I.U.D.’s – the “set it and forget it” birth control method (hopefully).

The intrauterine device (IUD) has been around modern medicine as a method of contraception for a hundred years. Over those 100 years, different prototypes of varying shapes, compositions and sizes have been tried leaving us with two main options to choose from nowadays. There is the copper IUD (non-hormonal), and the hormonal IUD. Both options come in varying sizes and doses of progestin.

Today I want to talk about the advantages and disadvantages of the different types of IUDs, so you can build your knowledge base around the birth control options available to you.

As always, please talk to your primary health care provider about which option is best for you at this time in your life, but I wanted to compile a head to head comparison of the different IUD’s, so you can advocate for your health too!

Given the nature of an IUD (being inserted into the uterus), regardless if it’s the copper or hormonal, have the following advantages and disadvantages in common.

Advantages:

One of the main attractions to choosing an IUD as a method of contraception is its convenience factor. There is no daily pill, no injections, no daily temperature taking or weekly insertion of a vaginal ring. Like I said, set it and forget it.

One IUD prescription has good longevity. Depending on the type of IUD you are getting, it can remain inserted for 3- 10 years. That means no running out of pills and scrambling to the doctor for a prescription renewal and then to the pharmacy in order to stay on your pill schedule.

Disadvantages:

Given the nature of an IUD (it being a foreign object inserted into the uterus) comes with risks associated with it. This is where the “hopefully” comes in – that once you get your IUD inserted, you’re good to go without suffering any of the side effects or risks that comes with it. The following are rare risks, however rare they are, they are important to know before you decide to move forward with this type of contraception.

• Increased risk of Pelvic inflammatory disease (PID). This can happen right after insertion if an infection is already present in the vagina / on the cervix (by inserting the IUD, it could potentially allow the infection to gain entry into your uterus!) This is why it’s good to swab for STI’s prior to insertion just to be safe. The IUD has a string that passes through the cervix to connect to the part that is in the uterus (how the practitioner is going to remove it when the time comes), and that string can be a potential vehicle of transport for an infection to move from the vaginal canal into your uterus. It is important to note that IUDs do NOT protect you from STI’s and could potentially increase your risk of developing PID. Condoms are the best method to prevent acquiring STI’s.
• There is an increased risk of ectopic pregnancy. An ectopic pregnancy is when the blastocyst (fertilized egg) implants and begins to develop somewhere other than the uterus. Because IUDs sit inside and occupy the space of the uterus, and on the SLIGHT chance that a sneaky sperm gets by the IUD (copper or hormonal) unscathed and fertilizes an egg, the uterus is already occupied and may be slightly inflamed so the fertilized egg is going to choose another area to implant and begin to grow.
• Risk of uterine perforation. The IUD is a relatively hard plastic little “T”- shape sitting inside a soft organ. If it is not placed properly to begin with there is a risk that one of the ends of the “T” could perforate your uterus.
• Risk of expulsion. This means there is the potential that your uterus will not “hold” the IUD and it will make its way through your cervix and out your vaginal canal. This is more common on women who have given birth vaginally, and more likely to happen during your period when your uterus is shedding blood and the IUD is swept up and removed with the uterine lining.

With all of the above risks, a key sign to look for is persistent moderate to severe abdominal pain that is progressively worsening. It is not uncommon to experience cramps immediately after the IUD insertion, lasting a couple days, or experience cramps during menses. PLEASE PLEASE PLEASE follow up with the practitioner who inserted the IUD if you’re experiencing new onset of lower abdominal pain that is uncharacteristic of your normal monthly cramps, or persistent abdominal pain weeks after the IUD insertion.

The Copper IUD

• How it works
  • Copper functions as a spermicide (meaning it kills sperm before it can fertilize an egg)
  • Copper can be slightly irritating to the uterine lining, making the uterus an unsuitable environment for a fertilized egg to implant and grow
• Advantages
  • 99% effective at preventing pregnancy
  • Hormone free – you can still track and monitor your hormone health without the IUD interfering, and reap the benefits of your intact female hormones. This is an attractive option to those who have tried hormonal birth control and their bodies could not tolerate the side effects.
  • Can leave it in from 5-10 years  if well tolerated and pending what copper IUD is inserted.
  • Can be used as an emergency contraception if inserted maximum 5 days after unprotected intercourse, and then can remain inserted to use as a method of contraception.
• Disadvantages
  • Even though it is hormone free, there are still potential side effects that come with the copper IUD. The most common side effects being: heavier and longer periods, spotting between periods, increase in cramping and uterine discomfort. The potential increase in cramping may not allow you to “forget” that you have an IUD. Unfortunately some women do not tolerate IUD’s well and are reminded daily  through persistent cramping that they have this little structure sitting in their uterus. I feel like a lot of horror stories are swapped about the copper IUD (or IUDs in general for that matter), however I think it is important to keep in mind that each woman is going to respond differently to an IUD.What I’m trying to get at here is, if you think the copper IUD aligns with your health goals but are scared because of what you’ve heard happened to a friend of a friend’s cousin, don’t knock it until you’ve tried it. Talk with your primary care practitioner to see if this option is worth trying out, the copper IUD may be the birth control method you’ve been searching for!

The Hormonal IUD

• First off what is “progestin” and what does that mean for your overall hormone health
  • Progestin is an umbrella term used to describe synthetic hormones that were created to mimic progesterone in the body. Progestins are NOT BIOIDENTICAL to progesterone, meaning progestins have a different biochemical structure then progesterone, therefore slightly different actions. They are similar enough to act on the uterine lining, cervical mucous and supress endogenous hormones (similar enough to do their job), however different enough from endogenous progesterone that progestins also have the capacity to have androgenic activity too. That means they can act similar to testosterone in your body (hello acne, unwanted hair growth and changes in mood). The form of progestin in hormonal IUDs is called “levonorgestrel”. This specific progestin has relatively potent progestogenic and androgenic activity in relation to other progestins, which is why it can be used at such a low dose effectively, but this also means there is an increased risk of those unwanted androgenic side effects (acne, unwanted hair growth, mood changes).
• How it works: The function of progestin in the uterus is to
  • Thicken uterine lining
  • Thickening the cervical mucous
  • Slow sperm movement and decrease sperm survival
• There are a couple options to choose from when selecting a hormonal IUD. They vary in progestin dose, as well as physical size of the IUD.
  • Mirena
    • 52 mg Levonorgestrel
    • releases 20 mg of levonorgestrel daily into your uterus
      • Gradually reduces to 10 mg/day after 5 years of use
    • Replace after 5 years
  • Kyleena
    • Smallest (5 year) IUD physical size –good option for petit women
    • Releases 19.5 mg/day of Levonorgestrel
      • Gradually reduces to 7.4 mg/day after 5 years
    • Replace after 5 years
• Advantages
  • 99% effective
  • Lighten a heavy period
  • Potentially fewer side effects then a hormonal birth control pill (due to more local action of the levonorgestrel in the uterus compared to systemic action of oral contraceptive pills)
  • No estrogen – good for patients with contraindications to estrogen containing birth control pills – the following are contraindications to using estrogen containing birth control pills:
    • Smoking history and > 35 years old
    • History of venous thromboembolism or pulmonary embolism
    • Cerebrovascular disease
    • Hypertension
    • Diabetes with microvascular complications
    • History of heart attack or ischemic heart disease
• Disadvantages
  • Hormonal side effects:
    • Acne
    • Hair loss
    • Weight gain
    • Decreased libido
    • Breast tenderness
    • Increase in PMS symptoms
  • You stop menstruating – may be a pro depending on how you feel about having a period
  • Increase the potential to develop ovarian cysts
  • Headaches
  • Has the potential for systemic absorption of progestins which can interfere with your naturally occurring sex hormones

So there you have it – a brief summary of the different types of IUD’s available to you listed with the pros and cons of those options. The goal of this post was to provide information on this one type of birth control, however it is important to know that there are MANY birth control options available. I am an advocate for educating my patients so they can make an informed decision around their health and feel confident that their choice best reflects their health goals at this time in their lives. I encourage you to continue reading and learning about all the options available around sexual health, ask your doctor or primary care provider questions, and don’t settle for a birth control option you don’t feel comfortable with – there will be one out there that best reflects your health goals and works for you!

In health,

Dr. Kira Lewis

Information in this post is intended as general information. It is not to replace medical advice from your primary care physician