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Intrauterine Device (IUD)

What is it?

An IUD is a small, T-shaped object that is placed in the uterus to protect against pregnancy. It is one of the most commonly used birth control methods around the world. Currently, only two types of IUDs are available in the United States: the ParaGard Copper T 380A and Mirena. The Copper T works by using copper to prevent pregnancy and is effective for 10 years, while Mirena releases a form of progestin called levonorgestrel and is effective for 5 years. Both types of IUDs have a "string" attached to the bottom of the "T". The string is actually a piece of strong plastic, so it does not absorb bacteria like a cotton string would. It is long enough for a woman to feel it with her finger, but it cannot be seen outside of the vagina.

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How it works

The main way both IUDs work is by not allowing sperm to fertilize the egg, probably because the substances released by the IUD immobilize sperm. Also, each type has its own ways of preventing pregnancy.

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How do I get an IUD?

IUDs are inserted into the uterus by a doctor. Before the doctor actually inserts the IUD, there are a series of steps to make sure that it is an appropriate method of birth control for the individual woman.

Planning the Insertion: While the IUD can be inserted at any time, usually the most comfortable time is during the woman's period because at that time the cervix is softer. Also, the menstrual fluid acts as lubrication for the insertion, and the woman's chance of being pregnant during menstruation is very low.

The Insertion Process: Sometimes the doctor will tell the woman to take an over-the-counter painkiller to reduce the cramps that the insertion may cause. Additionally, the doctor might give the woman an antibiotic to prevent against possible infection as a result of insertion.

For the actual insertion, a doctor will use a speculum to hold the vagina open. Then an instrument called a tenaculum keeps the uterus steady by attaching to the cervix. Sometimes the doctor measures the length of the uterus and cervical canal with a tool called a sound. Finally, the doctor inserts a tube containing the IUD. The arms of the T bend back as the IUD is pushed into place; once it is placed, the arms open up into the standard T shape. Everything but the IUD is removed, leaving the string hanging through the cervix into the vagina. Sometimes during insertion, cramping can occur and be somewhat uncomfortable. By breathing slowly and deeply the woman may reduce the discomfort. While most women sail through the insertion with nothing more than mild cramps, some women with sensitive cervical tissue may need a local anesthetic.

After Insertion: Doctors usually recommend having someone there to drive or escort the woman home. Once she is home, she should rest until she is comfortable. Most women don't have problems adjusting to their new IUDs; however, some women can take several months to fully adjust. There can be heavy bleeding and cramping during the first few months, but doctors can prescribe medication to reduce bleeding and cramps.

After the woman's first period with the IUD, she should go in for a check up to make sure it is still in place. Also, all women with IUDs need to check them regularly between periods and examine their pads or tampons each day during menstruation to make sure the IUD was not expelled. Finally, every woman should go to the doctor at least once a year in order to make sure her IUD is as it should be.

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Checking the IUD

A woman can check her IUD by feeling for the string that dangles into the vagina. She should check often when she is between periods, and she should also look closely at her pads or tampons to make sure the IUD didn't fall out during menstruation. To feel for the string, a woman should…

  • wash her hands, then sit or squat.
  • put her finger into her vagina until she reaches the cervix, which feels a lot like the tip of the nose.
  • find the string that comes through the cervix. If it feels longer or shorter than normal, or if it is no longer there, the IUD might have moved. In this case, a woman should call her doctor so it can be repositioned; also, the woman should use another form of birth control until she sees her doctor.
  • NEVER PULL ON THE STRING Pulling can change the placement of the IUD or even make it come out.

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Is something wrong with my IUD?

If you cannot feel the string or if you think you might be pregnant, call your doctor immediately. For other warning sign, remember "PAINS":

If you have any of these warning signs, call your doctor immediately!

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Effectiveness

The failure rate for the IUD is less than 1%, making it one of the most effective non-permanent forms of birth control in the world.

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Advantages

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Disadvantages

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Cost

The cost of the entire process—exam, insertion, and follow up—ranges from $250 to $450. Medicaid covers these costs. Also, considering that you can use the Copper T for up to 10 years and Mirena for 5 years, the cost works out to be less per year than most other types of birth control.

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But I heard they were dangerous!

In the 1970s, IUDs were extremely popular. At that time, the FDA did not test IUDs, so faulty and poorly designed IUDs were on the market. The most notorious one was the Dalkon Shield. This IUD had a braided string which allowed bacteria to grow, causing PID (pelvic inflammatory disease); if untreated, PID can lead to infertility. However, now the FDA tests IUDs, and the ones on the market now are much safer than ever before.

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IUDs work best with women who:

You should not use an IUD if you:

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Created October 29, 2003, last updated September 26, 2007