Guest Author - Denise Howard, M.D., M.P.H,

Looking for a birth control that is highly effective, low risk, reversible and requires little effort to use? Consider the intratuterine device.

An intrauterine device is placed in the uterus through the. It is attached to a string which extends through the cervix allowing easy removal by pulling the string. They provide contraception through a number of different effects. Impaired sperm motility, ovulation prevention and alteration of the endometrium so that implantation is not possible are a few of the proposed mechanisms.

The IUD has a reported effectiveness of >99%, making it equally or more effective as permanent sterilization. It can be easily inserted and removed in the doctor’s office. The risk of complications is low and can be minimized by appropriate selection of candidates. This is a good option for women who are not good candidates for hormonal contraception and those who want a simple method of contraception but are not ready to undergo a permanent procedure.

Currently there are 2 types available in the U.S. One is hormonally based and the other nonhormonal. The Paragard (the copper T380A IUD) is made of copper and is approved for use up to 10 years. There is a possibility that this maybe extended to 12 years. The Mirena contains the hormone levonorgestrel which is a progestin hormone. It releases the hormone directly into the endometrium at a rate of 20 mcg a day. It is approved for 5 years but continue to release 14 mcg per day during year 5-7. The Mirena IUD has the additional benefit of decreased blood loss with menses. Some women don’t even have a period due to the effect of the progestin. Thus, the Mirena IUD is a treatment option for women with heavy irregular periods, painful periods and those with endometriosis.

The IUD is also an effective tool for Emergency contraception. Emergency contraception is also available in a pill form. Progestin only pills or certain estrogen/progestin combination pills can be taken. Plan B is a pill that is specifically manufactured for use as emergency contraception. If emergency contraception (also called the morning after pill) is utilized, it should be given as soon as possible after pregnancy exposure but no later than 120 hours after the event. The success varies and is dependent on the timing within the cycle that it is taken. It reportedly results in a 89% reduction in pregnancy. It works through varies mechanisms: ovulation prevention, impairing the endometrium and inhibiting fertilization.

The intrauterine device should be entertained by all women who are in a monogamous relationship, desires effective, easy contraception but are not yet ready for permanent sterilization. A bonus if you elect to use the Mirena is a reduction or even loss of menstrual blood flow.