HEALTH SERVICES

IUD

What is it?
Intrauterine devices or IUDs are small, "T-shaped" contraceptive devices made of flexible plastic. IUDs are available by prescription only. A woman and her clinician decide which type is right for her, and the clinician inserts it in her uterus to prevent pregnancy. Two types are now available in the U.S.:

• ParaGard (Copper T 380A) — contains copper and can be left in place for 12 years

• Mirena — continuously releases a small amount of the hormone progestin, and is effective for five years

Both kinds of IUDs work by preventing sperm from joining with an egg by affecting the way they move. The hormone in Mirena increases effectiveness. It thickens cervical mucus, which provides a barrier that prevents sperm from entering the uterus. It also prevents some women's ovaries from releasing eggs (ovulation).

IUDs also alter the lining of the uterus. In theory, this may prevent pregnancy by preventing the implantation of a fertilized egg — but this has not been scientifically proven.

IUDs have a string attached that hangs down through the cervix into the vagina. A woman can make sure the IUD is in place by feeling for the string in her vagina. A clinician uses the string to remove the IUD.

Getting an IUD
You must see a clinician to find out if you can use an IUD.

• Your Medical History — Your clinician will ask questions about your medical history and lifestyle. It is very important to be open and honest about your sex life because the IUD isn't right for all women. For example, your clinician will want to know what risks you may take for getting sexually transmitted infections because the IUD provides no protection against them.

• The Pelvic Exam — Your clinician will check to be sure your cervix, vagina, and internal organs are normal and not infected. You may be tested for sexually transmitted infections, such as gonorrhea or chlamydia, vaginal infections, precancerous cervical cells, or any other condition that needs to be treated.

• Scheduling the Insertion — An IUD can be inserted at any time. However, insertion may be more comfortable midcycle, when the cervix is naturally dilated.

Before insertion

• Be sure to read the package insert that comes with the IUD.

• Discuss any questions you have with your clinician.

• Learn how to watch for possible side effects or other problems

How effective is it?
99%

Upside

• Nothing to put in place before intercourse, increases spontaneity

• Doesn’t change hormone levels

• May reduce menstrual cramps and flow

• The ability to become pregnant returns quickly when IUD use is stopped

• Can reduce the risk of pregnancy by 99.9% if inserted within five days after unprotected vaginal intercourse

Downside

• Changes to menstrual flow

• Spotting between periods is common with IUD use

• May cause a 50 to 75% increase in menstrual flow; in some cases this may lead to anemia

• Menstrual cramps or backaches

Tell your clinician immediately if you

• Find that the string length has become shorter or longer

• Are not able to feel the string

• Feel the hard plastic bottom of the "T" of the IUD against the cervix

• Think you might be pregnant

• Have periods that are much heavier or last much longer than usual

• Have severe abdominal cramping, pain, or tenderness in the abdomen

• Have pain or bleeding during sex

• Have unexplained fever and/or chills, flu-like symptoms - muscle aches, fatigue

• Have unusual vaginal discharge

• Have a missed, late, or unusually light period

• Experience unexplained vaginal bleeding