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Patient Information: Birth Control

The IUD

The IUD is a small, flexible plastic device that is inserted into the uterus by a physician to prevent pregnancy. Most IUDs have one or two slender strings that come down into the vagina that help you and the physician know it is in place. Some IUDs have copper wires wrapped around them, and some have a hormone called progesterone. Because the IUD remains in place for five to ten years, it is actually one of the least expensive methods of birth control.

The IUD posssibly works by preventing a fertilized egg from implanting and growing in the wall of your uterus. It may also slow down sperm and prevent them from reaching an egg or it may damage an egg before the sperm can get to it, prevently fertilization. Physicians are still uncertain as to exactly how the IUD works.

The advantages of the IUD are that it is very effective. It prevents pregnancy in about 97 out of every 100 women that uses it. It requires you to do nothing to make it work; it cannot be felt by either you or your partner if it is in place correctly. Most women have few lasting side effects from the IUD.

The disadvantages of the IUD are that it may cause heavier bleeding and cramping during your periods, especially in the first two or three months. Having an IUD also increases your chances of developing a pelvic infection. Some women are not able to retain an IUD - the IUD either "falls out" or must be removed because of heavy bleeding and cramping (usually within the first three months). If pregnancy occurs while the IUD is in place, the IUD must be removed to prevent a seriously infected miscarriage. A miscarriage may occur, even if the IUD is removed. There is also a small risk of the IUD puncturing the uterus when it is inserted, or after it is in place.

Who may use the IUD? In general, women who have had at least one child and are in a stable, mutually monogamous relationship (you and your partner have no other partners), and who want to have a reversible form of birth control are the most appropriate candidates for an IUD. Women who have ever had a pelvic infection (PID) may not use an IUD. Women with multiple sexual partners should not use an IUD. Women with certain medical conditions, such as heart valve diseases and defects, diabetes, or who are on long term steroid therapy should not use an IUD. Your doctor will need to determine whether or not the IUD is an appropriate method of birth control for you.

The IUD must be inserted by a physician or a nurse practitioner. It is often inserted during a period to ensure that you are not pregnant, and because the cervix is dilated. It may also be inserted at any other time if the provider is certain you are not pregnant. It may also be inserted at the time of a termination of a pregnancy or the birth of a baby. Insertion of an IUD is painful for some women; it makes others feel faint. Feeling faint usually does not last more than a few minutes; cramps may be felt for several days after insertion.

Check your IUD by:

• Feeling for the string weekly during the first three months, and after each period for as long as you have your IUD. Insert one finger into your vagina while squatting and find the round, firm cervix. Your provider will want to check your string a few weeks after your next period.
• If you have cramps after insertion, take Tylenol or aspirin. If the cramping continues for more than a few days after insertion, or if it becomes too painful for you, call your provider.
• Use another reliable method of birth control, such as foam and condoms, for at least the first month. This is the time when the IUD is most likely to "fall out".
• Check all pads and tampons carefully during every period to make sure the IUD has not been expelled.
• IUDs with copper must be changed every four years, those with progesterone must be changed every year. You still need to have a pelvic exam and a Pap smear once a year.

Possible Problems and Warning Signals

• If at any time you do not feel the string, or you feel the IUD at the opening of your cervix, use another method of birth control and call your provider.
• If you miss a period by 10-14 days, get a pregnancy test and call your provider.
• Know what kind of an IUD you have, and when it must be changed.
• If you are seen for any other medical problems, be sure to tell the provider you have an IUD.
• Never remove the IUD yourself.

Know the Danger Signals

• Late or missed period.
• Abdominal pain.
• Fever or chills.
• Increased or foul-smelling vaginal discharge.
• Spotting, bleeding, heavy periods or clots.

Call the provider or clinic if you have any of these signals, or if you have any questions.

Peer Review Status: Internally
Peer Review Date: 2004