Wednesday, January 21, 2015

Intrauterine Device (IUD)


Intrauterine Device (IUD)
Multiple Responses:
An intrauterine device (IUD or coil) is a small contraceptive device, often 'T'-shaped, often containing either copper or levonorgestrel, which is inserted into the uterus. They are one form of long-acting reversible contraception which are the most effective types of reversible birth control. Failure rates with the copper IUD is about 0.8% while the levonorgestrel IUD has a failure rate of 0.2% in the first year of use. Among types of birth control, they along with birth control implants result in the greatest satisfaction among users. As of 2007, IUDs are the most widely used form of reversible contraception, with more than 180 million users worldwide.

Evidence supports effectiveness and safety in adolescents and those who have and have not previously had children. IUDs do not affect breastfeeding and can be inserted immediately after delivery. They may also be used immediately after an abortion. Once removed, even after long term use, fertility returns to normal immediately.

While copper IUDs may increase menstrual bleeding and result in more painful cramps hormonal IUDs may reduce menstrual bleeding or stop menstruation altogether. Cramping can be treated with NSAIDs. Other potential complications include expulsion (2–5%) and rarely perforation of the uterus (less than 0.7%). A previous model of the intrauterine device (the Dalkon shield) was associated with an increased risk of pelvic inflammatory disease, however the risk is not affected with current models in those without sexually transmitted infections around the time of insertion.

The letters IUD stand for "intrauterine device." IUDs are small, "T-shaped" devices made of flexible plastic. A health care provider inserts an IUD into a woman's uterus to prevent pregnancy.

There are two types of IUD available in the United States — copper (ParaGard) and hormonal (Mirena or Skyla).

birth control ParaGard IUD
The ParaGard IUD contains copper. It is effective for 12 years.
birth control Mirena IUD
The hormonal IUD releases a small amount of progestin. There are two brands. Mirena is effective for five years. Skyla is slightly smaller and effective for three years.

Both the copper and hormonal IUDs work mainly by affecting the way sperm move so they can't join with an egg. If sperm cannot join with an egg, pregnancy cannot happen.

For some women, hormonal IUDs may prevent the egg from leaving the ovary. Pregnancy cannot happen if there is no egg to join with sperm. Progestin also prevents pregnancy by thickening a woman's cervical mucus. The mucus blocks sperm and keeps it from joining with an egg.

Effectiveness is an important and common concern when choosing a birth control method. IUDs are one of the most effective forms of birth control available. Less than 1 out of 100 women will get pregnant each year if they use an IUD.

Keep in mind that the IUD doesn't protect against sexually transmitted infections. Use a condom along with the IUD to reduce the risk of infection.

The ParaGard IUD can be used as emergency birth control, to prevent pregnancy after unprotected intercourse. It can reduce the risk of pregnancy by 99.9 percent if inserted within 120 hours (five days) after unprotected intercourse.

Most women can use an IUD safely. But all medications have some risks, so safety is a common concern when choosing a birth control method. Certain conditions increase the risk of side effects. Talk with your healthcare provider about your health and whether an IUD is likely to be safe for you. There are many other methods of birth control that may be safe for you if you cannot use an IUD.

You should not use an IUD if you:
  • have had a pelvic infection following either childbirth or an abortion in the past three months
  • have or may have a sexually transmitted infection or other pelvic infection
  • think you might be pregnant
  • have cervical cancer that hasn't been treated
  • have cancer of the uterus
  • have unexplained bleeding in your vagina
  • have a uterine perforation during IUD insertion

A health care provider may find that the unique size, shape, or condition of a woman’s uterus does not allow correct placement of an IUD. This is not common.

You should not use the ParaGard IUD if you:
  • have, or may have, an allergy to copper or have Wilson's Disease — an inherited disease that blocks the body’s ability to get rid of copper
You should not use a hormonal IUD if you
  • have severe liver disease
  • have, or may have, breast cancer

If you have a condition that makes it unsafe to use an IUD, don’t worry. There are many other methods of birth control that may be safe for you. Read about other methods to find one that is right for you.

IUDs are some of the least expensive, longest lasting forms of birth control available to women today. There are many other benefits:
  • IUDs may improve your sex life. There is nothing to put in place before intercourse to prevent pregnancy. Some women say that they feel free to be more spontaneous because they do not have to worry about becoming pregnant.
  • The ParaGard IUD does not change a woman's hormone levels.
  • Hormonal IUDs may reduce period cramps and make your period lighter. On average, menstrual flow is reduced by 90 percent. For some women, periods stop altogether.
  • IUDs can be used during breastfeeding.
  • The ability to become pregnant returns quickly once the IUD is removed.

Some women may worry that they are pregnant if they do not have a regular period. But the IUD is very effective. If you are concerned about a possible pregnancy, you can always take a pregnancy test.

Overall, most women who get an IUD are very satisfied with their choice.

It's important to think about the possible side effects of using an IUD.

You may have:
  • mild to moderate pain when the IUD is put in
  • cramping or backache for a few days
  • spotting between periods in the first 3–6 months
  • irregular periods in the first 3–6 months — with Mirena or Skyla
  • heavier periods and worse menstrual cramps — with ParaGard

Pain relievers can usually reduce bleeding, cramping, and other discomforts. If they are severe and do not seem to lessen, tell your healthcare provider.

Serious problems with the IUD are rare. There are three main things to watch out for when using an IUD:
  • The IUD can sometimes slip out of the uterus. Sometimes it comes all the way out. Sometimes it only comes out a little. This is more likely to happen to women who are younger and who have never had a baby. If the IUD slips out of place, pregnancy can happen. If it comes out only part of the way, it has to be removed.
  • In rare situations, a woman could develop an infection when using the IUD. This happens if bacteria get into the uterus when the IUD is inserted. Most infections develop within three weeks of having the IUD inserted. If the infection is not treated, it can affect a woman's ability to become pregnant in the future.
  • In very rare situations, when the IUD is inserted, it can push through the wall of the uterus. This might sound painful, but it usually isn't. Usually, when this happens, the health care provider will notice it and it can be fixed right away. But if not, the IUD can move around and harm other parts of the body. When this happens, surgery may be needed to remove the IUD.

Most often, if complications happen, they are easy to treat with medicine or other treatments.
It's important to pay attention to any symptoms you might have after starting the IUD. Tell your healthcare provider immediately if you:
  • find the length of the string ends to be shorter or longer than they were at first, when you feel for them with your fingers
  • are not able to feel the string ends when you check
  • feel the hard plastic bottom of the "T" part of the IUD against the cervix, when you check
  • think you might be pregnant
  • have periods that are much heavier than normal or last much longer than normal
  • have severe abdominal cramping, pain, or tenderness in the abdomen
  • have pain or bleeding during sex
  • have unexplained fever and/or chills
  • have flu-like symptoms, such as muscle aches or tiredness
  • have unusual vaginal discharge
  • have a missed, late, or unusually light period
  • have unexplained vaginal bleeding

IUDs and Pregnancy
The risk of pregnancy while using an IUD is very low. But if the IUD slips out of place, pregnancy can happen. If you become pregnant, have the IUD removed as soon as you find out that you are pregnant. If you are pregnant with an IUD in place, there is an increased risk of:
Even with the risks, some women may choose not to have the IUD removed during pregnancy. If you don't want to have the IUD removed while you are pregnant, you need to work with your health care provider through your pregnancy.
Ectopic pregnancies are a serious concern. They can be life-threatening. Women who use IUDs are much less likely to have an ectopic pregnancy than women who are not using birth control. But if a woman does become pregnant while using an IUD, it is more likely to be ectopic than if she was not using the IUD.

Symptoms of an ectopic pregnancy include:
  • irregular vaginal bleeding
  • pain in the abdomen or tip of the shoulder
  • sudden weakness or fainting

If you have any of these symptoms while using an IUD, get medical care right away.

You can have sex as soon as you like after the IUD is inserted:
  • The ParaGard IUD is effective immediately.
  • Hormonal IUDs are effective immediately if inserted within seven days after the start of your period. If you have Mirena or Skyla inserted at any other time during your menstrual cycle, use another method of birth control like a condom, female condom, or spermicide if you have vaginal intercourse during the first week after insertion. Protection will begin after seven days.

To get an IUD, you need to visit a health care provider. Your healthcare provider will ask you some questions about your medical history and the way you live your life. It is important to be open about your sex life because the IUD may not be right for you. But don’t worry. There are many other birth control methods to choose from if you cannot use the IUD.

If an IUD seems to be a good choice for you, your healthcare provider will check your vagina and internal organs. You may be tested for sexually transmitted infections or for other infections to make sure it’s safe for you to get an IUD. If you have any kind of pelvic infection, you may need treatment before getting an IUD.

An IUD can be inserted at any time of the month. But it is usually more comfortable if you have it inserted in the middle of your menstrual cycle. That is when the cervix — the opening to the uterus — is the most open.

An IUD can be inserted after a pregnancy or abortion.

You can have an IUD inserted:
  • up to 48 hours after giving birth OR after waiting at least four weeks after giving birth. Women who are breastfeeding should wait four weeks before having a hormonal IUD inserted.
  • immediately after an aspiration abortion
  • four weeks after a D&E abortion
  • when the abortion is complete after taking the abortion pill. Your healthcare provider can help you decide when to get the IUD inserted.
A health care provider will insert the IUD. The IUD is inserted into the uterus through the cervix using special instruments.
It is common for women to feel some cramping when the IUD is inserted. Many women only feel mild discomfort. The cramps go away after you rest, or if you take some pain medication. Some health care providers suggest that women take pain medication before the IUD is inserted to lessen the cramps. Some health care providers inject a local anesthetic around the cervix to reduce discomfort.

When the IUD is inserted, some women may feel dizzy. Rarely, a woman might faint. You can ask someone to come with you when you get the IUD inserted so you don’t have to drive or go home alone. You should plan to rest at home until any discomfort goes away.
When the IUD is in place, a string will hang down into the vagina. It will be about one to two inches long.

You should have a checkup after your first period. Don't wait longer than three months after you get your IUD to make sure it is still in place. Women using an IUD should have regular checkups to make sure everything is all right. This can be done at the same time as your periodic GYN exam. Remember when you have your IUD inserted. That way, if you see other healthcare providers, you can tell them when it needs to be replaced. The ParaGard IUD should be replaced after 12 years. Mirena should be replaced after five years. Skyla should be replaced after three years.

If an IUD is going to slip out of place, it will most likely happen in the first few months of use. But it may occur later. The IUD is most likely to slip out of place during your period. Check your pads, tampons, or cups to see if the IUD has fallen out. If it has, you must check with your healthcare provider. Until then, use another form of birth control such as condoms.

Between your periods, you can check for the string ends if you want to, but do not pull on them. Pulling the strings might make the IUD move out of place or even come out.

Having an IUD removed or replaced is usually simple. Your healthcare provider will do it for you. Women should never try to remove IUDs themselves or ask nonprofessionals to do it for them. Serious damage could result.
In rare cases, IUDs cannot be easily pulled free. In these cases, the cervix may have to be dilated and a surgical tool may be used to free the IUD. In very rare cases, surgery becomes necessary.

You need to see a health care provider to get an IUD. Your healthcare provider can help you decide if an IUD is right for you. You can find a healthcare provider who can help you with getting an IUD at your local Planned Parenthood health center or at other clinics.

The IUD is the most inexpensive long-term and reversible form of birth control you can get. Unlike other forms of birth control, the IUD only costs money in the beginning. The cost for the medical exam, the IUD, the insertion of the IUD, and follow-up visits to your healthcare provider can range from $0 to $1,000. That cost pays for protection that can last from 5 to 12 years, depending on which IUD you choose. In general, hormonal IUDs costs more than the ParaGard.

Planned Parenthood works to make healthcare accessible and affordable. Some health centers are able to charge according to income. Most accept health insurance. If you qualify, Medicaid or other state programs may lower your health care costs.

The IUD is a little, t-shaped piece of plastic that gets put in your uterus to mess with the way sperm can move and prevent them from fertilizing an egg. Sounds odd, but it works like a charm. IUDs offer years of protection—between three and twelve, depending on the type you get. And if you want to get pregnant, you can have the IUD removed at any time. In the U.S. there are three types of IUDs: Mirena and ParaGard, which are already widely available, and a new IUD called Skyla.

This plastic IUD releases a small amount of the synthetic hormone progestin to help your body keep sperm from reaching your cervix. It lasts up to 5 years and may give you lighter periods.

This IUD is 100% hormone-free and doesn’t alter your periods. It's made of plastic and a small amount of natural, safe copper. It can stay inside you up to 12 years.

This plastic IUD is the smallest one available and has been FDA-approved for women who have not had a child. It releases a small amount of the synthetic hormone progestin to help keep sperm from reaching your cervix. It works for up to 3 years.

Get it and forget it
If you're a busy person who doesn't want to worry about remembering birth control, the IUD just may be for you. Once it's in, you're good to go for years.

Hands free
No packages or prescriptions to pick up at the pharmacy, so there's nothing that could get lost or forgotten.

Total privacy
No one can tell when you have an IUD. (Some partners say they can feel the string, but that can be adjusted.) There's no tell-tale packaging, and nothing you need to do just before you have sex.

Safe and sound
Most experts agree, if you’re a healthy woman, you’re probably a good candidate for the IUD. That’s true even if you’re young, haven't ever been pregnant, or haven’t had kids yet.

The pregnancy question
You should return to fertility (fancy way of saying you should go back to being able to get pregnant) very quickly after you have the IUD removed. Which is great if you want to have a baby. But if you're not ready to get pregnant as soon as you have an IUD taken out, be sure to protect yourself with an alternate method.

Don't take our word for it. Check out the videos above to hear women and men talk about their experiences with the IUD. And be sure to ask your health care provider which method is best for you.

Intrauterine Device (IUD) for Birth Control
An IUD is a small, T-shaped plastic device that is wrapped in copper or contains hormones. The IUD is inserted into your uterus by your doctor. A plastic string tied to the end of the IUD hangs down through the cervix into the vagina. You can check that the IUD is in place by feeling for this string. The string is also used by your doctor to remove the IUD.

Types of IUDs
  • Hormonal IUD. The hormonal IUD, such as Mirena or Skyla, releases levonorgestrel, which is a form of the hormone progestin. The hormonal IUD appears to be slightly more effective at preventing pregnancy than the copper IUD. There are two hormonal IUDs—one works for 5 years, and the other works for 3 years.
  • Copper IUD. The most commonly used IUD is the copper IUD (such as Paragard). Copper wire is wound around the stem of the T-shaped IUD. The copper IUD can stay in place for up to 10 years and is a highly effective form of contraception.

How it works
Both types of IUD prevent fertilization of the egg by damaging or killing sperm. The IUD also affects the uterine lining (where a fertilized egg would implant and grow).
  • Hormonal IUD. This IUD prevents fertilization by damaging or killing sperm and making the mucus in the cervix thick and sticky, so sperm can't get through to the uterus. It also keeps the lining of the uterus (endometrium) from growing very thick.1 This makes the lining a poor place for a fertilized egg to implant and grow. The hormones in this IUD also reduce menstrual bleeding and cramping.
  • Copper IUD. Copper is toxic to sperm. It makes the uterus and fallopian tubes produce fluid that kills sperm. This fluid containswhite blood cells, copper ions, enzymes, and prostaglandins.1

You can have an IUD inserted at any time, as long as you are not pregnant and you don't have a pelvic infection. An IUD is inserted into your uterus by your doctor. The insertion procedure takes only a few minutes and can be done in a doctor's office. Sometimes a local anesthetic is injected into the area around the cervix, but this is not always needed.

IUD insertion is easiest in women who have had a vaginal childbirth in the past.

Your doctor may have you feel for the IUD string right after insertion, to be sure you know what it feels like.

What To Expect After Treatment
You may want to have someone drive you home after the insertion procedure. You may experience some mild cramping and light bleeding (spotting) for 1 or 2 days.

Your doctor may want to see you 4 to 6 weeks after the IUD insertion, to make sure it is in place.
Be sure to check the string of your IUD after every period. To do this, insert a finger into your vagina and feel for the cervix, which is at the top of the vagina and feels harder than the rest of your vagina (some women say it feels like the tip of your nose). You should be able to feel the thin, plastic string coming out of the opening of your cervix. It may coil around the cervix, which can make it difficult to find. Call your doctor if you cannot feel the string or the rigid end of the IUD.

If you cannot feel the string, it doesn't necessarily mean that the IUD has been expelled. Sometimes the string is just difficult to feel or has been pulled up into the cervical canal (which will not harm you). An exam and sometimes an ultrasound will show whether the IUD is still in place. Use another form of birth control until your doctor makes sure that the IUD is still in place.

If you have no problems, check the string after each period and return to your doctor once a year for a checkup.

Why It Is Done
You may be a good candidate for an IUD if you:
  • Do not have a pelvic infection at the time of IUD insertion.
  • Have only one sex partner who does not have other sex partners and who is infection-free. This means you are not at high risk for sexually transmitted infections (STIs) or pelvic inflammatory disease (PID), or you and your partner are willing to also use condoms.
  • Want an effective, long-acting method of birth control that requires little effort and is easily reversible.
  • Cannot or do not want to use birth control pills or other hormonal birth control methods.
  • Are breast-feeding.

The copper IUD is recommended for emergency contraception if you have had unprotected sex in the past few days and need to avoid pregnancy and you plan to continue using the IUD for birth control. As a short-term type of emergency contraception, the copper IUD is more expensive than emergency contraception with hormone pills.

How Well It Works
The IUD is a highly effective method of birth control.1
  • When using the hormonal IUD, about 2 out of 1,000 women become pregnant in the first year.2
  • When using the copper IUD, about 6 out of 1,000 women become pregnant in the first year.2
  • Most pregnancies that occur with IUD use happen because the IUD is pushed out of (expelled from) the uterus unnoticed. IUDs are most likely to come out in the first few months of IUD use, after being inserted just after childbirth, or in women who have not had a baby.

Advantages of IUDs include cost-effectiveness over time, ease of use, lower risk of ectopic pregnancy, and no interruption of foreplay or intercourse.1

Other advantages of the hormonal IUD
Also, the hormonal IUD:
  • Reduces heavy menstrual bleeding by an average of 90% after the first few months of use.1
  • Reduces menstrual bleeding and cramps and, in many women, eventually causes menstrual periods to stop altogether. In this case, not menstruating is not harmful.
  • May effectively relieve endometriosis and is less likely to cause side effects than high-dose progestin.3
  • Reduces the risk of ectopic pregnancy.
  • Does not cause weight gain.

Risks of using an intrauterine device (IUD) include:
  • Menstrual problems. The copper IUD may increase menstrual bleeding or cramps. Women may also experience spotting between periods. The hormonal IUD may reduce menstrual cramps and bleeding.1
  • Perforation. In 1 out of 1,000 women, the IUD will get stuck in or puncture (perforate) the uterus.1 Although perforation is rare, it almost always occurs during insertion. The IUD should be removed if the uterus has been perforated.
  • Expulsion. About 2 to 10 out of 100 IUDs are pushed out (expelled) from the uterus into the vagina during the first year. This usually happens in the first few months of use. Expulsion is more likely when the IUD is inserted right after childbirth or in a woman who has not carried a pregnancy.1 When an IUD has been expelled, you are no longer protected against pregnancy.

Disadvantages of IUDs include the high cost of insertion, no protection against STIs, and the need to be removed by a doctor.

Disadvantages of the hormonal IUD
The hormonal IUD may cause noncancerous (benign) growths called ovarian cysts, which usually go away on their own.

The hormonal IUD can cause hormonal side effects similar to those caused by oral contraceptives, such as breast tenderness, mood swings, headaches, and acne. This is rare. When side effects do happen, they usually go away after the first few months.

Pregnancy with an IUD
If you become pregnant with an IUD in place, your doctor will recommend that the IUD be removed. This is because the IUD can cause miscarriage or preterm birth (the IUD will not cause birth defects).

When to call your doctor
When using an IUD, be aware of warning signs of a more serious problem related to the IUD.
Call your doctor now or seek immediate medical care if:
  • You have severe pain in your belly or pelvis.
  • You have severe vaginal bleeding.
  • You are passing clots of blood and soaking through your usual pads or tampons each hour for 2 or more hours.
  • You have vaginal discharge that smells bad. You have a fever and chills.
  • You think you might be pregnant.

Watch closely for changes in your health, and be sure to contact your doctor if:
  • You cannot find the string of your IUD, or the string is shorter or longer than normal.
  • You have any problems with your birth control method.
  • You think you may have been exposed to or have a sexually transmitted infection.

What To Think About
The IUD is most likely to work well for women who have been pregnant before. Women who have never been pregnant are more likely to have pain and cramping after the IUD is inserted. They are also more likely to expel the IUD. But they can still use the IUD.

Pelvic inflammatory disease (PID) concerns have been linked to the IUD for years. But it is now known that the IUD itself does not cause PID. Instead, if you have a genital infection when an IUD is inserted, the infection can be carried into your uterus and fallopian tubes. If you are at risk for a sexually transmitted infection (STI), your doctor will test you and treat you if necessary, before you get an IUD.

Intrauterine devices reduce the risk of all pregnancies, including ectopic (tubal) pregnancy. But if a pregnancy does occur while an IUD is in place, it is a little more likely that the pregnancy will be ectopic. Ectopic pregnancies require medicine or surgery to remove the pregnancy. Sometimes the fallopian tube on that side must be removed as well.

IUD use and medical conditions
An IUD can be a safe birth control choice for women who:4

  • Have a history of ectopic pregnancy. Both the copper IUD and hormonal IUD are appropriate.
  • Have a history of irregular menstrual bleeding and pain. The hormonal IUD may be appropriate for these women and for women who have a bleeding disorder or those who take blood thinners (anticoagulants).
  • Have diabetes.
  • Are breast-feeding.
  • Have a history of endometriosis. The hormonal IUD is a good choice for women who have endometriosis.

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