Birth Control Options for Women - Intrauterine Devices (IUDs)

Inserting the IUD

With some exceptions, an IUD can be inserted at any time, except during pregnancy. It is typically inserted in the following manner by a trained health professional:

A plastic tube containing the IUD (the inserter) is slid through the cervical canal into the uterus.
A plunger in the tube pushes the IUD into the uterus.
Attached to the base of the IUD are two thin but strong plastic strings. After the instruments are removed, the health care provider cuts the strings so that about an inch of each dangles outside the cervix within the vagina.

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The strings have two purposes:

They enable the user or health care provider to check that the IUD is properly positioned. (Because the IUD has a higher rate of expulsion during menstruation, the woman user should also check for the strings after each period.)
They are used for pulling the IUD out of the uterus when removal is warranted.

Candidacy for the IUD

The IUD is often an excellent choice for women who do not anticipate future pregnancies, but who do not wish to be sterilized. Women who are unable to use hormonal contraceptives (for example, those with heart disease, epilepsy, migraines, hypertension, or liver disease) may be good candidates for the copper IUD.

Women with risk factors that preclude hormonal contraceptives should probably avoid progestin-releasing IUDs, although the progestin doses are much lower with LNG-IUS and probably do not pose the same risks. Other women who may be poor candidates for the IUD are those with the following history or conditions:

Current or recent history of pelvic infection.
Risk factors for sexually transmitted diseases (such as having multiple sexual partners).
History of menstrual disorders. (Progestin-releasing IUDs may be an option for women with heavy or painful bleeding. They should avoid the copper-releasing IUDs, however.)
Current pregnancy.
Abnormal Pap tests.
Cervical or uterine cancer.
Anatomical abnormalities of the uterus.
A very large or very small uterus.

Advantages of the Intrauterine Device

The IUD is one of the safest, least expensive, and most effective contraceptive devices available. In spite of its clear advantages and current safety record, only 1% of American women currently use the IUD. (Over 10% of European women have chosen the IUD.) This low use in America is mainly due to persisting and now unwarranted fears of serious infection. [See Infection below.] In fact, increasing its use would most likely reduce both the number of abortions and sterilizations in the US, without producing unwanted infertility.