Intrauterine devices (IUDs) are small, flexible, T-shaped plastic devices that are inserted into the uterus. In the United States, 12% of women who use contraception use IUDs. IUDs are popular because of their advantages as a contraceptive method, including being highly effective and having minimal side effects. Also, IUDs need to be changed only every 3, 5, 8, or 10 years, avoiding the need to use a daily, weekly, or monthly contraceptive method.
IUDs must be inserted and removed by a doctor or other health care professional. Insertion takes only a few minutes. Insertion may be painful, so an anesthetic may be injected into the cervix before the IUD is inserted. Removal usually causes minimal discomfort.
IUDs prevent pregnancy by
Killing or immobilizing sperm
Preventing sperm from fertilizing the egg
Creating an inflammatory reaction inside the uterus that is toxic to sperm
Understanding Intrauterine Devices
copper wire wrapped around the base and on the arms of the T. A plastic string is attached to the IUD. The string enables a woman to make sure the device is still in place and a doctor to easily remove it. |
copper IUD.
The copper IUD is effective for at least 10 years. When it is left in place for 12 years, fewer than 2% of women become pregnant.
One year after removal of an IUD, 80 to 90% of women who try to conceive do so.
Most women, including those who have not had children, and adolescent girls, can use IUDs. However, IUDs should not be used when the following conditions are present:
A pelvic infection, such as a sexually transmitted infection or pelvic inflammatory disease
A structural abnormality that distorts the uterus
Unexplained bleeding from the vagina
Cancer of the cervix or cancer of the lining of the uterus (endometrium)
Pregnancy
For copper IUDs, Wilson disease or an allergy to copper
Having had a sexually transmitted infection, pelvic inflammatory disease, or a mislocated (ectopic) pregnancy in the past does not prevent women from using an IUD.
Personal beliefs that prohibit abortion do not prohibit the use of IUDs because IUDs do not prevent conception by causing a fertilized egg to be aborted. However, when used for emergency contraception after unprotected sex, a copper
An IUD may be inserted at any time during the menstrual cycle if women have not had unprotected sex since their last period. If they have had unprotected sex, a pregnancy test must be done before an IUD is inserted, and women are advised to use another method of contraception until the test is done. Pregnancy must be ruled out before the IUD is inserted unless women wish to use an IUD as emergency contraception after unprotected sex. In such cases, a copper IUD may be inserted to prevent unwanted pregnancy. If inserted within 5 days of one episode of unprotected sex, a copper
Before the IUD is inserted, doctors may recommend testing for sexually transmitted infections (STIs) based on a woman's risk factors. However, doctors do not need to wait for STI test results before inserting the IUD. If results are positive, the STI is treated, and the IUD is left in place. If doctors observe a discharge that contains pus just before the IUD is to be inserted, an IUD is not inserted. In such cases, STI testing is done, and antibiotics are started immediately, without waiting for test results. The IUD is then inserted after treatment of the infection is complete.
Before insertion, an anesthetic may be injected into the cervix to decrease pain during insertion.
An IUD may be inserted immediately after a miscarriage or an abortion that occurs during the 1st or 2nd trimester and immediately after the placenta is delivered after a cesarean delivery.
Photograph © Hank Morgan/Photo Researchers Inc.
The uterus is briefly contaminated with bacteria at the time of insertion, but an infection rarely results. IUD strings do not provide access for bacteria. An IUD increases the risk of a pelvic infection only during the first month of use. If an infection develops, it is treated with antibiotics. The IUD can be left in place unless the infection persists after treatment.
A routine follow-up visit after IUD insertion is not necessary. However, women should see their doctor if they have problems such as pain, heavy bleeding, abnormal vaginal discharge, or fever, if the IUD is expelled, or if they are dissatisfied with the IUD.
Possible problems
Bleeding and pain are the main reasons that women have an IUD removed, accounting for more than half of all removals before the usual replacement time. The copper
Typically, IUDs are expelled in fewer than 5% of women during the first year after insertion, often during the first few weeks. Sometimes a woman does not notice the expulsion. Plastic strings are attached to the IUD so that if she wishes, a woman can check every so often to make sure that the IUD is still in place. However, a woman typically has bleeding or pain if an IUD is expelled or is in the wrong position. If another IUD is inserted after one has been expelled, it usually stays in place. If doctors suspect that the IUD has been expelled, women must use another form of birth control until the problem is resolved.
Rarely, the uterus is torn (perforated) during insertion. Usually, perforation does not cause symptoms. It is discovered when a woman cannot find the plastic strings and ultrasonography or an x-ray shows the IUD located outside the uterus. An IUD that perforates the uterus and passes into the abdominal cavity must be surgically removed, usually using laparoscopy, to prevent it from injuring and scarring the intestine.
If women conceive with an IUD in place, they are more likely to have a mislocated (ectopic) pregnancy. Nonetheless, the overall risk of an ectopic pregnancy is much lower for women using IUDs than for those not using a contraceptive method because IUDs prevent pregnancy effectively.
Possible benefits
In addition to providing effective birth control, all types of IUDs may reduce the risk of uterine (endometrial) cancer and cancer of the ovaries.
The copper IUD can provide effective contraception for women who cannot use hormonal methods.
