Q&A Topic: The IUD Contraceptive Device

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Elisa E. Burns, MD, FACOG

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Q. Should I consider using an IUD as a contraceptive? I’ve heard about problems.

A.  The warning you may have received was probably the result of lingering stigma from charges against a certain type of IUD decades ago – charges fully disproven. In the 1960s, the IUD was a popular form of birth control in the U.S. Problems developed in the 1970s when there appeared to be evidence linking the Dalkon Shield IUD with a higher rate of pelvic inflammatory disease in young women, which caused them to become sterile. The culprit appeared to be the string at the end of the device that projected from the cervix, letting the IUD be pulled from the uterus. The Dalkon Shield’s multifilament string apparently trapped bacteria, which entered the uterus. By 1976, the Dalkon shield was off the market. But with more research, the truth came to light. The supposed risks of this brand and of all IUDs were disproven. The probable cause of the higher rates of pelvic inflammatory disease was bacteria from untreated gonorrreah or chlamydia, two sexually transmitted diseases.Over the last five to ten years, as new IUDs have come on the market and the device’s high rate of effectiveness and safety has been repeatedly affirmed, the IUD has become increasingly popular with American women.

Q. How does the IUD work?

A. Also called the “coil,” it’s a small, T-shaped, mostly plastic device that is inserted in the uterus. It works by both disrupting fertilization of the egg by the sperm and preventing implantation of a fertilized egg in the uterus.

Q. How effective is the IUD as a contraceptive?

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A. The IUD has always been the most effective form of birth control other than having your tubes tied. It’s 99 percent-plus effective. What’s more, the implantable, long-acting, reversible contraception it offers is exactly what young people need. Unlike with birth control pills, you don’t need to remember to do anything, and this actually gives the IUD an edge in effectiveness over the pill.

Q. Do I have a choice of type of IUD?

A. Yes. One type is plastic that incorporates copper, which damages sperm, preventing them from joining with eggs. This type is effective for 10-plus years. The hormonal IUD is all-plastic and releases low levels of the naturally-occurring hormone progesterone, making the inside of the uterus fatal to sperm. It’s effective for up to five years.  Both types also cause changes in the uterine lining that prevent implantation of a fertilized egg.The two kinds of IUD are equally effective. It’s a question of personal preference. The fact that the non-hormonal type stays in long-term makes it more convenient. Yet periods can be heavier and crampier, and some women don’t like the idea of taking a hormone. The hormonal IUD makes periods lighter and less painful. And unlike with birth control pills, the hormone is localized:  Only a very small amount is absorbed into the rest of your body.

Learn More About Dr. Burns
Director, Quality & Outcomes
Institute for Robotic & Minimally Invasive Surgery
Northern Westchester Hospital

Northern Westchester Hospital is a proud member of Northwell Health.

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Read Past Topics from Dr. Burns:
Robot-Assisted Gynecologic Surgery
Pelvic Organ Prolapse
The Pap Test

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