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Monday, September 19, 2011

IUD for birth it safe?

Why would anyone want an intrauterine device?  Wasn’t there some big-deal lawsuit over IUDs-gone-wrong a while back?  I can answer in one sentence:  modern IUDs are safe, effective to protect against unwanted pregnancy, and they have advanced well beyond the old Dalkon Shield device that spawned a class-action suit. on.

The new IUDs come in two basic forms: hormone containing and non-hormone containing.  The former lasts a total of 5 years and the latter can stay in place for 10 years.  The infection rate is astonishingly low for both, as are the pregnancy rates.  But there are reasons to choose one above the other and reasons not to choose an IUD at all depending upon individual risk factors.  So you’ll have to ask your doctor if an IUD is right for you (I couldn’t resist putting that in).

Women with enlarged uteruses due to fibroids or other pathology, and women with undiagnosed irregular/abnormal uterine bleeding are not good candidates for an IUD.  But once their abnormal bleeding has been investigated and cancer ruled out, they could still consider using one of these devices.  A simple office procedure known as endometrial biopsy can help sort that out.

Those who have multiple sexual partners and who may therefore be more at risk for sexually transmitted infections are not advised to use an intrauterine device.  The device has an attached string that sits just outside the cervix at the top of the vagina, and if bacteria, particularly gonorrhea or chlamydia are introduced from a partner, the bacteria can travel directly into the uterine cavity and result in a major pelvic infection known as PID (pelvic inflammatory disease).

Women who have never had a baby might not want to go through the extra bit of discomfort with IUD insertion through their relatively narrow cervical canal, but they are certainly still considered viable candidates to use this method. 

And what about that discomfort?  Some people choose to take something containing ibuprofen (Motrin) prior to have an IUD inserted just to cut down on the cramping of the uterine wall as the device settles in the center of the cavity.  But in truth, the procedure can be very quick such that premedication is not necessary.  That’s an individual choice.

The hormonal IUD, commercially marketed as Mirena, is the most popular IUD right now.  It can actually stop menstrual flow altogether or at least significantly cut down on the total number of bleeding days.  The progesterone component in the center of this soft, flexible device inhibits the regrowth of the uterine lining each month such that there really isn’t much tissue to slough off in each cycle.  The drawback is that some women have very irregular spotting on this method, and this might be annoying enough to cause them to discontinue use.

The Parguard, a copper IUD, has absolutely no hormonal component.  Menses tend to be unaffected by the presence of the device although some women experience an overall increase in the flow.  The biggest plus for this one is the 10-year staying power.  At the end of that interval, the old one can be removed and replaced with a new IUD at the same time.

Now all these features sound good, but surely there is a drawback to using IUDs.  If I had to name one thing that bothers me the most, it would be the risk of perforation of the uterine wall (as can happen with a difficult insertion) that could land that IUD in the abdominal cavity where it can wreck havoc with the bowels, bladder and other innocent tissues residing in its path.  This is a rare occurrence, but it can happen to anyone.  The signs would be inability to feel the string protruding from the cervix shortly after the device has been placed in the doctor’s office.  Pain is another sign that the IUD is not in the right location; however, cramping is such a common event immediately following the procedure that it would be difficult to sort out what is happening without the benefit of an exam by a provider.

Overall, I believe the modern IUDs are worth looking into if you are searching for a more long-term birth control option and hate to have to deal with taking a pill every day.  The manufacturers have user-friendly websites with a lot of product information and testimonials to help make an informed choice.  Link to more information about contraceptive options.

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