Is This Choice Right for You?
Each woman has unique birth control needs. To decide which method is best for you, get the facts and think about what matters most to you. This booklet gives you key facts about IUDs (intrauterine devices, also known as intrauterine contraception). It also includes a framework to help you decide whether IUDs are a good choice for you. At the end are some useful Web sites that can tell you more about this contraceptive method.
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How IUDs Work
In the United States, women can use either of two types of IUD: one contains copper (Copper T 380A, brand name Paragard®), and the other contains the hormone levonorgestrel (LNG, brand name Mirena®). How do they work? A health care provider (HCP), such as a doctor, nurse practitioner, physician assistant, or midwife, inserts the device into the uterus (womb). It is a quick and safe procedure with little discomfort. Both products prevent pregnancy mostly by keeping a woman’s egg and a man’s sperm from meeting. Copper disrupts sperm movement. The hormone helps block sperm from getting into the uterus. Both products also may make it harder for an egg to reach or attach to the uterus.
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“I didn’t know much about intrauterine contraception before I started looking for a new birth control method. I found that IUDs had a lot of features I wanted — and women almost never get pregnant with one in place.”
– Jennifer, Salinas, CA
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IUD Facts You Should Know…
IUDs Are Highly Effective Birth Control
No birth control method is foolproof — except not having sex at all. But IUDs work even better than other very effective types of birth control.
For instance:
| Out of 100 women using a birth control method? | How many become pregnant each year with typical use? |
| IUD | Maybe 1 woman, most likely no one |
| Contraceptive Injection (DepoProvera® | About 3 |
| Pill | About 8 |
| Condom | About 15 |
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“My partner and I are very happy with my IUD. There’s nothing we have to do, and it gives us peace of mind knowing how well it works.”
– Carly, Benson, TX
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IUDs Are Very Safe for Most Women
Almost all women can use IUDs safely, including nursing mothers. Some women who should not have an IUD inserted are those who currently have a sexually transmitted infection (STI), are allergic to copper or the hormone LNG, don’t have a normal-shaped uterus (womb), or have cervical or endometrial cancer. Your HCP will check for these and other problems before putting in an IUD. As soon as an IUD is taken out, your normal fertility will return. You could become pregnant right away.
Serious Problems with IUDs Are Rare
| Problem | How many per 100 IUDs Inserted | Note |
| Uterus (womb) is punctured while IUD is being placed. | Less than 1 | If this occurs, the HCP will remove the IUD, and you will need to choose another birth control method. The wound almost always heals itself. |
| Pelvic infection occurs within 30 days of IUD placement. | Less than 1 | Risk increases for women who have STIs (infections passed on through sex, such as gonorrhea). Risk for STI increases when you or your partner has sex with others without using a condom. |
| IUD slips from its placement spot or falls out of the uterus. | 1-7 (during first year) | When an IUD falls out, the user may become pregnant. The device never moves from the uterus to other major organs. |
IUDs Are Easy to Use
- Once a device is in place, it can stay in place for 5 to 12 years. You can have it taken out sooner — to have a child or change methods.
- All you have to do is to check now and then that the string is still in place. Your HCP will show you how.
- This method is private. There are no products to buy at the drugstore or keep around the house. Sometimes your partner may feel the string.
- IUDs protect you from pregnancy each time you have sex — even though you don’t feel it or notice it’s there.
Your Choice: Thinking It Over
Should you try an IUD?
This section covers some issues to keep in mind with these products. It also lists some questions. Your answers can help you think about how your goals and lifestyle may affect your choice of birth control.
| Key Features | Copper IUD (Paragard) | Hormonal IUD (Mirena) |
| Highly effective? | Yes | Yes |
| Very Safe? | Yes | Yes |
| Effect on monthly period during first few months? | Bleeding may become more heavy and painful; problems often lessen over time. Spotting between periods may occur. | Lessens bleeding and cramping, and bleeding stops for some women (this is safe). Spotting between periods may occur. |
| Last how long? | At least 10 to 12 years | At least up to 5 years |
| Hormone contents? | No hormones. Good option for women who can’t or won’t take hormones. | Includes a hormone (progestin). Side effects with this hormone can include bloating and tender breasts. |
IUDs do not protect against sexually transmitted infections (STIs), including HIV. Condoms should be used if you are at risk.
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“I used to use pills, but I’d often forget to take them or to renew them on time at the drugstore. With the IUD, I don’t have that worry. It’s always there.”
– Marie, New York City, NY
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Issues to Keep in Mind
- Cost. Around the United States, an IUD costs between about $175 and $500. This includes the device and HCP charges. But after this one-time cost, you pay nothing more for birth control for the next 5 to 12 years (and perhaps 14 years — research is looking at this now). So it is a very good value in the long run. Most HMOs, some insurance plans, and Medicaid cover IUDs. Check with your health plan and HCP to find out what your costs will be.
- Pain. The majority of women do not experience pain during IUD insertion; just mild discomfort. Ask your HCP before the visit about how to reduce pain if you’re worried about this.
- STIs. Like most methods of birth control, IUDs do not protect you from any disease passed on through sex. If you or your partner has an STI or if you have sex with people besides each other, you also can use products like condoms to protect against STIs.
- Emergency Contraception (EC). You can prevent pregnancy up to 5 days after sex by using emergency contraception. The copper IUD can be used as emergency contraception. Having an IUD put in after sex is nearly 100 percent effective in helping you prevent pregnancy.
To find out more about birth control methods, visit www.arhp.org/contraception
Questions to Ask Yourself
- Do I want to avoid being pregnant for a few years? The IUD is an easy way to postpone having children for the short-term, or up to 12 years. If you’re in your late 30s or early 40s, an IUD could last throughout your childbearing years.
- Do I want (more) children in the future? You can have the IUD taken out whenever you want to have a child. Your fertility will return right away.
- Do I prefer a method that doesn’t require any action before or during sex? Many women become pregnant because the couple does not always put birth control in place once sex is under way. And some people feel that thinking about birth control during sex hurts “the mood.”
- Have you ever had to use Emergency Contraception (EC) because you had sex but didn’t protect yourself? An IUD protects you against pregnancy all the time it’s in place. You don’t need to plan ahead for sex — or take action later if you didn’t.
- Do you smoke or have other health problems that keep you from taking the pill (or using other methods with hormones)? Copper IUDs are a safe and highly effective method for women who should not use hormones.
Web Sites with Additional Information
Association of Reproductive Health Professionals:
www.arhp.org/contraception
Planned Parenthood® Federation of America:
www.ppfa.org
Clinical Advisors:
Linda Dominguez, RN-C, NP, Albuquerque, NM
Kirtly Parker Jones, MD, Salt Lake City, UT
Ward Cates, Jr., MD, MPH, Resarch Triangle Park, NC
Writer:
Joy Mara, Wheaton, MD
This publication was made possible by an unrestricted educational grant from Barr Laboratories, Inc.
About Audrey Kelly, PharmD