The intrauterine device, often called an IUD, is a small T-shaped device that is inserted through the cervix into the uterus by a medical professional. At The Woman’s Health Pavilion, we offer a range of FDA-approved IUD options for women in Queens and on Long Island. Today’s devices provide effective contraception for 3, 5, or 10 years, depending on which type of IUD is used. When the IUD reaches its expiration date—or anytime earlier if a woman wishes—the IUD is removed by a medical professional. Fertility is expected to return immediately after the IUD is removed.
The Woman’s Health Pavilion offers a range of contraceptive solutions. To find the right one for you, request an appointment with a gynecologist or support staff at any of our Long Island locations. We see patients 7 days a week and offer same-day appointments for urgent conditions.
Birth Control You Can Count On
The IUD provides a very reliable form of birth control, chiefly because it doesn’t rely on the user to do anything.
- You don’t have to fill prescriptions.
- You don’t have to remember to take pills.
- You don’t take any special precautions prior to intimacy.
- You just “set it and forget it.”
Failure rates with “perfect use” and “typical use” are basically the same: Pregnancy is reported in well under 1% of users per year. Importantly, however, among women who do get pregnant with an IUD in place, many pregnancies are ectopic, developing in the tubes. Since this is a serious medical condition, women with an IUD in place who suspect they may be pregnant must be evaluated by a physician urgently.
Types of IUDs
The 5 types of IUDs currently available in the United States are:
- Skyla® and Liletta® are 3-year devices
- Mirena® and Kyleena® are 5-year devices
- Paragard®is 10-year device
Hormone-Releasing IUDs
Liletta, Skyla, Kyleena, and Mirena all contain a tiny amount of a hormone called levonorgestrel impregnated into a plastic core; each of these IUDs slowly releases levonorgestrel into the uterine cavity. Importantly, the amount of hormone released by these devices is infinitesimally small and intended to act locally on the inner uterine lining.
Levonorgestrel-containing IUDs barely alter blood levels of hormones: To put this in perspective, consider that the Mirena device releases less than 20 micrograms per day of levonorgestrel, much of which is not absorbed into the blood, while typical birth control pills contain 100 or 150 micrograms of levonorgestrel designed to be completely absorbed. As such, systemic (whole-body) side effects are expected to be minimal with any of the levonorgestrel-containing devices.
Copper IUD
While levonorgestrel-containing devices rely on a tiny amount of hormone to provide contraception, the Paragard device contains no hormones; instead, the device itself is made of copper, which is spermicidal (i.e., it kills sperm). The chief side effect, which limits the popularity of Paragard, is heavy bleeding: The Paragard device is notorious for causing heavy periods. This does not happen in all women, but it is common enough for us to warn patients to expect it. Levonorgestrel-containing IUDs were introduced to eliminate this problem: The small amount of levonorgestrel contained in Liletta, Skyla, Mirena, and Kyleena is intended to make periods much lighter. In fact, for many women menstrual flow may be so light that it is essentially nonexistent: About 50% of women using Mirena report no periods after 6 to 12 months of use.
Is it OK to miss my period?
There is nothing unhealthy about missed periods when a levonorgestrel-containing IUD is in place. The small amount of hormone in the IUD is specifically designed to keep the lining of the uterus (the endometrium) very thin, so there is very little to be expelled during a period. Thus, women don’t get a period, but it’s not because blood or tissue is “backed up,” it’s simply because there’s no blood or tissue built up to be expelled. When the IUD is eventually removed, women’s periods are expected to revert to normal.
For many women—especially those who suffer from heavy periods — the very light periods associated with hormone-containing IUDs are a welcome relief. In fact, we sometimes use these IUDs to treat women with heavy periods. It is important to note, however, that most women using an IUD will have disorganized and sometimes annoying bleeding for the first 3 to 6 months after insertion. Typically, this bleeding is not heavy, but may take the form of staining which lingers after a period, or reappears between periods. After women “get over the hump” of the first 3 to 6 months, they get to enjoy light, regular periods (or no periods at all).
Levonorgestrel-containing IUDs are sometimes helpful for managing menstrual cramps also. We’ve found this to be particularly true in women who have their worst cramps on their heaviest flow days: Since these IUDs markedly reduce menstrual flow, cramps related to heavy flow and passage of clots may very well be relieved after an IUD is inserted.
IUD Insertion
Insertion of all types of IUDs is generally performed during an office visit. At The Woman’s Health Pavilion, we generally obtain cervical cultures prior to inserting an IUD. Once we have confirmed there are no significant cervical infections, insertion is scheduled during your period because:
- Insertion is easier because the cervix tends to be naturally open at this time of the month.
- We can be sure you’re not pregnant at the time of insertion.
Insertion is uncomfortable, but the discomfort only lasts a few minutes for most women. Women describe the discomfort of IUD insertion as being like bad menstrual cramps or (for those who have had children) a labor contraction. We encourage women to take 400 mg of ibuprofen 60 minutes before IUD insertion to minimize cramping. Cramps are expected to resolve shortly after insertion; we generally expect women to feel fine later that same day. Certainly if cramping persists or worsens after IUD insertion, women should return to the office for evaluation.
IUD Risks
While IUDs provide effective, long-term contraception and rarely cause serious problems, there are some possible risks, which include:
- Perforation
- Expulsion
- Infection
Perforation
Perforation indicates that the device, on insertion, may be actually be pushed through the muscular wall of the uterus. Perforation may be noticed immediately by the provider inserting the device, or may become apparent some time later when the IUD causes pain, bleeding, or other symptoms. Should perforation occur, women will need to use an alternate method of contraception, and their existing IUD will need to be removed. In many cases, perforation will require at least a laparoscopic look at the perforated IUD, to make sure it is not attached to surrounding structures like the intestine. Generally, a perforated IUD can be removed, and the remaining defect in the uterine wall will heal without difficulty.
Expulsion
Expulsion refers to the IUD being expelled from the uterus. In some cases the IUD may be completely expelled, or more commonly, it may be displaced from its proper position. If an IUD is not sitting properly in the uterine cavity, women will likely notice cramps and persistent bleeding. Women who have an IUD are supposed to reach deep into their vagina every month to feel for their IUD string; if the string can’t be felt, or if the hard tip of the IUD itself is felt, a medical evaluation is essential. Obviously, if the IUD is not seated properly inside the uterus, it cannot be relied upon to prevent pregnancy.
While IUD expulsion is uncommon, certain groups of women are more at risk of expulsion. You are more likely to experience expulsion if you:
- Have fibroids
- Have not had children
- Are postpartum
We suspect that many of the “expulsions” that occur are probably because the devices were never seated correctly in the uterus in the first place. Interestingly, when physicians are taught how to insert an IUD, checking the placement with ultrasound is NOT considered routine or obligatory. It is nonetheless our custom at The Woman’s Health Pavilion to check IUD placement immediately after insertion. If we are dissatisfied with an IUDs position after placement, we remove it immediately and re-insert a new device. Perhaps this is why we see so few subsequent expulsions: An expulsion rate of 5% is typically quoted, but we see far fewer expulsions in our practice.
Infection
Infection can occur after placement of an IUD. The risk of infection is low and is generally limited to the first few weeks after insertion. Women with an insertion-related infection may notice persistent discomfort (which is not normal after insertion) and/or staining, or may have fever or chills. These infections can occasionally be serious, so medical attention is advised. In some cases the IUD may have to be removed, but some women can be successfully treated with antibiotics while keeping their IUD.
A unique propensity to cause infection was at the heart of the infamous Dalkon Shield saga, which gave IUDs a “bad rap” in this country for decades. From 1970 to 1974, an IUD called the Dalkon Shield was available and marketed heavily to medical professionals. Because of a serious design flaw—together with some unconscionable corporate behavior—many women suffered serious pelvic infections after insertion of a Dalkon Shield. The design feature that made the Dalkon Shield especially likely to cause infection was identified in the 1970s (its multi-filament tail had a tendency to ‘wick’ vaginal fluids and bacteria into the uterus) and the IUD was pulled from the market in 1974.
The public memory of this fiasco still lingers today: Many women are still vaguely fearful of IUDs, even if they can’t remember why. IUDs available today do not have the faulty multifilament tail design, and are not nearly as likely to cause serious infections.
The best candidates for an IUD are women in long-term monogamous relationships, because this minimizes the risk of infection associated with IUD use.
Is an IUD right for me?
The best candidates for an IUD are women in long-term monogamous relationships, because this minimizes the risk of infection associated with IUD use. Women who have already had children will find IUD insertion easier, and will have less risk of expulsion, but IUDs can safely be used in women without children as well. In fact, IUDs are an especially good choice for young women who might otherwise be unreliable with other forms of contraception. You can get more information specific IUDs at the websites listed above. If you are considering an IUD for contraception, we can answer your questions during your consultation at The Woman’s Health Pavilion.
