Birth Control Options for Women - Intrauterine Devices (IUDs)

Menstrual difficulties can be so troublesome with either IUD that, according to one study, they were responsible for a removal rate of 5% to 15% within a year of insertion.

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Infection. The current versions of IUD pose a slightly higher risk for pelvic inflammatory disease in the first month following insertion. The risk of PID in women without any symptoms of sexually transmitted infections, however, is the same in both IUD users and nonusers. Some physicians employ preventive antibiotics before inserting the IUD, but a major analysis did not find that this was helpful. (An early IUD, the Dalkon Shield, which sported a braided tail, was banned after reports of several deaths and a very high rate of infection.)

Ovarian Cysts. The LNG-IUS may increase the risk for ovarian cysts, but such cysts usually do not cause symptoms and resolve on their own.

Expulsion. An estimated 2% to 8% of IUDs are expelled from the uterus within the first year. Expulsion is most likely to occur during the first three months after insertion. Expulsion rates may be higher than average if the IUD is inserted immediately after delivery of a child. In one out of five cases, the user fails to notice that the device is gone, and thus faces the risk of unintended pregnancy. The risk for expulsion is highest during menstruation, so users are strongly advised to examine their sanitary napkins for the IUD every day during the period and to regularly check for the IUD strings throughout the month.

Effects on Pregnancy. None of the current IUDs increase the risk for infertility. In the very unlikely event that a woman conceives with an IUD in place, however, there is a higher risk of an ectopic pregnancy or miscarriage.

Click the icon to see an image of an ectopic pregnancy.

If the IUD is removed right after conception, than the risk for miscarriage is close to average (about 20%). There is no evidence that the IUD in a pregnant woman increases the risk for birth defects in the infant.

Perforation. A potentially serious complication of the IUD is the accidental perforation of the uterus during insertion or later perforation if the IUD shifts position. Such an occurrence is very rare and the risk is higher or lower depending on the skill of the inserter.