CWC Article - The IUD

The IUD

By: Bradley G. Goldberg, M.D.

The intrauterine device (IUD) is used by an estimated 90 million women world wide. This makes it the most widely used method of reversible contraception in the world, being especially popular in the Scandinavian countries such as Sweden, Norway, and Finland. Unfortunately, in the United States, less women use this method than in any other developed country in the world.

The reason for this low rate of use among American women stems from a fear of infection that really is no longer an issue. This fear was the result of problems surrounding a particular brand of IUD called the Dalkon shield, which has been off the market since 1974. The Dalkon shield was very different from currently available IUD’s, and had several design flaws which led to a rate of pelvic infection that was up to eight times higher than that seen with other available devices.

Modern IUD’s are very safe and effective. The two that are currently available in this country are the Copper T380 (ParaGard) and the hormone-releasing Progestasert and Mirena, which continuously release the female hormone progesterone. Although the Progestasert must be changed yearly, Mirena lasts for 5years and the copper containing ParaGard can be left in place for up to ten years. Since the only costs involved are related to the initial insertion fee and the price of the IUD itself, the copper IUD is the least expensive reversible contraceptive available, with an average monthly cost of about $5, assuming 10 years of use.

Currently, the copper containing IUD has been tested in over 9,000 women in studies that began in 1972 and its safety has been proven. Although there is a slight risk of pelvic infection in the first 3-4 months after insertion, after this time period the risk is the same as for non-users. For women who are in monogamous relationships, the risk of infection is very low, or non-existent. In addition, your doctor can prescribe antibiotics at the time of insertion which could decrease this risk even further.

The IUD’s currently available have extremely low pregnancy rates, and are over 99% effective. This is more effective than the typical use of either condoms or the pill. Another important point is that the IUD does not cause abortions, it works by interfering with the sperm passage through the uterus, and actually creates an environment in the uterus that is spermicidal. Although it does also prevent implantation, this is not the mechanism that makes it effective.

The IUD can be inserted in your doctors office in about 5-10 minutes. It is a "T" shaped device that is placed within the uterine cavity through the natural opening of the woman’s cervix. Side effects can include cramping and heavier periods, although these can usually be controlled with mild medications.

The IUD is not for everyone. Good candidates are women who have had at least one child, are in a stable, faithful relationship (which minimizes the chance of exposure to sexually transmitted infections), desire reversible contraception, and have no recent history of or current pelvic inflammatory disease (pelvic infection). If you think this might be the method for you, please discuss it further with your physician.

Bibliography

1. Another look at the Dalkon Shield: meta-analysis underscores its problems. Sivin, I.,
Contraception 1993 Jul; 48(1): 1-12.

2. ParaGard T380A, Product Monograph, 1996, Excerpta Medica, Inc., Princeton, NJ.

3. Novak’s Gynecology, Twelfth Edition, Jonathan S. Berek, M.D.,
Williams & Wilkins Baltimore, 1996.

4. The Intrauterine Device, ACOG Technical Bulletin #164, February 1992.