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Intrauterine Devices
 
 

The intrauterine device (IUD) is a highly effective and convenient method of contraception. However, many women and providers in the United States are reluctant to use or recommend it because of the poor safety legacy of the Dalkon Shield IUD. Today, however, new IUDs are recognized by the Food and Drug Administration, the World Health Organization, the American Medical Association, and the American College of Obstetricians and Gynecologists as some of the safest and most effective reversible methods of birth control for women and potential alternative to sterilization. In addition to providing women with a viable option for family planning, these products offer a number of underreported benefits, including protection against disease.

A note on terminology. There are several terms used to describe contraceptive devices that work in the uterus. Intrauterine contraception, or IUC, includes the intrauterine device, or IUD, and the intrauterine system, or IUS. While the term IUD is often used interchangeably with IUS, the term IUS is only used to refer to devices containing hormones.

Frequently Asked Questions About Intrauterine Devices (IUDs)

What are intrauterine devices (IUDs)?

What IUDs are available?

How effective are IUDs?

What are some of the advantages to using an IUD?

What are some of the side effects associated with an IUD?

Who can use the IUD?

Who should not use an IUD?

When can the IUD be inserted?

How are IUDs obtained?

Are IUDs covered by insurance?

Don't see your question here? Let us know.

What are intrauterine devices (IUDs)?
An intrauterine device (IUD) is a safe, effective long-acting reversible contraceptive (LARC) option.  IUDs are small devices made of flexible plastic that contain copper or a natural hormone, progestin.  IUDs work primarily by preventing fertilization of the egg.  The copper IUD, ParaGard®, works by blocking sperm from reaching the egg and is effective at preventing pregnancy immediately after insertion.  The hormonal IUD, Mirena®, works in various ways by keeping the ovaries from releasing eggs, helping cervical mucus to form to block the opening of the uterus and/or affecting the ability of the sperm to move towards the egg. It takes about 7 days for the hormonal IUD to begin preventing pregnancy.1, 2 Intrauterine devices do not provide protection against HIV and other sexually transmitted infections.

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What IUDs are available?
Two IUDs are currently available in the United States: ParaGard, a plastic T-shaped device wrapped in copper wire and Mirena, a progestin-releasing IUD.  Mirena is effective for up to 7 years and ParaGard is effective up to 12 years.3

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How effective are IUDs?

Current data show that both the Mirena and ParaGard IUDs are 99% effective at preventing pregnancy. Fewer than 1 in 100 women using the IUD experience accidental pregnancy during the first year of use.4 

ParaGard can be used as a form of emergency contraception and may be inserted to prevent pregnancy up to 5 days following unprotected sex. When inserted within several days of unprotected sex, it reduces a women’s risk of pregnancy to 1 in 1,000.5

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What are the advantages to using the IUD?
Once the IUD is in place, it is very convenient, there is no daily pill, and there is nothing to insert before intercourse.   ParaGard has no effect on hormone levels in the body.  Mirena may reduce cramps, make menstrual periods lighter and some women stop getting periods altogether while using this IUD.  Fertility returns soon after the IUD is removed.6  Due to the length of time the IUD can be used, it is one of the most cost effective methods of contraception on the market.

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What are side effects associated with using the IUD?
Side effects associated with the IUD insertion procedure include mild pain, cramping, and backaches.  After Mirena insertion, the menstrual cycle may become shorter, lighter, or stop altogether and women may experience spotting between periods within the first few months of use.  An increase in menstrual cramping and heavier bleeding is common after ParaGard insertion.  More serious side effects include the IUD slipping out of place, infection of the uterus, and the IUD puncturing the uterine wall, but these serious events are rare.7  

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Who can use the IUD?
An IUD is an appropriate contraceptive choice for women who prefer a very effective method of contraception and want a long-acting method that does not require doing something every day. It is especially appropriate for women who want a reversible method of birth control and who have only one sexual partner who is also monogamous.  The IUD may be used by all women of reproductive age who have had children and those who have not. 8 

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Who should not use an IUD?
An IUD is not an appropriate contraceptive choice for women who have had a sexually-transmitted infection (STI) or pelvic inflammatory disease (PID) in the past 3 months or currently.  Women who are already pregnant, have cervical or uterine cancer, or have unexplained vaginal bleeding are also advised not to use the device.9

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When can the IUD be inserted?
IUDs may be inserted at any time of the month, but most doctors advise it be inserted during the menstrual cycle because it is the time when the cervix is most open.  If a woman has just given birth, an IUD may be inserted immediately following delivery.  Some doctors recommend waiting 4 weeks after delivery to insert the device.10  

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How are IUDs obtained?
Licensed health care professionals prescribe IUDs and insert the device in a medical office or clinic. 

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Are IUDs covered by insurance?
For insurance coverage purposes, the IUD is considered to be a reversible contraceptive and in the same category as the implant, the diaphragm, and the pill.  Most health maintenance organizations (HMOs), some insurance plans, and Medicaid cover IUDs, but to varying degrees.  Patients should check with their health insurance plans to figure out the exact cost of their insertion.  According to a Guttmacher study of insurance coverage of contraceptives, 86% of health plans cover IUDs.11

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1 ARHP. Copper T IUD factsheet. Available at:  http://www.arhp.org/Publications-and-Resources/Patient-Resources/Fact-Sheets/Copper-T-IUD. Accessed April 27, 2012.

2 ARHP. Hormonal IUD factsheet. Available at:  http://www.arhp.org/Publications-and-Resources/Patient-Resources/Fact-Sheets/Hormonal-IUD. Accessed April 27, 2012.

3 Planned Parenthood. What is an IUD. Available at:  http://www.plannedparenthood.org/health-topics/birth-control/iud-4245.htm. Accessed April 27, 2012.

4 Center for Disease Control. Contraception. Available at: http://www.cdc.gov/reproductivehealth/UnintendedPregnancy/Contraception.htm#3. Accessed April 27, 2012.

5 Hatcher R.  Let’s get serious. Contraceptive Technology. 20th ed. New York: Ardent Media; 2011.

6 Brown University Health Education. Intrauterine device. Available at: http://brown.edu/Student_Services/Health_Services/Health_Education/sexual_health/safer_sex_and_contraceptives/iud.php. Accessed April 27, 2012.

7 Planned Parenthood. What are the disadvantages of an IUD. Available at:  http://www.plannedparenthood.org/health-topics/birth-control/iud-4245.htm. Accessed April 27, 2012.

8 Rubin S. Letter to Editor: Underuse of the IUD in contraceptive care and training. Family Medicine. June 2010;42:388.

9 Planned Parenthood. How safe is the IUD. Available at: http://www.plannedparenthood.org/health-topics/birth-control/iud-4245.htm.  Accessed April 27, 2012.

10 Planned Parenthood. What happens when I have an IUD inserted. Available at:  http://www.plannedparenthood.org/health-topics/birth-control/iud-4245.htm. Accessed April 27, 2012.

11 Sonfield A, Gold R, Frost J, Darrouch J. U.S. insurance coverage of contraceptives and the impact of contraceptive coverage mandates.  Guttmacher Institute Perspectives on Sexual and Reproductive Health. 2002;36:2 Available at: http://www.guttmacher.org/pubs/journals/3607204.html. Accessed April 27, 2012.

 

 

 

 
Resources
Assessment of the Quality of Information on the Internet about the IUD [PDF, 59KB]
RHTP article published in Contraception in November 2004.
 
 
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