Do the Benefits of an IUD Outweigh the Potential Side Effects?

Today’s IUDs are safe and effective
IUD, intrauteran device

Whether you’re contemplating using an intrauterine device (IUD) as birth control or to curb the effects of a gynecological issue, you might wonder if the pros outweigh all the cons you’ve probably heard about. Here’s what you need to know about IUDs, according to Ob/Gyn Ashley Brant, DO, MPH.

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There are 2 FDA-approved types

  • Hormonal IUDs (Mirena, Kyleena, Skyla and Liletta) release low levels of the hormone progestin.
  • Non-hormonal IUDs (Paragard) contain copper and transform the uterus into a hostile environment for sperm.

Both types work mainly by preventing egg fertilization, but keep in mind that IUDs don’t protect against sexually transmitted infections (STIs).

Misconceptions abound

Despite the fact that modern versions are quite safe, IUDs still tend to get a bad rap. Dr. Brant often hears concerns from patients about migration, when the IUD moves through the uterine wall into the abdominal area. “Even though it seems like almost everybody knows somebody to whom that’s happened, it’s actually a pretty rare complication,” she says. Migration can happen if the uterus is torn, usually by an instrument during IUD insertion; however, these uterine perforations only occur in 0.01% of cases.

Other serious complications from IUDs are rare too. Pelvic inflammatory disease (PID) occurs in just 1% of women within the first 20 days after insertion and in 0.5% in the first three to six months.

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Then there are the uncommon side effects women report from the hormonal IUD like weight gain, hair loss, mood changes and acne. As of now, there isn’t enough research to support or refute a definitive link between the two, Dr. Brant says. In fact, the low level of progestin released — one-fifth of the amount found in combination birth control pills — is tolerated well by the majority of women.

The many benefits of IUDs

  • They’re long-acting. Depending on the type, IUDs are FDA-approved to last anywhere from three to 10 years.
  • They’re more than 99% effective at preventing pregnancy, a figure similar to permanent sterilization.
  • You can have an IUD taken out any time and your fertility returns immediately.
  • Hormonal IUD use often leads to lighter, shorter, less painful periods, which is why they’re prescribed for women who have heavy, painful periods. Up to half of women even stop having their periods altogether after three years on Mirena, though this percentage is lower with other hormonal IUDs, says Dr. Brant.
  • There’s minimal effort required, an added bonus if you’re forgetful about birth control. You just have to make that initial appointment to get it inserted.
  • They can be used in any age population, from teens to menopausal women.
  • Research shows that hormonal IUDs may reduce your risk of developing endometrial cancer.
  • They can be inserted right after you give birth, though this does increase the risk of expulsion.
  • The copper IUD can be safely used for emergency contraception up to five days after unprotected sex or birth control failure.

But there are potential cons too

  • The insertion procedure can be mildly to moderately painful. “I recommend that people take ibuprofen beforehand,” says Dr. Brant. “It doesn’t actually help with the pain during the insertion, but it does help with the cramping afterward.”
  • With either type, during the first few months, you may experience irregular bleeding and/or cramping. You can continue to take 600 to 800 mg of ibuprofen every six to eight hours for this as well, Dr. Brant says. (NOTE: If the pain persists or gets worse and ibuprofen isn’t cutting it, and/or you’re soaking through a pad or more an hour, you’ll need to see your doctor right away.
  • Irregular bleeding and/or cramping that hasn’t gone away after three months may result in your doctor putting you on ibuprofen for one to three months to alleviate pain and decrease bleeding or temporarily prescribing birth control pills to help regulate your cycle.
  • If you do get pregnant with an IUD (the chances are 0.2% to 0.8% in the first year and less after that), your risk of ectopic pregnancy is higher.
  • You’ll need to see your doctor for another procedure to get the IUD taken out.
  • An IUD isn’t recommended if you have an abnormally shaped uterus since placing it is more difficult and increases the risk of perforation.

Factors to help you decide

Dr. Brant asks her patients these 3 questions to help them come to a decision that’s right for them:

  1. What’s your time frame for wanting to get pregnant? “If you’re thinking you want to be pregnant in the next year, maybe you don’t need something that’s going to be so long-acting,” she says.
  2. What’s important to you? Do you want a method of birth control that you don’t have to think about? Would you rather use something that you have more immediate control over?
  3. What are your periods like now? If you have heavy, painful periods, you may not want to choose the copper/non-hormonal IUD because it tends to cause longer and/or heavier periods, says Dr. Brant.

The 3-step insertion process

Placing an IUD usually takes less than five minutes. To begin the insertion process, the doctor or nurse will likely feel your uterus to see which way it might be tipping. A speculum is placed, just like you’d have for a Pap smear, and the cervix is washed off with soap.

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You can expect to experience cramping three times, but only for a few seconds each time, says Dr. Brant.

  1. Usually, the cervix is grasped. To do this, your doctor uses an instrument that can feel quite pinchy. This pinching feeling usually only lasts 10 seconds or so. If you count backwards from 10, you’ll be feeling better by the time you get to zero.
  2. The inside of the uterus is measured. This feels like a stick is going up in an unfamiliar place, but it only takes a second or two. That’s what the IUD going in will feel like, too.
  3. The arms of the IUD are placed or drawn into the applicator straw. This is the same concept as a tampon applicator — and the whole thing is inserted into the uterus, right up to the top.
    Just when you think, “that’s far enough!” the arms will deploy and the straw will be removed. Your uterus may cramp in response to this new intruder, but that usually dies down in a few minutes. Lastly, the string of the IUD is trimmed and the speculum removed.

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