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How Safe and Effective are Today’s IUDs?

Brandi Alexander

September 20, 2007

Introduction

            The IUD, intrauterine device, is a form of long term birth control in which the device is inserted into a woman’s uterine cavity via the vagina.  The IUD is one of the lesser known forms of birth control.  This is partly due to controversy over how effective and safe the method is.  Doctors have also made claims on how exactly the device works.  There are two types of IUDs that work in two different ways. 

 

 

 

 

picture from http://www.fwhc.org/birth-control/iudinfo.htm

 

 

The copper IUD, which is commonly called the ParaGard, consists of a copper-wrapped, t-shaped, plastic frame with two threads attached to the bottom.  After the device is inserted into the uterus, it prevents pregnancy by inhibiting the sperm from traveling through the fallopian tubes.  Even with this, there is still a chance for fertilization, but the ParaGard also has a mechanism for this case.  If the egg is fertilized, the copper lining sheds from the frame and inactivates the sperm.  ParaGards have a 99% effectiveness rate, which is about the same as all forms of birth control.  Some women experience a heavy and long menstrual cycle after insertion of the device.  Even with these long periods, spotting can occur in between cycles.  Any other more serious side effects should be called to the attention of your doctor. (http://www.paragard.com/paragard/index.php)

 

 

  (picture  from http://www.fwhc.org/birth-control/iudinfo.htm)

 

 

 

 

 

The Mirena IUD is the second form of the intra uterine device.  Unlike the ParaGard, the Mirena releases hormones into the body as a form of birth control.  This hormone is levonorgestrel which is a synthetic form of progestogen.  The Mirena prevents pregnancy using a combination of three different mechanisms.  The presence of the Marina produces an environment in which sperm cannot live and thrive.  It also blocks sperm at the entrance of the uterus by thickening the mucus membrane, and it also prevents the egg from being released.  Similar to the ParaGard, the Marina has an effectiveness rate of about 99%.  Like most forms of birth control, the Marina does have an effect on the menstrual cycle.  It takes about three to six months for the body to get used to the IUD, during which time, periods can be irregular and one can women can expect to have frequent bleeding.  After this time of irregularity, periods will usually be lighter, and about half of woman will stop having them.  There is a chance of light spotting each month.  One year after use, some women stop having periods altogether.   http://coolnurse.healthology.com/contraception/article1017.htm

Again, in the case of any more serious side effects a doctor should be notified.  Both of these IUDs are effective over a 10 year time span, and it should be said that the IUD does not protect users from AIDS or any other sexually transmitted diseases.

 

What is the controversy over IUDs and how is it proved wrong?

            For the past 30 years there has been controversy over how effective and safe IUDs are, and also how they prevent pregnancy.  This has cause a significant decrease in the use of the device in the Unite States.  However, in other countries, the IUD is still an extremely popular method of contraception.  Asian and European countries make up a huge portion of these countries.  The Association of Reproductive Health Professions claim that this is partly due to myths about the IUD in the United States.  Because of these misconceptions, there are very few trained professionals in the U.S. today that still use the IUD.  The common misconceptions include: causes, ectopic pregnancies, serves as an abortifacient, causes pelvic inflammatory disease, and cause infertility.  Also, many people exaggerated the side effects.  These myths were in the media and professional print, so they were very effective in deterring many interested women.  It is noted that the press frequently failed to print positive feedback from women who used and were

FIGURE 3. Worldwide Use of Intrauterine Contraception

TABLE 1. Myths About Intrauterine Contraception

  • Acts as an abortifacient
  • Causes ectopic pregnancies
  • Causes pelvic inflammatory disease (PID)
  • Causes infertility
  • Cannot be used in nulliparous women
  • Needs to be removed for PID treatment
  • Needs to be removed if actinomyces-like organisms are seen on Pap test

satisfied with device.

 http://www.arhp.org/healthcareproviders/cme/onlinecme/IUDCP/IUCuse.cfm   

There have been several studies investigating the relation of PID (pelvic inflammatory disease) to IUDs. Journal Watch reported that there is a relationship between the two, but numbers are low.  1 out of 1000 women experienced an infection after insertion. http://womens-health.jwatch.org/cgi/content/full/2003/507/6 .  PubMed also produced another study, in which results were nearly the same, reporting that 1.6 out of 1000 experienced the infections. http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=1347812&dopt=Citation  Doctors often prescribe antibiotics at the time of insertion even though these numbers are low.  These myths, and pelvic inflammatory disease were the most abundant and important concerns with the IUD.

 

 

Are they safe/effective?

            In conclusion, IUDs are safe and effective being that all claims toward the device were proved to be myths.  Not only is the method safe, it is also cost effective which appeals to women even more.  Family Health International conducted a study to support this claim.  The results proved that IUD could replace some birth control methods such as Norplant.  All methods of birth control are accompanied by side effects.  IUD’s most important side affect is PID, but this can be controlled and prevented by antibiotics and carefully application methods.  http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=10202746&dopt=Citation

The Association of Reproductive Health Professionals surveyed women who have used the IUD in their study.  Their reports show that 99% of women who have used the IUD were satisfied with the results/effectiveness.  This is very high, meaning that nearly every women surveyed was “very satisfied” or “somewhat satisfied” with their results.   http://www.arhp.org/healthcareproviders/cme/onlinecme/IUDCP/IUCuse.cfm

Although their has also been controversy over how these IUDs work, websites and studies all provided the same basic form of prevent.  The Feminists Women’s Health Center provides a summary of this method. (They work by changing the the lining of the uterus and fallopian tubes affecting the movements of eggs and sperm and so that fertilization does not occur.) http://www.fwhc.org/birth-control/iudinfo.htm 

If American Women pay more attention to the facts instead of common misconceptions and more OB/GYNs learn how to safely insert the IUD, the popularity of this safe, effective, and cost friendly form of birth control will greatly increase. 

 

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