals with a uterus.

Currently, IUDs are categorized as either non-hormonal or hormonal. Non-hormonal IUDs are usually wrapped in copper and are thought to work by creating inflammation in the uterus that’s toxic to the sperm and eggs, thereby preventing pregnancy. They’re effective for up to ten years and can be used by those who don't typically respond well to, are unable to use, or prefer not to use hormonal contraception. Additionally, they may be used as emergency contraception when inserted up to five days following following sex where contraception failed, was used incorrectly, or wasn't used and pregnancy was possible.

Alternatively, hormonal IUDs release a steady amount of progestin to help prevent pregnancy. The hormonal IUDs work by thickening the cervical mucus to prevent sperm from entering the uterus, thin the uterine lining to make it difficult for implantation, and also help suppress ovulation. There are several types of hormonal IUDs, but they generally can last three to five years, depending on the kind chosen. Many individuals choose the hormonal option because it may reduce menstrual cramps and blood flow, or sometimes stop periods altogether. Contrary to previous recommendations, both types of IUDs are low-risk for those without children.

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

  • A high-level of protection against pregnancy: Both hormonal and non-hormonal types are over 99 percent effective at preventing pregnancy.
  • Cost effectiveness: Depending on the health insurance plan, the initial cost is often free. This coverage may vary though, so it's wise to speak with the health insurance company to learn more about costs. For those who do need to pay for it, since it's only paid for once every three to ten years, rather than paying for other contraceptive methods each month, less money may be spent over time.
  • Allows for spontaneity: Once it’s in place, the IUD provides continual protection, unlike daily forms of birth control that rely on memory and using them correctly (ranging from the pill to condoms) for adequate protection. Another added benefit is that partners likely won’t feel the IUD during sex.
  • It’s reversible: Assuming there are no serious complications, it’s possible to get pregnant soon after your health care provider removes the IUD.
  • The potential for immediate effectiveness: If it’s inserted within the first seven days of the menstrual period, IUDs can be immediately effective against pregnancy. Outside of this window, it’s recommended that partners us another form of birth control (such as internal or external condoms) for the first seven days following insertion.

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

  • Visits to a medical provider: IUDs can’t be inserted by the user, and therefore requires a visit with a health care provider. There may also be subsequent visits for follow-up exams (including any pap smears as part of a regular gynecological exam) and removal.
  • Doesn’t protect against sexually transmitted infections (STIs): While effective against pregnancy, IUDs provide no protection against STIs.
  • Potential side effects: Immediately following insertion, individuals may experience cramping, dizziness, backache, changes in menstrual flow, and spotting between periods. Spotting may last three to six months following insertion.
  • Possible expulsion: Although very rare, an IUD can slip out of place, either moving slightly within the uterus or coming out completely. If this happens, pregnancy is much more likely.

The process for inserting and removing an IUD is generally quick and simple. A trained health care provider will use a speculum to open the vagina and use a special inserter to place the IUD through the cervix and into the uterus. This usually takes a few minutes and may be followed by brief cramping or mild pain. Providers clip the IUD’s strings to approximately one to two inches, allowing for people to check their strings (and IUD placement) at home and to facilitate future removal. While this process can take place during any time of the month, some providers will schedule an insertion to occur while a person is actively menstruating because the cervix is dilated and softened, allowing for a smoother insertion. It’s also likely to indicate that the person isn’t pregnant. After insertion, many people may feel fine, while others may experience backaches, cramping, and discomfort sufficient to warrant a day of rest. However, over-the-counter pain medications, heating pads, or warm baths can often ease the pain.

Removal is generally simple as well and can be removed at any time after insertion. An IUD can be removed any time after insertion. To remove the IUD, individuals will have to make another appointment with their health care provider. The procedure will be similar to the insertion in that a speculum will be used to open the vagina. From there, a provider will gently pull on the IUD string until the IUD’s arms (horizontal part of the “T”) fold upwards and slips out. Infrequently, special instruments may be used to facilitate removal, and in very rare circumstances where removal is difficult, surgery may be required to take out the IUD.

Though rare, there are a few potentially severe complications associated with IUDs. There’s a risk of infection and uterine perforation (when the IUD pushes through the wall of the uterus). Additionally, though the risk of pregnancy is very low and rare, if it does occur, it can result in infection, miscarriage, ectopic pregnancy, or early labor and delivery. If a person experiences pain, or suspects an infection or pregnancy at any time while using an IUD, it’s critical to seek medical attention immediately.

If you’re considering an IUD or you’re simply curious about them, you may consider talking with your health care provider who can talk you through any questions and concerns you may have. Ultimately, there are a lot of factors to consider when it comes to IUDs — whether they’re right for you, which kind is most appropriate for you, and what you can expect before, during, and after insertion. You can also learn more about contraception in the Contraception category of the Go Ask Alice! Sexual and Reproductive Health archives.

Cheers to learning about this birth control option!

Alice!

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