Choosing a form of contraception can make for a difficult decision. There are side effects to consider, as well as potential complications, and overall effectiveness.
IUDs are the buzz right now, and for several good reasons.
- They are the most effective (>99%) of all the reversible contraceptive options available in Canada. Only permanent contraception (vasectomy, tubal ligation) is as effective.
- They are reversible. Once pulled, a woman’s fertility will resume immediately, though we counsel women to wait for their next cycle before attempting to conceive.
- They are forgettable. The pill, patch, ring, or injection methods rely on a woman’s memory. Forgetting to take/use the medication as prescribed can significantly reduce their effectiveness.
- They are long-acting. IUDs are effective for 3-5 years
- They are estrogen-free. Some women have medical conditions that prevent them from using estrogen-based treatments. IUDs are safe in these women.
The Society of Obstetricians and Gynecologists of Canada (SOGC), as well as the American College of Obstetrics and Gynecology (ACOG), recommend IUDs as the first-line choice for preventing pregnancy.
What about the horror stories? Can they happen?
Unfortunately yes – no treatment is risk-free. However, significant complications should be considered uncommon/rare. In our own office, we have inserted many IUDs over the years, without complications. The vast majority of women are quite happy with their IUD and choose not to go back to other and less effective methods in the future.
What we have to bear in mind is that IUD clinics are more common than they were a decade or two ago, and IUD placements occur much more regularly. Our experience as a medical community is improving, and health care providers are becoming more skilled at inserting them.
Some women have family or friends that have had complications with their IUDs. We must remember that no two women are alike and that the majority of women do well with IUDs.
Some women describe severe pain with insertion. This was often in the past when our IUD options were limited. For women who have never had a baby before, the cervix is more narrow (stenotic) than women who have delivered a baby prior. Mirena is a hormone IUD that has been available since 1990. The device insertion tube for this IUD is almost 5 mm in diameter. The new ‘little sister’ IUDs, Jaydess (available since 2014), and Kyleena (available since 2017) are smaller, with insertion tubes <4 mm. This size reduction has enabled a much easier insertion, with less cervical stretching, and a decrease in pain.
Should I choose a copper or hormone-releasing IUD?
While copper IUDs remain a reasonable choice, the majority of women opt for and prefer hormone-containing IUDs. The big difference in choice centres around bleeding. Copper IUDs will generally increase bleeding and cramping. The hormone IUDs (Mirena, Kyleena, and Jaydess) reduce bleeding and pain.
Lastly, some myths about IUD use for preventing pregnancy.
Myth: Women who have never had a baby cannot use an IUD.
Fact: IUDs may be used successfully in carefully selected women
Myth: IUDs increase the risk of ectopic pregnancy.
Fact: IUD users have a lower risk of ectopic pregnancy than women who are not using any form of birth control.
Myth: IUDs increase the risk of infertility.
Fact: Women who have their IUD pulled can conceive at the same rate as women who have never used an IUD.
Myth: IUDs increase the long-term risk of pelvic inflammatory disease (PID), an infection of the uterus and ovaries.
Fact: There is an increase in PID in the first few weeks after insertion, related to the transfer of bacteria into the uterus. For this reason, health care providers can swab the cervix for sexually transmitted infection at the time of insertion. Long-term, there is no increased risk of PID.
Myth: IUDs are not effective contraceptives.
Fact: As mentioned above, IUDs are quite useful. The hormone-containing IUDs appears to be as effective as tubal ligation.
IUDs are an excellent contraceptive option. Yet they are not for everyone. It is essential to speak to your health-care provider if you have any questions are concerns.
For more information, please visit: My Health Alberta