Expand Your Contraceptive Options: Consider the IUD
"It's easy to forget a pill every day and it's time-consuming to use something every time you have sex," says Christina Brooks, a 36-year-old married mother of three children. "I just wish there were more birth control options for women."
Like many married women in their 30s and 40s, Christina wonders if there is an easier alternative besides a daily pill or surgery to remove her uterus. A relatively recent design of an old birth control method may help her.
Remember the IUD?
"The IUD (intrauterine device) has been around a long time," says Diana Cheng, MD, a gynecologist with the Maryland Department of Health and Mental Hygiene, "but it's a very underutilized method... It's effective for ten years [and it's] so simple."
What Is an IUD?
The modern IUD is a very small T-shaped piece of plastic that is inserted into a woman's uterus by a doctor. It is about as thin as a toothpick and as long as a small paper clip. Two short pieces of specialized thread hang from its end through the cervix so the doctor can easily remove it when no longer needed. The most common IUD available now has a thin copper wire wound around it that helps to disable sperm. The IUD prevents pregnancy just as well as birth control pills or getting your tubes tied.
How Does It Work?
Many women have avoided using the IUD because they thought it prevented implantation of a healthy fertilized egg. In contrast, studies over the last twenty years show that the IUD works mainly by preventing fertilization between the sperm and the egg. The IUD causes mild inflammation in the lining of the uterus, which disables incoming sperm.
"Healthy sperm never get up into the tubes," says Kristin Dardano, MD, assistant professor of obstetrics and gynecology at the Baystate Medical Center in Springfield, Massachusetts. "So they never actually meet an egg and fertilize."
A Newer Type of IUD
The U.S. Food and Drug Administration (FDA) approved a newer IUD in December 2000. This IUD contains a small amount of the hormone progesterone, which adds to the IUD's effectiveness by decreasing menstrual bleeding. This IUD should also reduce cramping and discomfort in women who have heavy periods.
Because the IUD lasts between five and ten years, it is also extremely cost-effective. The greatest cost is having it put in initially, but after that there are no other expenses.
What About the Risk of Infection?
Although used by over 100 million women worldwide, many women and doctors in the United States shied away from the IUD after a particular type of IUD, the Dalkon Shield, caused a severe infection called pelvic inflammatory disease (PID) in some women. The Dalkon Shield, which was taken off the market in 1983, had removal threads that were made up of many tiny strands twisted together. Bacteria could easily climb up these many strands and cause infection. All the IUDs now on the market have threads made of only one strand of material. This has significantly decreased the chance of infection from using an IUD. It is now considered safe.
Using an IUD
"It is a fabulous option," says gynecologist Judi Hersh, MD, of Bridgewater, New Jersey. "It really is one of the best methods to choose in a woman who has completed her childbearing, is in a monogamous relationship, [and] is looking for a method that's pretty permanent, but for whatever reason chooses not to proceed with sterilization for herself or her partner."
Dr. Hersh says there may be some mild cramping at the time of insertion. After the insertion, all a woman has to do is check that she can feel the threads at the end of the cervix once a month after each menstrual cycle. Rarely, the IUD might come out with menstrual blood or float higher into the uterus, so checking the strings makes sure it is still in the right place. Side effects with the copper IUD can include increased cramping and bleeding but the new progesterone-releasing IUD actually eliminates that side-effect.
"A good candidate is someone who doesn't want to be thinking about contraception every day," adds Dr. Cheng. "Women who use it are very, very happy with it."
American Academy of Family Physicians
American College of Obstetricians and Gynecologists
The Society of Obstetricians and Gynaecologists of Canada
Women's Health Matters
Last reviewed January 2008 by Ganson Purcell Jr., MD, FACOG, FACPE
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