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Almost 50% of pregnancies in the United States are unintended. More than half of these unintended pregnancies occur in women who were not using contraception or among those who were using their method incorrectly - pills, patches, rings and condoms can easily be forgotten, which dramatically affects their efficacy.
The intrauterine device (IUD) is the most effective, reversible form of contraception - the failure rate is 1%. Unfortunately, IUDs are underused in the U.S.; less than 3% of American women use this method compared with 20% of their European counterparts.
Why is IUD use so much lower in the U.S.? There are many misconceptions about the product, most likely related to the Dalkon Shield, a very unsafe IUD that was available in the 1970’s. Many women suffered horrible infections and scaring to their pelvic organs. This collective memory of the Dalkon Shield has biased many doctors and women against IUDs, even though modern IUDs have been well studied and have an excellent track record for safety.
When women are asked about the IUD more than half are unsure about its safety and efficacy. Common IUD myths include:
- IUD causes infection. Untrue, the risk of getting an infection in the first three months after an IUD is inserted is less than 1%. IUDs also do not increase the risk of acquiring a sexually transmitted disease if exposed. The only infection issue is that an IUD should not be inserted if a woman has untreated gonorrhea or chlamydia, so for some women STD testing before insertion will be recommended.
- IUD scars the fallopian tubes causing infertility. Untrue, a large study published several years ago in the New England Journal of Medicine looked at more than 1,500 women who had infertility due to scarred fallopian tubes - there was no relation to past IUD use. A previous infection with chlamydia is the biggest risk factor for this form of infertility.
- Only women who have been pregnant can have an IUD. Also untrue. IUDs are safe and effective for all women regardless of their pregnancy history. However, the uterus must be a certain size to accommodate an IUD. For most women who have never been pregnant the IUD will fit just fine, but doctors always check before insertion just to make sure. This is generally not an issue for a women who has been pregnant as the uterus never quite shrinks back down to its former size (just like everything else!).
- The IUD causes heavy, painful periods. Untrue again. There are two different IUDs, the Paraguard, which is made of copper and effective for 10 years and the Mirena, which contains the hormone progesterone and is used for 5 years. For some women, the copper IUD may cause slightly heavier bleeding and more cramping, but for many it has no negative effect. For women who have heavy periods to begin with, the Mirena is the way to go because the hormone progesterone thins out the lining of the uterus reducing menstrual flow. By one year 50% of women with the Mirena IUD will have no periods.
If you need contraception ask your doctor about an IUD. They are very safe and less than 10 minutes of your time can provide five to ten years of highly effective worry free contraception.
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For more info: on birth control.
Remember, this column does not constitute individual medical advice
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Comments
Thanks for this informative piece! The Association of Reproductive Health Professionals (ARHP) has some helpful patient resources on the topic, including these:
Health Matters fact sheet: Dispelling Common Myths About Intrauterine Contraception
A Woman's Guide to Understanding IUDs (also available in Spanish)
A Woman’s Guide to Understanding Today’s Birth Control Choices (also available in Spanish)
They can be found under the Contraception Reproductive Health Topic Area, under Patient Pesources (arhp.org)
Mirena contains a progestin, not progesterone. That is an extremely important distinction to make. Progestins are made by taking a progesterone molecule and tweaking it in the laboratory to make a not-found-in-nature molecule so that it can be patented. We pay more for patent medicines. Progestins tend to have many negative side effects. Progesterone does not.
For a detailed report about Mirena, please visit the Virginia Hopkins Health Watch at virginiahopkinstestkits and do a search for Mirena.
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