Understanding Birth Control and IUDs

The Importance of Birth Control

Birth control plays a vital role in preventing unintended pregnancies. While many associate the term ‘birth control’ with oral contraceptives like ‘The Pill’, intrauterine devices (IUDs) are recognized as the most effective option for preventing fertilization. Despite a higher initial cost, IUDs are the most cost-effective method in the long run. Approximately 150 million women globally utilize IUDs, yet misconceptions about their efficacy persist.

What is an IUD?

An IUD is categorized as a long-acting reversible contraception (LARC). Its effects are long-term but can be reversed immediately upon removal, restoring fertility. IUDs are T-shaped devices inserted into the uterus by a healthcare professional, positioned near the entrance of the fallopian tubes, where eggs are fertilized. Available sizes range from 28mm to 32mm wide and 30mm to 36mm long, accommodating the narrower uterine widths often found in adolescents and women who have not given birth vaginally.

How Does an IUD Work?

In the United States and Canada, two types of IUDs are approved: the copper IUD and the levonorgestrel (LNg) IUD. Both types are highly effective, with failure rates of 0.08% for copper IUDs and 0.02% for LNg IUDs, but they function differently.

The LNg IUD releases progestin, a synthetic form of progesterone, which inhibits the growth of the endometrium—the uterine lining essential for a fertilized egg’s development. It also desensitizes the endometrium to estradiol, preventing ovulation, and thickens cervical mucus to hinder sperm movement. The LNg IUD is available in three doses: 13.5mg, 19.5mg, and 52mg, with the smallest lasting three years and the others lasting five years. All doses are equally effective at preventing unintended pregnancies, and they may lead to lighter or absent menstrual bleeding.

The copper IUD operates by releasing copper ions that impair sperm function, preventing fertilization. It can also serve as emergency contraception if inserted within five days after unprotected intercourse. The copper IUD is effective for up to 10 years and starts working immediately upon insertion, though it may lead to heavier menstrual bleeding compared to LNg IUDs.

Are There Any Risks?

The most common complication associated with IUDs is displacement or dislodging, which should be promptly addressed by a healthcare provider. Less frequently, there is a risk of unintended pregnancy, often resulting in an ectopic pregnancy, where a fertilized egg develops outside the uterus. Uterine perforation during insertion is another rare risk, but having a trained professional perform the procedure significantly reduces this concern. Women considering IUDs may worry about pelvic inflammatory disease (PID); however, the risk is minimal and mostly associated with pre-existing sexually transmitted infections (STIs), which can be treated with antibiotics without necessitating IUD removal.

How is an IUD Inserted?

The process of obtaining an IUD starts with a consultation with a healthcare provider to discuss various birth control methods, potential complications, side effects, and benefits. If a negative pregnancy test is confirmed, an IUD can be inserted on the same day. During the insertion process, the healthcare provider may also conduct an STI test. After examining the uterus, tools such as a speculum and tenaculum are used to facilitate the insertion of the IUD into the uterus, effectively preventing pregnancy.

References

Bartholomew, S. (2009). What mothers say: The Canadian maternity experiences survey. Public Health Agency of Canada.
Black et al. (2016). Canadian contraception consensus (part 3 of 4): Chapter 7 – intrauterine contraception. Journal of Obstetrics and Gynecology Canada, 38(2), 182-222.
Hubacher D. (2014). Intrauterine devices & infection: Review of the literature. The Indian Journal of Medical Research, 140(Suppl 1), S53–S57.
Lanzola, E. L., & Ketvertis, K. (2020). Intrauterine device (IUD). In StatPearls [Internet]. StatPearls Publishing.
Whaley, N. S., & Burke, A. E. (2015). Intrauterine contraception. Women’s Health, 759–767.
Wildemeersch D. (2009). New intrauterine technologies for contraception and treatment in nulliparous/adolescent and parous women. Facts, Views & Vision in ObGyn, 1(3), 223–232.
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