Non-hormonal Contraceptive Methods – Intrauterine Devices

(Published July 2013)

Description

Intrauterine devices (IUDs), also referred to as intrauterine contraception (IUC) or the intrauterine system (IUS), are long-acting reversible contraceptive method that involves the placement of a small T-shaped device inside the uterus. The Copper T 380A (brand name ParaGard^®) is a non-hormonal IUD (another IUD available in the US, brand name Mirena^®, contains the hormone levonorgestrel). IUDs have among of the highest patient satisfaction and continuation rates.¹⁸

Use

The Copper T IUD contains polyethylene with Copper along the vertical stem and horizontal arms. A polyethylene string is secured to the device, allowing for easy removal. It is placed in the uterus during an office visit.

• The Copper T IUD is approved for 10 years of use, although studies have shown it to be effective for as long as 20 years.¹⁹

• The device causes an immune response that creates a hostile environment for sperm, thereby preventing fertilization of an ovum. In addition, it appears that the device also disrupts the normal division of oocytes and the formation of fertilizable ova.²⁰
• The Copper T IUD can be used off-label as emergency contraception. It can be inserted up to 5 days after unprotected intercourse and reduces the risk of pregnancy by more than 99 percent.²¹

Effectiveness

• IUDs are extremely effective. The Copper T IUD is effective immediately after insertion and has a failure rate of 0.8 percent with typical use.⁷

Risks

• Complications associated with IUDs include uterine perforation during the insertion procedure.
• Because bacteria may be introduced into the uterus during IUD insertion, there is a slight increased risk of infection during the first month of use.
• IUD poses no increased risk of infections or infertility associated with pelvic inflammatory disease (PID) beyond the first month of use.²³
• Expulsion of the device occurs in 2 to 10 percent of users within the first year.²²
• Expulsion may be more common in nulliparous women.²²
• Providers can consider obtaining gonorrhea and chlamydia cultures for women at risk of STIs at the time of IUD insertion. If results are positive, antibiotic treatment should be started, but there is usually no need to remove the device.²⁴
• The risk of unintended pregnancy with this method is less than 1 percent.⁷

Side Effects

• The Copper-containing IUD increases the duration and amount of menstrual bleeding, resulting in approximately 50 percent greater blood loss.^25-27
• Women with heavy or painful menses may not tolerate this IUD

Contraindications and Precautions

Advantages

• Long-term method (10 to 20 years)
• Discreet
• Extremely effective
• After up-front cost, cost-effective for term of use
• Rapid return to fertility after removal
• Can be inserted any time during menstrual cycle when
  pregnancy can be excluded
• Can be inserted immediately after abortion or delivery (i.e., after placenta is delivered) or as long as 4 weeks afterward
• Lack of hormones makes IUDs appropriate for smokers older than age 35, postpartum women who are breastfeeding, and others with contraindications to estrogen or progestin

Disadvantages

• Requires visit to trained clinician for insertion and removal
• Some risk of expulsion within first year
• No protection against STIs
• May make menses heavier and longer

Counseling Messages

• The Copper T IUD is an excellent contraceptive choice for women who desire a highly effective and long-term but reversible method of contraception.
• Women who want reassurance about the placement of the device can check for presence of the string, although checking on a regular basis is not necessary.
• It is important for women to be aware of the warning signs of expulsion and infection.
• Follow-up visits after IUD insertion are important.
• This method does not protect against STIs.