IUD Birth Control: It Had A Bad Rap But Let’s Examine The Facts

“Dr. McDonald, I really want to talk to you about birth control. I keep forgetting to take my pill and I don’t want to get pregnant.”

“Well, Everyday Patient, there are multiple types of birth control that you can try without having to take a pill every day. Have you ever considered an IUD?”

“Oh, no. I heard those are terrible.”

Okay, this conversation with Everyday, or Eve for short, is a little exaggerated, but the sentiment stands. With the exception of those ladies who have close friends or family members with IUDs, or the very well researched patient, many women are afraid of the idea of having an IUD.

The phrase I hear most often is “I have heard horror stories about those”. Horror stories? Like Friday the 13th style? Is the IUD lurking under your bed or in your closet ready to shred your lady parts to smithereens? No, it is not. It is actually great birth control. For some reason, it has a bad rap, but if we examine the facts, it should be much more highly regarded.

Nine out of ten women keep their IUD and have it removed only due to expiration or desire for pregnancy rather than dissatisfaction. This is because not only does it remove a woman’s need to refill a medication every 1-3 months, or take it every day, week or month, IUDs are over 99% effective, even long term. This is way more effective than condoms, pills, patches or rings.

Historic IUDs, not actual ones that we use these days. Don’t be afraid!

IUDs are not for everyone, but a majority of women, 9 out of 10 women, love them.

To put it in perspective, the efficacy for birth control pills, even when taken exactly as prescribed, at the same time, no interfering or extenuating circumstances is only about 92%.  After the initial 1-3 months when irregular bleeding or spotting can occur, most women can look forward to regular cycles, or possibly shorter, lighter, less painful menstrual cycles.

How long can you have an IUD?

A woman can have an IUD for 3, 5 or 10 years depending on the type. No IUD has a minimum duration so you are not required to keep it any length of time. Being able to have reliable reversible birth control for years can be awesome. One thing that NO medicinal contraceptive does is prevent STDs. If you are not in a monogamous relationship, remember to protect yourself with condoms.

IUDs fall under the category of LARC- Long acting reversible contraceptives. An IUD works by sitting inside of your uterus and creating an environment that is not conducive for implantation of a pregnancy. It’s like having a mean (but cute), security guard in your uterus that blocks semen from getting into the uterus, and leaves no place for a fertilized egg to take hold in the uterine wall. Securit-IUD keeps pregnancy out.

Dalkon Shield

A lot of the fear of IUDs in the U.S. came from the Dalkon Shield fiasco of the 1970s

The Dalkon Shield was blamed for infections and infertility. With today’s IUDs, data shows pelvic infection rates do not increase, and fertility rates do not decrease apart from the age related changes that naturally occur between the time of insertion and the time of removal.

Is it all roses? Yes, but it depends on what kind of thorns you are willing to endure (see what I did there?….)  The placement of an IUD for many women is crampy. I find that women who have menstrual cramps regularly with their cycles tolerate the cramps better than women who never have cramps and don’t know what they feel like (not data behind that statement, just personal experience). Also the irregular bleeding can last as little as a couple of weeks, or as long as 3-6 months in extreme cases.

The fear that resonates with most women who are new to the IUD idea is the risk of it migrating through the uterine muscle and ending up in the abdomen to float free and wreak havoc. Studies show the risk of uterine perforation or migration is less than 1 in 1000 (1 in 100 in some studies). To minimize that risk, women should have their IUD placed by a trained clinician and checked 4-6 weeks after placement. Every woman should also check her “strings” monthly. (Side bar, taking 400-600mg of Ibuprofen before placement can significantly help with the cramping.)

I love my IUD

I love it because I don’t have to think about it.

Levonorgestrel IUDs (LN-IUD)
Copper IUD

I also love it because I know that if I lose my mind and decide that we want to have more children one day (my husband would try to get an IUD himself if I told him that #notpossible), I can just remove it and my fertility remains present. Avey, my imaginary patient, should at least consider trying that level of securit-IUD over her I-take-it-most-of-the-time pill. She is unlikely to get oops-pregnant with one.

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Check out this awesome interactive NY Times article about birth control efficacy over time. Click here.


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