Intrauterine Devices

Intrauterine Devices
The intrauterine device (or coil) has been in use for over a century. It is a foreign object placed in the uterus through the cervix to prevent pregnancy. It is attached to a string which extends through the cervix allowing easy removal by pulling the string. It provides contraception through a number of different effects. Impaired sperm motility, ovulation prevention, destruction of the ovum and alteration of the endometrium so that implantation is not possible.
The IUD has a reported effectiveness of more than 99%, making it equally 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 non-hormonal. The Paragard (the copper T380A IUD) is made of copper and is approved for use up to 10 years. The failure rate is 1.9/100 women over 10 years which is comparable to female sterilization. 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 so has possible effectiveness of up to 7 years. Its 1 year failure rate is 0.2/100 women. This IUD has the additional benefits of decreased blood loss with menses. Some women don’t even have a period due to the effect of the progestin. Thus it is a treatment option for women with heavy irregular periods, painful periods and those with endometriosis.
As with all procedures, there are potential risks and undesirable side effects. Expulsion is the major concern which occurs in 2-10% of users over one year. The likelihood of expulsion occurs when it is placed immediately postpartum or if it is placed in a uterus with a size outside of the recommend parameters of 6-10 centimeters. There is also the potential of uterine perforation at the time of insertion but this is extremely unlikely, occurring in 1/1000 insertions. Heavy bleeding, prolonged bleeding and pain are the most common reasons for removal and this occurs in 3.6-24% of users.
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. If you elect to use the progestin device there is the bonus of a reduction or even absence of menstrual blood flow.
I hope this article has provided you with information that will help you make wise choices, so you may:

Live healthy, live well and live long!


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