IUD or not to IUD?
IUD Rockville Gynecologist Blogs about the Safety and Efficiency of IUDs
The following article was authored by Rockville gynecologist and leading Washington DC womens health provider, Dr. Yuri Prikoupenko, we hope you find it interesting.
What is the most common contraceptive method used in the USA?
You would think the answer would be birth control pills, but it is not! Not even condoms! It is natural family planning—basically withdrawal and timed intercourse (avoiding intercourse at the time of presumptive ovulation). We are talking about women who are actually trying to prevent pregnancy through this highly inefficient method and not even those whose religious beliefs preclude them from using any method or form of birth control.
As a practicing Rockville gynecologist, I find this a little sad considering that we live in the 21st century, in the country that wants to be a leader in healthcare as well as anything else.
How is the situation around the world? This table should give you an idea of the percentage of females who use contraceptives such as birth control, IUDs and a range of sterilization procedures.
Why are we so different in America?
One theory is that IUDs are much more popular in other parts of the world than in the USA. Why is that?
While there are multiple reasons, one is that we as doctors do not do enough to break old stereotypes and educate our patients on the safety and efficiency of IUDs.
And this all because of the Dalkon Shield IUD that left a very poor legacy in the USA in the early 70s. After being administered to millions of women across the country, several studies showed that the Dalkon Shield significantly increased the risk of infection and pelvic inflammatory disease. The Dalkon Shield device was taken off the market in 1974, rightfully so. However, its legacy still looms over the word “IUD,” and as a result some gynecologists are still quite reluctant to prescribe modern day IUDs, which have improved dramatically in both safety and efficiency since the Dalkon Shield.
Despite the findings that confirm the IUD’s high degree of safety and effectiveness, as well as its suitability for most women, efforts to ‘revitalize’ IUD use in the USA and developing countries as part of family planning programs have many challenges. Providers tend to overestimate the IUD’s association with negative side effects and conditions. In addition, myths and misconceptions at the client and community levels remain widespread.
IUDs, currently approved by FDA, are very different from the Dalkon Shield and have an excellent safety profile.
Their use is endorsed by the American Congress of Obstetricians and Gynecologists (ACOG), especially for women desiring long-term contraception and who may be poor candidates for birth control and sterilization procedures in Rockville and across the nation. Moreover, IUDs are promoted by the World Health Organization (WHO) as a cost effective and easy to use contraceptive device.
That being said, let’s look at what type of IUDs are available in the USA. I say this because in Europe, for instance, there are at least three more types of IUDs available than what we have here.
The copper IUD (CuT 380A), brand name ParaGard, has an effectiveness profile comparable to that of female sterilization, vasectomy and implants. Three to eight women per 1,000 using the ParaGard IUD become pregnant within the first year. A long-term international study sponsored by WHO found an average annual failure rate of 0.4% or less, and a cumulative failure rate of 2.2% after 12 years of use, which is comparable to that of female sterilization.
Copper-bearing IUDs have been shown to be very safe for most women (Category 1 or Category 2). This includes women who are: postpartum, post-abortion and farther from pregnancy or birth (i.e., “interval” IUD insertion); breastfeeding; HIV-infected; young and/or nulliparous; and unable to use hormonal methods. IUDs are highly protective against ectopic pregnancy via their high efficacy in preventing any pregnancy.
Women who use copper-bearing IUDs have a 91% lower risk of ectopic pregnancy than do women using no contraception. However, among women who do become pregnant while using an IUD, the relative risk of ectopic pregnancy is higher than in non-users, with an estimated 6% to 8% being ectopic. Still, this means that 92% to 94% of the rare pregnancies in IUD users will not be ectopic. While some women report increases in menstrual bleeding with copper IUD use, no significant changes in hemoglobin levels have been found. WHO thus advises that the ParaGard can generally be used by women with iron deficiency anemia (Category 2).
Levonorgestrel-containing (or “levonorgestrel-releasing”) IUDs release 20 micrograms of the progestin levonorgestrel into the uterus daily. Brand name of this product is Mirena. Mirena IUD prevents pregnancy mainly via local hormonal effects in the uterine cavity: prevention of endometrial growth, thickening of cervical mucus, and inhibition of sperm motility and function. After an initial increase in spotting during the first few months, Mirena brings about a highly significant reduction in bleeding and/or spotting. In women with normal menstruation, the Mirena reduces blood loss by 75% at three months and reduces the number of bleeding days. After the first year of use, 70% to 90% of women using the Mirena experience a reduction in monthly bleeding, and 20% to 30% of women experience no bleeding at all.
Mirena is effective for five years and has a somewhat lower failure rate than copper-bearing IUDs (0.1%-0.3% in the first year of use).] Unlike copper-bearing IUDs, Mirena cannot be used to provide emergency contraception. WHO’s medical eligibility classification categories and practice recommendations for levonorgestrel-containing IUDs are the same as for copper-bearing IUDs, except for clinical considerations related to the hormone the IUD contains.
Overall, Mirena greatly reduces the risk of ectopic pregnancy, by virtue of it being a very effective method of birth control. However, women who become pregnant while using Mirena will have higher chance of the pregnancy being ectopic, 30%-50%. If pregnancy is suspected, it is essential that you notify your doctor right away. Women experiencing abnormal uterine bleeding or pelvic pain should not use IUDs prior to receiving medical treatment from their gynecologist in Rockville, MD.
ParaGard, Mirena and other types of IUDs surely have their potential side effects, therefore, the decision to use one should be determined on a case-by-case basis by your Rockville MD gynecologist.
If you are considering using an IUD or any other type of contraceptive, please contact my office to schedule a consultation appointment. As an experienced womens health Rockville provider, I can help you make an educated decision.
Dr. Yuri Prikoupenko
11125 Rockville Pike, Suite 107
Rockville, Maryland 20852