Birth Control Options for Women - Intrauterine Devices (IUDs)

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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 should also check for the strings after each period, especially if she has heavy cramps.)
• 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
• 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. ]

IUDs have the following advantages:

• The IUD is more effective than OCs at preventing pregnancy and it is reversible. Once it is removed, fertility returns. (In spite of outdated concerns, studies have found no adverse effects on fertility with the current IUDs.)
• Unlike the pill, there is no daily routine to follow.
• Unlike the barrier methods (spermicides, diaphragm, cervical cap, and the male or female condom), there is no insertion procedure to cope with before or during sex.
• Intercourse can resume at any time, and as long as the IUD is properly positioned, neither the user nor her partner typically feels the IUD or its strings during sexual activity.
• It is the least expensive form of contraception over the long term.