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The Intrauterine Device (IUD)
What: An IUD is a tiny T-shaped device that is implanted into the uterus by a doctor. It has a cord dangling down into the upper part of the vagina and remains in the uterus for five to 10 years, when it is time to remove it and insert a new one. IUDs work by creating a uterine environment that is inhospitable to sperm, and one type also secretes progestin as a backup. These devices were horribly maligned after the Dalkon Shield medical debacle of the '70s (rightfully so) but now seem poised to make a comeback. Manufacturers say that flaws in the design and procedure that made old IUDs so dangerous for women (like the Shield's woven double strands that transmitted dangerous bacteria) have been fixed, and the CDC has approved IUDs as safe for women at low risk for STDs. Among reproductive researchers and healthcare providers, at least, the IUD has become the new "it" contraceptive. The percent of women on birth control who favor the IUD has increased to 5.5 percent from 1.3 percent in 1995, and Carusi says that she and her colleagues have seen a big uptick in the number of Boston users in the past few years. There are two types of IUDs currently available in the United States:
  • The ParaGard is made of copper. It's been around since 1984 and doesn't contain hormones but has been known to cause heavy periods, breakthrough bleeding and uncomfortable cramps. It can be left in the uterus for up to 10 years.
    ParaGard failure rate: 0.6–0.8%

  • The Mirena is made of plastic and contains a progestin hormone called levonorgestrel that is often used in birth control pills. It's estrogen free, and can be safely left in the uterus for up to five years. This type of IUD, which the FDA approved as a contraceptive in 2000 and as a treatment for heavy menstrual bleeding in 2009, is more commonly chosen by women.
    Mirena failure rate: 0.2%

Who: Currently most popular with women with at least one child, it has started catching on with women without kids. The CDC acknowledges that while "well-conducted studies" show no increased risk to fertility, there is some conflict over the data—despite that, IUDs are CDC-approved for women with children as well as those without.

  • It doesn't require another thought for at least half a decade.
  • It's more reliable than birth control pills.
  • There's no estrogen involved.
  • When it's inserted correctly, women can't feel it—nor can their partners.
  • It can be inserted as early as six weeks after a woman gives birth and is then safe for use during breastfeeding.
  • It's reversible.
Why not:
  • The cost for the IUD and the insertion ranges from $500 to $1,000. While affordable when amortized over the life span of the device, it's a lot to pay up front. The cost barrier should disappear in 2013 when insurance plans will be required to cover FDA-approved contraception.
  • The insertion doesn't tickle; Carusi describes it as a "visceral, internal pain" (usually less intense for women whose cervixes have been stretched by giving birth). One writer described it as "a spasm unlike any something deep inside me being twisted up and wrung out." The procedure only lasts a few minutes, and Carusi said the pain goes away as soon as it's over, but some women experience lingering cramps for a few days.
  • While IUDs alone haven't been proven to cause infertility, catching an STD like chlamydia or gonorrhea while using an IUD is extremely dangerous and can cause infections that result in infertility. Because of this risk, many single women opt to double-up protection with a condom.
  • Researchers will admit that they don't know exactly why the insertion of this device in the uterus why it works so well as a contraceptive, even without hormones.
  • IUDs have a scary history, and for some women, that history involved their moms and aunts.
As a reminder, always consult your doctor for medical advice and treatment before starting any program.