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What About an IUD ... as Your Contraceptive Choice?

 

When considering a woman’s contraceptive options, IUDs bear discussion.   Some women have familiarity with IUD use, others have “heard of them”, but don’t have a real concept of how they’re used or how they work.   An IUD (Intra-Uterine-Device) is a contraceptive device placed inside the uterus, in an in-office procedure, that generally takes less than 5 minutes for your doctor to insert.  Pregnancy prevention occurs by a ‘foreign body’ inflammatory reaction that occurs based on the metal or plastic frame (T-shaped, about the size of an open paperclip) and by the local effect of the medication released by the IUD (either copper or progesterone.) This ‘inflammatory reaction’ likely creates a toxic environment for sperm (spermicidal), as well, likely inhibits implantation.

 


Though IUD use for contraception has been around for many years, with well proven efficacy, the precise mechanism of their contraceptive action, is not proven.  Two types of IUD most widely available for use are the Mirena IUD (a progesterone-coated device) and the Paragard IUD (a copper-coated device.)  The Mirena IUD is a 5 year device, with the advantage of creating lighter menstrual flows based on the continuous exposure of progesterone to the uterine lining.  In a regular menstrual cycle the uterine lining grows thick and fluffy to support implantation of a fertilized egg.  If no pregnancy occurs, the uterine lining sloughs off, which is the actual menstrual bleeding.  With the continuous exposure of the uterine lining to the progesterone from the Mirena IUD, growth of the lining is inhibited, leading to significant decrease in tissue for release at the end of the cycle, and therefore, light (or minimal to no) menstrual flow at the conclusion of the cycle.

The Paragard IUD is a 10 year, copper-coated device, without a hormonal component, and therefore, no long term effect in diminishing menstrual flow.  Both devices have (excellent) similar efficacies, very close to tubal ligation (sterilization) in their contraceptive rates.  IUD’s are a very reliable form of ‘reversible’ contraception, in that, fertility is restored upon removal.  They may be maintained until their expiration, or removed anytime earlier if fertility desired.

Some of us may remember a time, over 20years ago, when the Dalkon Shield (a popular IUD at the time) was recalled due to concerns of increasing pelvic infections associated with its use.  Investigations proposed one likely explanation for the increase in pelvic infections to the braided, multifilament material used in the string portion of the IUD, potentially acting as a ‘wick’ to spread vaginal bacterial infection into the pelvis.  IUD’s have replaced the braided, multifilament string material with a monofilament, non-braided material.  Modern IUD’s have not been associated with the same high rate of pelvic infections.


Suzanne Hall, MD (@drsuzyyhall)

Eastside Gynecology Obstetrics, PC

Offices located in Roseville, Macomb, Grosse Pointe, and Rochester MI


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