What is an Intrauterine Device?
An IUD is a small, flexible T-shaped object that is placed in the uterus during a physicians visit to protect against pregnancy. IUDS are one of the most commonly used birth control methods around the world. IUDS are extremely effective at preventing pregnancy (99.2-99.9% effective), but provide no protection against sexually transmitted infections. Currently, two types of IUDs are available in the United States: the ParaGard Copper T 380A and Mirena. The Copper T works by using copper to prevent pregnancy and is effective for up to 12 years, while Mirena releases a form of progestin called levonorgestrel and is effective for 5 years. An IUD can be removed easily by a physician at any time. Both types of IUDs have a plastic string attached to the bottom of the "T". The string is long enough to be felt with a finger, but it cannot be seen outside of the vagina. The position of the string should be checked after each menstral cycle to ensure that it is positioned near the cervix, but not inside the uterus.
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How it Works
Both IUDs are effective because of their ability to immobilize sperm, and resist implatation onto the uterine wall. Mirena and Paragard work uniquely to prevent pregnancy.
ParaGard can be used as an emergency contraceptive device as the copper fillament in Paragard works immediately to prevent implantation by changing the lining of the uterus. Because of this, even if a sperm does fertilize the egg, the embryo cannot attach itself to the endometrium (uterine lining).
Mirena releases small amounts of the synthetic progesterone suppliment named Levonorgestrel which thickens cervical mucus thereby making it difficult for the sperm to enter the uterus. Also, like the ParaGard, it prevents implantation by changing the uterine lining.
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How Do I Get an IUD?
IUDs are inserted into the uterus by a doctor. Before the doctor actually inserts the IUD, there are a series of steps to make sure that it is an appropriate method of birth control for the individual woman.
Before Instertion:
- Medical History: The doctor will ask you about your medical history and your lifestyle. It is extremely important to be completely honest about your sex life because the IUD is not always the best choice for some women.
For example, the doctor will want to make sure that the woman is in a monogamous relationship (she only has sex with one other person and that person has no other sex partners).
- Pelvic Exam: The doctor will perform a pelvic exam to make sure both the cervix and the vagina are normal.
- Bimanual Exam: After the pelvic exam, the doctor will feel the size, shape, and position of the uterus and ovaries by putting one or two fingers into the vagina and placing the other hand on the abdomen.
Planning the Insertion: While the IUD can be inserted at any time, usually the most comfortable time is during the woman's period because at that time the cervix is softer. Also, the menstrual fluid acts as lubrication for the insertion, and the woman's chance of being pregnant during menstruation is very low.
The Insertion Process: Sometimes the doctor will tell the woman to take an over-the-counter painkiller to reduce the cramps that the insertion may cause. Additionally, the doctor might give the woman an antibiotic to prevent against possible infection as a result of insertion.
For the actual insertion, a doctor will use a speculum to hold the vagina open. Then an instrument called a tenaculum keeps the uterus steady by attaching to the cervix. Sometimes the doctor measures the length of the uterus and cervical canal with a tool called a sound. Finally, the doctor inserts a tube containing the IUD. The arms of the T bend back as the IUD is pushed into place; once it is placed, the arms open up into the standard T shape.
Everything but the IUD is removed, leaving the string hanging through the cervix into the vagina.
Sometimes during insertion, cramping can occur and be somewhat uncomfortable. By breathing slowly and deeply the woman may reduce the discomfort. While most women sail through the insertion with nothing more than mild cramps, some women with sensitive cervical tissue may need a local anesthetic.
After Insertion: Doctors usually recommend having someone there to drive or escort the woman home. Once she is home, she should rest until she is comfortable.
Most women don't have problems adjusting to their new IUDs; however, some women can take several months to fully adjust. There can be heavy bleeding and cramping during the first few months, but doctors can prescribe medication to reduce bleeding and cramps.
After the woman's first period with the IUD, she should go in for a check up to make sure it is still in place. Also, all women with IUDs need to check them regularly between periods and examine their pads or tampons each day during menstruation to make sure the IUD was not expelled. Finally, every woman should go to the doctor at least once a year in order to make sure her IUD is as it should be.
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Checking the IUD
A woman can check her IUD by feeling for the string that dangles into the vagina. She should check often when she is between periods, and she should also look closely at her pads or tampons to make sure the IUD didn't fall out during menstruation.
To feel for the string, a woman should...
- wash her hands, then sit or squat.
- put her finger into her vagina until she reaches the cervix, which feels a lot like the tip of the nose.
- find the string that comes through the cervix. If it feels longer or shorter than normal, or if it is no longer there, the IUD might have moved. In this case, a woman should call her doctor so it can be repositioned; also, the woman should use another form of birth control until she sees her doctor.
- NEVER PULL ON THE STRING Pulling can change the placement of the IUD or even make it come out.
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Is something wrong with my IUD?
If you cannot feel the string or if you think you might be pregnant, call your doctor immediately. For other warning sign, remember "PAINS":
P--period late or no period
A--abdominal pain
I--increased temperature, fever, or chills
N--nasty or foul discharge
S--spotting, unexplained bleeding, unusually heavy or light periods
If you have any of these warning signs, call your doctor immediately!
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Effectiveness
The failure rate for the IUD is less than 1%, making it one of the most effective non-permanent forms of birth control in the world.
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What are the advantages of an IUD?
- Extremely effective in protecting against pregnancy
- One of the least expensive methods of birth control on the market
- Does not interrupt lovemaking
- Women who cannot take hormones can use the Copper T
- Mirena can lessen the amount of blood lost during menstruation; 20% of women eventually stop having periods.
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What are the disadvantages of an IUD?
- Increased risk of infection in the first 4 months
- Can be expelled (pushed out) without the woman knowing it
- The Copper T can increase menstrual blood loss and increase menstrual cramps
- It is very rare, but possible, that the IUD punctures the uterus (this happens in 1 to 3 out of 1,000 insertions).
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Cost
The cost of the entire process—exam, insertion, and follow up—ranges from $250 to $450. Medicaid covers these costs. Also, considering that you can use the Copper T for up to 10 years and Mirena for 5 years, the cost works out to be less per year than most other types of birth control.
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Is an IUD Right for me?
IUDs work best with women who:
- are in a monogamous relationship because IUDs do not prevent against sexually transmitted diseases.
- have not had PID, gonorrhea, or chlamydia in the past year.
- have given birth to at least one child (the IUD is less likely to be expelled).
You should not use an IUD if you:
- currently have a sexually transmitted bacterial infection like chlamydia or gonorrhea.
- had an abnormal Pap smear that has not been resolved.
- have abnormal bleeding, eptopic pregnancy, severe anemia, or a history of uterine fibroid tumors.
- have cervical or uterine cancer.
- do not have access to medical care in case of a problem.
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But I heard they were dangerous!
In the 1970s, IUDs were extremely popular. At that time, the FDA did not test IUDs, so faulty and poorly designed IUDs were on the market. The most notorious one was the Dalkon Shield. This IUD had a braided string which allowed bacteria to grow, causing PID (pelvic inflammatory disease); if untreated, PID can lead to infertility. However, now the FDA tests IUDs, and the ones on the market now are much safer than ever before.
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