Eve Espey, an ob-gyn in Albuquerque, New Mexico, had her last child at 39 and then got an IUD inserted, because it offered 10 years of effective, forgettable contraception. "I can't tell you how many patients come to my clinic for the pill and leave with an IUD," she says. "I talk about the studies, but it's when I tell them, 'I have an IUD, and I love it,' that they say, 'Oh, really?'" But despite Espey's enthusiasm (and she's not alone—IUDs are the most popular method of birth control among female ob-gyns), only 2 percent of women in the U.S. who use contraception choose them, while 31 percent opt for the pill. An informal office poll confirmed our theory that many women are simply in the dark: To the question "Would you use an IUD?" we got responses ranging from "Didn't they stop making those in the '70s?" to "Do they create a force field in the uterus?" If you answered yes to either, keep reading.
Intra-What?
IUD stands for "intrauterine device." It's a flat, inch-long, plastic or copper T-shaped contraceptive that is inserted by a doctor or nurse into the uterus. The procedure takes 5 to 10 minutes. "Many women are pleasantly surprised when they see how tiny it is," says David Grimes, M.D., a professor of obstetrics and gynecology at the University of North Carolina at Chapel Hill.
There are two IUDs on the market: the Mirena, which releases a small, targeted amount of progestin (a synthetic form of the hormone progesterone) into the uterus—not the bloodstream—and lasts five years; and the ParaGard Copper T, which is encased in copper and nonhormonal, and lasts 10 years.
How They Work (No Force Fields)
The Mirena releases hormones that thicken cervical mucus, thin the uterine lining, and basically make the uterus an inhospitable place for sperm to survive and fertilize eggs. The hormone-free ParaGard achieves the same result through a different action—its copper casing causes an increase of ions and enzymes in the tubal and uterine fluids, inhibiting sperm function and fertilization. Both are over 99 percent effective, according to the birth-control bible Contraceptive Technology (Arden Media).
The myth that IUDs are abortifacients—birth control that works by aborting fertilized eggs—is just that. "IUDs can't terminate a pregnancy," says ob-gyn Anita Nelson, a professor at the David Geffen School of Medicine at UCLA. (The World Health Organization defines pregnancy as the implantation of a fertilized egg.)
The History of the IUD, PDQ
IUDs were first approved in the U.S. in the 1960s, but in 1971, a faulty one with a vaguely menacing name, the Dalkon Shield, was recalled because it increased the risk of pelvic inflammatory disease (PID) and infertility. Today's devices (the ParaGard was approved in 1984; the Mirena in 2000) are safe. "The Dalkon Shield was an anomaly," says Grimes, who has led several studies that have disproved the link between IUDs and PID. "A lot of bad epidemiology has now been clarified by better studies. Aside from the Dalkon Shield, we can say that IUDs have always been quite safe." If you're wondering what does cause PID, 90 percent of cases stem from sexually transmitted infections (STIs) like chlamydia and gonorrhea—which can be treated with an IUD in place (IUDs do not protect against STIs and HIV).
How's It Going ... In?
A doctor or nurse puts a tenaculum (a kind of clamp) on the cervix and pushes the IUD through its internal opening. Because the IUD is traveling from a nonsterile to a sterile area, there's a slight risk of infection for 20 days after insertion; a patient should see her doctor if she experiences fever, unusual discharge, or belly pain in the first three weeks.
An IUD has two threadlike strings attached so it can be removed easily by a doctor. "They only come an inch out of the cervix; it's not like you'll be sweeping the floor with them," says Espey, who adds that they shouldn't interfere with sex. "And you can use a tampon with it. I get that question a lot."
Does It Hurt Like a Mother?
Well, a rigid little shape is going to pass through your cervix. And no, it doesn't tickle. But the good news for moms is that insertion tends to be less painful if you've had children. "I tell patients, 'It's going to be uncomfortable for 35 to 40 seconds, followed by 10 to 20 minutes of cramping,'" says Espey, who is also an associate professor at the University of New Mexico. You can talk to your doctor about a cervical block, a shot that numbs the cervix.
But the Perks Are Great
The IUD is the most popular contraceptive outside the U.S. Here are four compelling reasons to play catch-up:
• Convenience: "It's a small amount of discomfort with insertion for 5 to 10 years of hands-off contraception," Espey says.
• Cost: An IUD is by far the cheapest long-term contraceptive method, though not over the short term—initial costs, including the device and doctor's fees, can run to $700.
• Reversibility: Once either kind of IUD is removed, the return to fertility is very quick. "There's almost no delay," says ob-gyn Karen Meckstroth, M.P.H., an assistant professor at the University of California, San Francisco. "The uterine lining needs to build up, which takes about one menstrual cycle."
• Bonus: Both IUDs may protect against endometrial cancer.
Potential Side Effects
The Mirena can cause cramping and one to three months of spotting; within a year, periods decrease by 90 percent or stop altogether. (It's considered medically safe to skip your monthly period, but ask your doctor if you're concerned.) For ParaGard users, the first few periods can be extremely heavy and crampy, but flow should normalize after a year.
Next Page: Mirena vs. ParaGard
