Updated July 28, 2014.
Written or reviewed by a board-certified physician. See About.com's Medical Review Board.
Though the number of women choosing to use IUDs as their contraceptive method is rapidly growing, this method is nowhere as popular as the pill or condoms. Did you know that IUDs are just as effective as a vasectomy?
So why are so many of you not taking advantage of this highly effective and long-acting birth control method? Unfortunately, there is a lot of misconception about IUD use and safety. Because of a checkered past, IUD use has been stigmatized.
In the 1970’s, when the FDA had limited authority over the medical device industry, the first popularized IUD, the Dalkon Shield, was introduced.
The design of the Dalkon Shield included a multifilament string that allowed bacteria to enter into the uterus. It was responsible for pelvic infections, miscarriages, sepsis (blood poisoning), infertility and hysterectomies. These injuries lead to thousands of lawsuits. Under pressure from the FDA, the Dalkon Shield was removed from the market, and the agency recommended that all women who were currently using the Dalkon Shield to have the device removed. Although this IUD has not been available for nearly four decades, it has left a negative impact and stigma on IUD use in the United States.
Currently, there are three IUD brands are available in the US: Mirena, ParaGard, and Skyla. Unlike IUDs from the past, these IUDs are safe and prove to be reliable long-term contraceptive methods. You may experience some side effects after having an IUD inserted, but in most cases, these go away after the first few weeks to months.
Although serious complications with Mirena, Skyla, and ParaGard IUD are rare, it is possible that these complications can occur. So if you should you experience any problems, it is critical to report these issues to your doctor right away to avoid further complications.
Possible Mirena/Skyla/ParaGard IUD Complications:
- Perforation: An IUD can, rarely, be pushed through the uterus wall during insertion. Generally, this is discovered and corrected right away. If not, the IUD can move into other parts of the pelvic area and may damage internal organs. Surgery may then be needed to remove the IUD.
- Infection: Although there is some risk of PID (pelvic inflammatory disease) associated with IUD use, the risk is small after the first 20 days following insertion. Generally PID is sexually transmitted. You have a higher risk of getting PID if you or your partner have sex with multiple partners. Pelvic infection can be caused by bacteria getting into the uterus during insertion. Most infection develops within 3 weeks of insertion. Infection (due to the IUD insertion) after 3 weeks is rare. Infection that occurs after this time is most likely due to exposure to STD's during sexual intercourse. Studies indicate that IUDs don't cause PID or infertility.
- Expulsion: The Mirena, Skyla or ParaGard IUD could partially or completely slip out of the uterus -- this is most likely to occur during the first few months of use (although it can also happen later on) or when you have your period. With Mirena or ParaGard, there may be a slightly higher expulsion risk in women who have never had a baby or for younger women. Because Skyla is a tiny bit smaller than the other two IUDs, it is a little less likely to be expelled in nulliparous women (though expulsion of the Skyla IUD can still happen). If IUD expulsion occurs, you can become pregnant, so use a back-up birth control, such as a condom, and call your doctor. Mirena and Skyla must be removed if these IUDs become partially expelled. It is a wise idea to check your pads and tampons during your period to make sure that the IUD has not fallen out.
Increased Risk Factors Associated With IUDs (Mirena, ParaGard, and Skyla):
Most women will no problems using Mirena, ParaGard, or Skyla. That being said, certain conditions may increase your chances of developing serious complications while using an IUD. These include being at risk for sexually transmitted infections at the time of insertion or having:
- Serious blood clots in deep veins or lungs.
- Had PID in the past 12 months.
- Have diabetes or severe anemia.
- Have blood that doesn't clot sufficiently or take a medication to help your blood clot.
- Have had two or more sexually transmitted infections within the past 2 years.
- Have or had ovarian cancer.
- Take daily medication(s) containing a corticosteroid (such as prednisone).
- Have a history of tubal infection (this does not apply for women who had a pregnancy in their uterus since the infection).
- Have uncontrolled infections of the cervix or vagina, such as bacterial vaginosis.
- Have a uterus positioned very far forward or backward in the pelvis.
- A history of impaired fertility and the desire to get pregnant in the future.
Unfortunately, many doctors still have misconceptions about the safety of IUDs as well as outdated ideas about who can and cannot use an IUD.
Yet for many women, the IUD can be a wonderful contraceptive choice. It is convenient, effective, doesn’t require you to do anything for it to work, eco-friendly, and it doesn’t interfere with sexual spontaneity. Just like with other prescription birth control, there are some risks and potential complications associated with IUD use, but most women are happy with this long-term contraceptive option.
Sources:
Johnson BA. "Insertion and removal of intrauterine devices."American Family Physician. 2005; 71:95-102. Accessed via private subscription.
Shelton JD. "Risk of clinical pelvic inflammatory disease attributable to an intrauterine device."The Lancet. 2001 Feb; 357(9254):443. Accessed via private subscription.
Thiery M. "Intrauterine contraception: from silver ring to intrauterine contraceptive implant."European Journal of Obstetrics & Gynecology and Reproductive Biology. 2000 June; 90(2): 145–52. Accessed via private subscription.
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