Intrauterine device (IUD)

An intrauterine device (IUD) is a small apparatus inserted into the uterus to prevent conception. The IUD remains in place until it's removed or expelled, which may be anywhere from one to 10 years with some devices.


Types of IUDs
IUD features vary by model, size, shape and whether copper or hormones are present. Two types of IUDs are currently available in the United States. Both types work primarily by preventing fertilization of the egg by the sperm.
The most common IUD in the United States is a plastic T-shaped design with copper wire wrapped around the stem and arms (Cu T 380A or Copper T 380A -- ParaGard). The copper IUD is often appropriate for women who cannot or prefer not to use hormonal methods of birth control, such as oral contraceptives. A single copper IUD may last up to 10 years.

Levonorgestrel (Mirena) is a recently approved IUD that contains the synthetic progestin hormone levonorgestrel. This type of IUD is effective for five years.
The copper and levonorgestrel IUDs are more than 99 percent effective in preventing pregnancy.


When an IUD may be recommended
An IUD may be an appropriate choice at any age if you want to prevent pregnancy for a number of years, especially if you're in a stable monogamous relationship and have no history of pelvic inflammatory disease.

When an IUD should not be used
An IUD should not be used if you have:
a known or suspected pregnancy
a high risk for contracting a sexually transmitted disease (through multiple sexual partners, for example)
a current or recent sexually transmitted disease
a current or recent case of pelvic inflammatory disease (PID, an infection of the uterus, ovaries and fallopian tubes) or a recurrent history of the infection
an infection after a recent delivery or abortion
known or suspected uterine or cervical cancer
unexplained vaginal bleeding
an unusually sized or abnormally shaped uterus, as may occur when uterine fibroids are present
HIV, AIDS or a weakened immune system
The copper IUD should not be used if you:

have a copper allergy or a copper-related illness (such as Wilsonyour doctor will review your medical history and do a pelvic exam. Lab work may be done to find out if you're pregnant or make sure you donn, 30 to 60 minutes before the procedure.

Procedure
The IUD is inserted through the cervix (the opening of the uterus). Although this can be done at any time, some doctors recommend inserting an IUD during or just after you period, when the cervix is more open and you depending on features of the specific IUD. Any contamination could cause an infection, so good infection control practices are essential.
During the procedure, notify your doctor immediately if you feel faint, dizzy or experience sharp pain.


Postprocedure care
Before you leave the doctor's office, it's important to learn how to feel the strings or threads that will protrude from the IUD about one to two inches into your vagina. When you can feel the strings, you'll know the IUD is in place and pregnancy is unlikely.
You may experience severe cramping for a few hours or even a few days after the procedure. If this occurs, your doctor may recommend pain medication. Schedule a follow-up visit three to six weeks after the insertion to be sure the IUD is in place and there are no signs of infection.


Follow-up care
Without pulling on them, check the strings attached to the IUD routinely. To help you remember, you may want to do it right after your period. Check more often during the first few months and anytime you have unusual cramping. Itement.
Follow your doctorany other type of heat-related treatment. Heat can damage the copper in a copper IUD.


Benefits
In addition to being a safe and highly effective form birth control, IUDs have various other benefits.
The contraceptive effect of an IUD is reversible. Your doctor can remove the IUD at any time, and fertility typically returns promptly. Plus, an IUD will not interfere with breastfeeding or affect your nursing infant. You can also use tampons and condoms while an IUD is in place.

IUDs are inexpensive and convenient. There's no interruption of sex when your IUD is in place, and a single IUD can remain in place for long periods of time. Once it's inserted, you won't even feel it.

You can use an IUD regardless of your age as long as you're at low risk for STDs.

Hormone devices often decrease the amount of menstrual blood flow, as well as ease painful menstruation.


Risks
Side effects of an IUD may include heavier and longer menstrual periods, especially with the first two periods after insertion. This depends on the IUD, however -- hormone-releasing IUDs actually decrease menstrual flow. You may also notice spotting between menstrual periods and increased menstrual cramping. Abdominal pain and increased menstrual bleeding are more common in teenagers than older women and those who've had children.
There's a slightly increased risk of pelvic inflammatory disease for up to 20 days after an IUD is inserted. This is related to bacteria that may enter your uterus when the IUD is inserted. This risk may be lower with the levonorgestrel IUD. Regardless of the type of IUD, the risk of PID drops after the first 20 days.

An IUD does not offer protection from sexually transmitted diseases, including HIV (the virus that causes AIDS). Some untreated STDs may progress to pelvic inflammatory disease, particularly in women who use an IUD. If you're not in a stable sexual relationship, you or your partner have multiple sexual partners, or you're dependent on drugs or alcohol, you're at high risk of developing an STD. Before you decide to have an IUD inserted, discuss the risks and benefits of various methods of birth control with your doctor.

Up to 20 percent of women, especially those who haven't delivered a child, may expel their IUDs. This usually happens within the first year. Although pregnancy is possible if the IUD is accidentally expelled and it goes undetected, pregnancy is rare with an IUD. Among women who become pregnant while using an IUD, thereervix or embed itself in the wall of the uterus. In such cases, surgical removal of the IUD may be necessary.


When to seek medical attention
Consult your doctor if you can't find the strings or threads attached to the IUD, they're shorter or longer than usual, you or your sexual partner can feel the tip of the IUD at your cervix, or you:
develop unexplained chills or fever
notice pelvic or abdominal pain or tenderness or severe cramping
notice unusual vaginal bleeding or discharge
develop sores in your vaginal area
have pain or bleeding during intercourse
have been exposed to an STD
have a scant, late or missed menstrual period
If you think you may be pregnant and your IUD is still in place, seek medical attention right away. The IUD should be removed as soon as a pregnancy is confirmed. Ectopic pregnancies are not more common among women who use IUDs, but an IUD is more likely to prevent a normal uterine pregnancy than an ectopic pregnancy.


Pregnancy-specific information
Although an IUD can be inserted immediately after you deliver a baby, the risk of spontaneous expulsion is higher. Most doctors recommend waiting four to eight weeks after childbirth to insert an IUD. "Missing strings" (where the IUD is still in place but the strings cannot be felt) are also more common in women who have IUDs inserted shortly after childbirth.