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After Falling Out of Favor, IUDs Are Back

By Marjorie Dwyer
Beth Israel Deaconess Medical Center Correspondent

Whether teaching dental hygiene to Massachusetts women, nutrition to new mothers in Kenya or leading an outdoor adventure program in the backwoods of Maine, Jessica Henneman wants her contraception to be as flexible as her busy lifestyle.

That's why she is among a growing number of women, including those in their 20s and 30s, choosing intrauterine devices (IUDs) over other forms of contraception available today. Once inserted, modern IUDs are considered safe, reliable and can remain effective for years.

"I travel a lot, go hiking, and sometimes live in the back country. I'm just starting out in my career and going to school. I have a million errands every day. I don't want to have to plan for one more thing," says Henneman, 24, a community health educator in the Boston area.

Around for centuries and a frequent choice of women in other countries, IUDs were popular among U.S. women until the Dalkon Shield made negative headlines in the 1970s. The Dalkon Shield was an IUD taken off the market after it was linked to pelvic infections, ectopic pregnancies (pregnancies occurring outside the uterus), infertility -- and lawsuits. As a result, patients were scared away from using IUDs and health professionals from prescribing them.

Now three decades later, there is renewed interest in IUDs among U.S. women. According to a government report, 2 percent of American women chose IUDs in 2002. While it remains a small percentage compared to the 30 percent who selected the birth control pill and 27 percent who underwent surgical sterilization ( tubal ligation), the number is reported to be increasing in recent years, particularly among younger women.

"It used to be that IUDs were not used in unmarried women or women who had not had children. But now they are used more liberally with young, single women," says Henneman's physician, Dr. Sadia Haider, director of the Division of Family Planning in Beth Israel Deaconess Medical Center's Department of Obstetrics and Gynecology.

While the risk of pelvic infections is higher among women with multiple sexual partners, for most women in monogamous relationships there is no increased risk of infection or infertility with modern IUDs. Dr. Haider emphasizes it is important to make sure women considering IUDs do not have active infections or sexually transmitted diseases (STDs) such as gonorrhea and chlamydia at the time of insertion. What's more, IUDs do not prevent STDs or HIV (the virus that causes AIDS). "Women are advised to use barrier methods such as the male condom to prevent HIV and STDs," she says.

A small percentage of IUDs are expelled during the first year, leaving women exposed to possible pregnancy. This occurs most frequently in women under age 20. Users must check the IUD's strings regularly to make sure it's in place.

For Jessica Henneman, a birth control pill had been her first choice. But when doctors determined the pill was increasing her blood pressure to an unsafe level, they sent her to Dr. Haider, who is an expert in contraception, to find an alternative form of birth control.

"Having the IUD inserted was the easiest process ever," Henneman recalls. She admits she might have wanted to do more research if she hadn't researched her options in advance and talked with a number of her friends who had IUDs and were pleased with them.

"I had one visit with Dr. Haider last summer. After talking with her I stayed an extra 45 minutes and had the Mirena put in-all in one fell swoop. I've had great results and no problems. I don't have to think about taking a pill every day. In fact, I don't have to think about my birth control for several years."

One feature that makes the IUD attractive to younger women is that it's a reversible form of birth control. "As soon as the IUD is removed, the hormones are back to normal and pregnancy is possible," says Dr. Haider. With other popular methods such as the popular Depo-Provera injection, it may take up to a year to be able to conceive after stopping the shot.

This was one factor that made the IUD appealing to Henneman.

"While I'm in a long-term relationship, I have no plans to start a family now. But it's good to know that if I change my mind in a few years, I can have it removed and my reproductive system will return to normal and I can have a family," she says. "It's nice because I can have leeway with my own life, schedule family planning and control my life."

IUDs Available in the United States

Today there are two IUDs approved for use in the United States that have generated renewed interest in the devices. Both are small, flexible, T-shaped plastic devices with attached threads and are inserted by a health practitioner into the uterus (womb).

"They each work differently, have few side effects and can be a good choice for estrogen-sensitive patients," says Dr. Haider.

The IUDs are a popular choice because they are discreet, convenient and don't get in the way of spontaneity. The devices are ideal for women who don't want to have to do anything about birth control for five to 10 years, though they can be removed at any time.

The two IUDs currently available in the U.S. are:

Mirena

Mirena, the most popular IUD, which releases a progestin hormone called levonorgestrel and is approved for use up to five years. The hormone inhibits the sperm's travel to the fallopian tubes and thins the lining of the uterus, creating an unwelcome environment for a fertilized egg.

"The Mirena is used most often because, after the initial insertion, most women have no periods and no bleeding. Some people are concerned about not having periods but this is perfectly healthy while using hormonal contraception," says Dr. Haider.

The Mirena is reported to be more than 99 percent effective and equal to sterilization. This means less than one out of every 100 women using it for one year will get pregnant. Some women do experience occasional light bleeding or hormonal side effects like tender breasts, changes in mood or acne, but these conditions generally are rare and mild.

ParaGard

ParaGard, a copper IUD, can be used for up to 10 years. The device releases small amounts of copper, by keeping sperm from entering the fallopian tubes and preventing fertilization of the egg. "With this IUD, you continue to have menstrual cycles and could have heavier bleeding," Dr. Haider says. Some women have cramping or backaches which may be controlled with non-steroidal anti-inflammatory medications. It also is more than 99 percent effective.

Intrauterine devices are inserted and removed with minimal discomfort in a health professional's office following a medical history and a physical exam. Costs for having an IUD inserted can run several hundred dollars for the device, plus the cost of the medical appointment and a follow-up visit. Many health insurance companies cover these costs. Because IUDs are effective for years, data shows the devices are more cost-effective than the pill and other contraceptive methods.

What at are the qualifications?

IUDs are considered a good option for women who:

  • Are not pregnant or planning a pregnancy for at least a year
  • Are at low risk for sexually transmitted infections
  • Desire a reversible form of birth control
  • Want or need to avoid birth control with estrogen

Who does not qualify?

Women generally don't qualify for an IUD if they have had:

  • Unusual vaginal bleeding
  • Active infection from sexually transmitted diseases
  • Sex with multiple partners
  • Wilson's disease or copper allergy

Schedule a Consultation

To schedule a consultation with the experts at the Department of Obstetrics and Gynecology at Beth Israel Deaconess Medical Center, call 1-800-667-5356.

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

Posted July 2010

Contact Information

Department of Obstetrics and Gynecology
Beth Israel Deaconess Medical Center
East Campus
330 Brookline Avenue
Boston, MA 02215
617-667-0475

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