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Intrauterine Devices (IUDs)

What isIUC.jpg an IUD?

An IUD (an acronym which stands for intrauterine device) is a small plastic device that is inserted into a woman's uterus by a clinician.  It provides highly effective, safe, and convenient birth control. The IUD is associated with an annual pregnancy rate of less than 1 out of 100 users, making it one of the most effective reversible birth control methods available today.  The IUD has been found to be about 20 times more effective than birth control pills.

The three brands of IUDs available in the United States are ParaGard, which uses a copper wire wrapped around the plastic device, and Mirena and Skyla, which contain a hormone called levonorgestrel.

ParaGard can remain in place up to 10-12 years and is completely non-hormonal. It sometimes causes heavier periods and increased cramping. ParaGard is also FDA-approved as emergency contraception, up to 5 days after unprotected sex..

Mirena must be replaced every 5-7 years, Skyla every 3 years.  The progestin hormone in Mirena and Skyla typically causes shorter and lighter periods.  In addition, the Mirena is FDA-approved as a treatment for heavy periods.

How does the IUD work?

The IUD works by preventing pregnancy before conception occurs.  ParaGard, Mirena and Skyla probably work quite differently:

ParaGard IUD causes an inflammatory reaction in the lining of the uterus that interferes with sperm transport.  In addition, copper is toxic to sperm.  The few sperm actually reaching the egg are unlikely to accomplish fertilization.

The progestin hormone in Mirena and Skyla IUDs causes the cervical mucus to become very thick and impenetrable to sperm. In addition, it causes the lining of the uterus to become very thin, which makes the environment inhospitable to sperm and prevents fertilization.

Who can use an IUD? 

Almost all women can use the IUD. The American College of Obstetricians and Gynecologists recommends the IUD as a first-line option for young adolescent women. All types of IUDs can safely be used by women who have or haven’t had children in the past.

ParaGard, Mirena and Skyla IUDs should NOT be prescribed for women with:

  • Current cervicitis or current pelvic inflammatory disease (PID)
  • Suspected pregnancy
  • Current abnormal bleeding or abnormal Pap smear that hasn’t been evaluated
  • Certain abnormalities of the cervix, or uterus, such as a uterine septum
  • Rare, serious medical conditions that may increase susceptibility to infections

The ParaGard IUD is NOT advised for women with:

  • Severe menstrual cramps and/or heavy periods
  • Abnormal bleeding or anemia
  • Allergy to copper
  • Blood clotting problems, or use of blood thinners

The Mirena and Skyla IUDs are NOT advised for women with:

  • Allergy to levonorgestrel, silicone, or polyethylene
  • Breast cancer now or in the past
  • Liver disease or a liver tumor

Talk to your clinician or schedule an appointment with Hall Health to determine if an IUD is an appropriate form of contraception for you.

What are the most common side effects associated with using an IUD?

Most women will have spotting and cramping immediately after insertion of an IUD.  The cramping usually subsides over several hours or a few days.  The spotting gradually diminishes, but intermittent spotting between periods may continue for 3-6 months.

With the ParaGard IUD, many women experience increased bleeding, cramping and backache with their periods.  Taking ibuprofen prior to the start of your period usually helps.  The opposite usually occurs with the Mirena and Skyla  IUDs: periods become lighter and cramping less intense; about one third of women stop having periods after a year of Mirena use.

One out of ten women using Mirena will develop a small cyst on the ovary related to ovulation; it usually disappears on its own in a month or two.  Such cysts are usually don't cause any discomfort, but can occasionally cause pain and rarely need surgery.

What risks are associated with IUD use?

Pelvic Inflammatory Disease (PID)

PID is a serious infection of the uterus, fallopian tubes and the ovaries that can lead to infertility, sterility and chronic pain.  The risk of acquiring PID is highest within the first 20 days after IUD insertion.  The rate of PID with IUD placement is less than 1%.

Symptoms of PID include:

  • Abdominal pain
  • Pain with intercourse
  • Vaginal bleeding or discharge
  • Fever. 

Call our clinic at (206) 221-2491 immediately if you experience any of these.

PID is usually sexually transmitted.  Women who have had PID, chlamydia or gonorrhea, or who have more than one sexual partner, or whose sexual partner has other partners, are at a greater risk of getting PID.

Expulsion

During the first year of use less than one out of 10 women may expel their IUD (it may partially or completely come out of the uterus), with the majority of expulsions occurring within the first month after insertion.  Most women who experience expulsions have not had children.  After the first year of use, the chance of expulsion decreases dramatically.  If your IUD is expelled without you realizing it, you could become pregnant.

Perforation of the uterus

Rarely the IUD may puncture the wall of the uterus and move into the abdomen.  Surgery may be necessary to remove the IUD.  The rate of perforations is low (about one in 1000 women each year). The risk of perforation appears to be higher (~5/1000) in women who are breastfeeding.

Pregnancy

A woman who becomes pregnant with an IUD in place should have the IUD removed immediately.  Continuing a pregnancy with an IUD in place has been associated with an increased risk of miscarriage or preterm labor and delivery.  It is not known if Mirena and Skyla can cause long-term effects on the fetus if they stay in place during a pregnancy.   In rare instances women in their second trimester of pregnancy with an IUD in place developed a serious infection related to the IUD.

The IUD overall greatly reduces the risk of ectopic pregnancy (pregnancy that forms outside of the uterus). However, IF a woman becomes pregnant with an IUD in place, it is at a higher risk for being ectopic than if she were using some other forms of contraception.. Five percent of pregnancies occurring with a copper IUD in place are ectopic.  Half of all pregnancies detected during safety testing of the Mirena were ectopic.   A missed period or pregnancy symptoms (nausea, breast tenderness, frequent urination, fatigue) should be reported to your medical provider.  Ectopic pregnancy can cause death if it is not treated in time.

How do I get an IUD? 

Call to schedule an appointment with the family planning counselor.  She will make certain you have a current STI screening and an annual exam with a normal pap smear. The IUD will be placed during a separate appointment.

It is important that you are not pregnant when you have an IUD placed.  If you are not at risk for pregnancy, your IUD can be placed at any time in the menstrual cycle. Otherwise, the IUD must be placed during your period or immediately afterward. Do a home pregnancy test the morning of your appointment for the IUD insertion. A pregnancy test can be performed in the clinic if needed.

We recommend that you eat something and take 600mg or 800mg of ibuprofen 1-2 hours before having the IUD placed.  Before the IUD is placed the clinician will measure the depth of your uterus with an instrument called a “sound.”  The IUD will then be gently placed into the uterus.  There may be some cramping during the insertion and some bleeding afterwards.

For the first 48 hours after your IUD is placed, do not have intercourse or put anything (e.g. tampons) in the vagina.  This will reduce the chance for infection.  For Mirena and Skyla, if you have sex during the next 7 days, use condoms or another reliable contraceptive until the IUD starts working. ParaGard is effective immediately after insertion. Mild cramping may occur for a few days after the IUD is inserted. Acetaminophen (Tylenol) or ibuprofen (Advil, Nuprin) may be used.  If the pain is severe, call our clinic at (206) 221-2491 to speak with a consulting nurse

Following IUD insertion:

  1. Return to the clinic for an IUD check within the following two months, or sooner if you have problems.
  2. Check the IUD string about a month after insertion by putting a clean finger into the vagina and reaching up toward your cervix, which should feel like about a month after insertion by putting a clean finger into the vagina.  Your clinician will show you how to check..  If you or your partner cannot feel the string, or you are concerned that the IUD is no longer in place, call our clinic.  In the meantime, abstain from sexual intercourse or use condoms or some other form of birth control.  Also, call our clinic if the string increases in length. You do not need to check your IUD strings regularly. Never pull on your IUD strings.
  3. Routine annual exams are recommended.

What are the IUD danger signs?

Contact us right away immediately if you have any of the following:

  • Heavy bleeding or cramping
  • Abdominal pain
  • Fever
  • Unusual vaginal discharge or genital sores
  • Irregular bleeding
  • Missed period
  • Pregnancy signs such as nausea, vomiting,  breast tenderness, frequent urination, fatigue
  • Severe or migraine headaches
  • Yellowing of the skin or whites of the eyes
  • Stroke or heart attack
  • Your partner becomes HIV positive

How is the IUD removed?

Most IUDs are removed easily by the clinician.  Removal is best done during a menstrual period, but the IUD can be removed at other times if necessary.  An IUD must be removed before another one can be inserted.

ParaGard IUD must be removed by 10 years, Mirena must be removed by 5 years and Skyla must be removed by 3 years.  The IUD can be removed earlier if a pregnancy is desired or for other reasons.

Never attempt to remove the IUD yourself.

Additional resources

Hall Health's website contains information about the Pill, Progestin-only pills (POPs), the OrthoEvra Patch, NuvaRing, Depo Provera and Nexplanon.  We also offer information about when you need a Pap test.

Bedsider.org provides information about many different birth control methods.

Planned Parenthood's website offers information on the effectiveness of different kinds of birth control methods.

If you have any questions and are a UW student or established Hall Health patient, you may call one of our Consulting Nurses for further information.

 

Authored by: Hall Health Center Women's Health Clinic staff

Reviewed by: Hall Health Center Women's Health Clinic staff, January 2014