Women's health advocates tend to be big fans of the intrauterine device, otherwise known as the IUD. And there are plenty of reasons why.
The small, t-shaped contraption is inserted into the uterus by a trained health care provider to prevent pregnancy by keeping sperm from joining an egg. IUDs are extremely effective (every year, less than 1 out of 100 women get pregnant while using an IUD), and are also "some of the least expensive, longest lasting forms of birth control available to women today," according to Planned Parenthood. (IUDs don't, however, protect against sexually transmitted infections.) The insertion procedure, which is done by a health-care provider, generally takes only a few minutes.
But while studies suggest that a growing number of women are using IUDs, the birth control pill is still far and away the most commonly used method among women who practice contraception.
That's largely because of the shadow left by the dangerous Dalkon Shield IUD, yanked from the market in the 1970s after floods of complaints about infection, infertility and even death. "The fact is, people still have big misconceptions," said Dr. Amy Bryant, an assistant professor of obstetrics and gynecology at the University of North Carolina. "I'm really surprised that more women don't know about how safe IUDs are."
With that in mind, here are eight things all women should know about IUDs. As always, talk to your doctor or health care professional to discuss the contraceptive choice right for you.
Dr. Amy Bryant, of the University of North Carolina, says she often sees patients whose mothers warn them against using IUDs -- again, because of the legacy of the faulty Dalkon Shield. "I sit patients down and tell them, 'Let's talk about what your mother told you, and what's true,'" she said. "It's true that there was one really bad one on the market [in the 1970s]. But ones today are incredibly safe." And doctors may be fueling the problem. A 2012 survey
found that roughly 30 percent of OB-GYNs, family physicians, and nurses and physicians assistants working in family planning, believed IUDs were unsafe.
Because they're a long-acting, modern method, many women assume IUDs are another form of hormonal contraception, but that's not necessarily the case. There are two brands of hormonal IUDs available in the United States -- Mirena and Skyla, which release a small amount of the hormone progestin (a synthetic progesterone) -- but there is also the copper ParaGard IUD, which is hormone-free. "Anyone who has a real or perceived issue with taking [hormonal contraception] should know the copper IUD has no hormones," explained Dr. Sara Pentlicky, an assistant professor of obstetrics and gynecology at the Perelman School of Medicine at the University of Pennsylvania. And hormonal IUDs have a lower dose of progestin than most birth control pills, so if a woman has problems with the pill, like weight gain or mood swings, the IUD might be a good alternative for them to discuss with their doctor anyway, Pentlicky added.
Again, because of the Dalkon Shield there's a lingering perception that IUDs are problematic when it comes to infections. "One of the common myths that is still being perpetuated is that they cause infections, or make infections worse, which is not true," Pentlicky said.
Nor are they totally out for women who've previously had an infection, sexual or otherwise, she explained. "I've heard patients say that because they had chlamydia in the past, they can't have one," Pentlicky said. It is
true that women with active pelvic inflammatory disease should wait (and get treated) before having an IUD inserted, she continued, and women should always talk to their doctors about whether an IUD is right for them -- particularly if they have an active infection. Still, major medical organizations including the Centers for Disease Control and Prevention, and American College of Obstetricians and Gynecologists say it's not necessary
for women who already have an IUD to get it removed if they subsequently get chlamydia or PID.
For many women, one of the big bonuses of taking a birth control pill is that it can, in some cases, help control acne. And that's not a benefit users get with the IUD. "The copper IUD has no hormones, so it won't affect acne," said Bryant. The only types of birth control pills that have been approved by the Food and Drug Administration for the treatment of acne are so-called combination pills, which include both estrogen and progesterone. The Mirena IUD only contains the latter and in such low doses, it's "not going to help" with acne, Bryant explained.
"It's very common to have cramping after [a doctor] puts it in -- usually, within the first 24 to 48 hours," Bryant said. But some women may experience cramping longer, for weeks or even months, as their bodies adjust, she continued. Longer-term, the copper IUD can increase women's risk of having "heavier, crampier" periods, Bryant added. Hormonal IUDs, on the other hand, may actually help with heavy menstrual bleeding and cramping.
As WebMD reports
, studies suggest that IUDs not only reduce heavy menstrual bleeding by up to 90 percent after several months of use, but often cause women to stop getting their periods altogether. Research suggests that "about 20 percent of women will stop having their period after the first year, 50 percent by the second and around 80 percent by the third," Pentlicky said. "For some women, that's welcome, but some do want their period every month."
Though the risk is relatively small -- happening in around 3 percent of cases, Bryant estimated -- it is possible for an IUD to fall out of place. "If an IUD is going to slip out of place, it will most likely happen in the first few months of use. But it may occur later," Planned Parenthood explains
. "The IUD is most likely to slip out of place during your period." Unfortunately, there's no way to predict which women might expel an IUD, even if it's inserted correctly (a process that takes just a few minutes and must be done by a trained medical professional, Bryant said). But there's some suggestion that Skyla, the newest IUD approved by the Food and Drug Administration, is better for younger women or women who haven't had children. That's because it is both slightly smaller and has a more narrow insertion tube. Again, talk to your doctor about your options, Bryant stressed.
Though they are effective for a long time -- between two and 12 years, Planned Parenthood explains
-- IUDs are not a permanent form of contraception, nor do they cause infertility. After the IUD is removed -- a simple procedure done by a health care provider that generally takes just a few minutes -- a woman's so-called "return to fertility" can be almost immediate, Bryant said. Unlike birth control pills, the IUD does not stop ovulation.