Birth Control: Pros & Cons of an IUD

Let’s get personal. We’re talking birth control. It’s a very personal choice for every woman. It can be used for a wide variety of reasons, like preventing pregnancy and managing hormonal issues.

You’ve got condoms, pills, the patch, the vaginal ring, the shot, implants, IUDs … the list goes on and on. It can be challenging to choose the option that’s right for your body. It seems like most of my friends favor of this birth control, and I wanted to find out why there’s been a rise in popularity.

I spoke with Dyan Aretakis, FNP, MSN, who focuses on primary care for adolescents at UVA’s Teen and Young Adult Health Center. She walked me through the basics and uncovered some of the controversy that left a negative stamp on this type of contraceptive.

What is the IUD?

IUD stands for intrauterine device, which is classified as a long-acting reversible contraceptive (LARC). It’s a small, t-shaped device that a healthcare professional inserts into your uterus to prevent pregnancy.

Depending on the type, the IUD can last between 3-10 years. It’s also more effective at preventing pregnancy than other methods, like oral contraceptives. And unlike taking a pill every day, many women forget they have an IUD, since they can’t feel it once implanted. The IUD can also help improve menstrual symptoms, like bleeding and cramping.

Who is Eligible for an IUD?

Beginning in 2005, and as recently as 2015, The American College of Obstetrics and Gynecologists strongly recommend the IUD for women of all ages. And in 2015, the CDC updated the U.S. Medical Eligibility Criteria to endorse IUDs.

Women who have had a child before receiving an IUD are classified as category 1. Women who have not yet had a full-term pregnancy are assigned a category 2, which still means the benefits outweigh the risks. 

Additionally, since IUDs don’t contain estrogen, they’re suitable for women who can’t take other methods that may include it.

IUD Types

There are five types of IUDs:

• Skyla or Mirena — contain small amounts of the female hormone progesterone; last either three or five years
• Liletta (new) — similar to Mirena
• Kyleena (new) — in between Skyla and Mirena in dosage and years
• Paragard — no hormone; works through the effect of copper and lasts 10 years

Hormonal IUDs

Hormonal IUDs release a low dose of progesterone, which tends to reduce or stop menstrual bleeding and cramps. Any bleeding or spotting is irregular rather than monthly. Since most effects are limited to the uterus, you may experience fewer side effects than with other hormonal methods.

Copper IUD

The copper IUD lasts for 10 years and is ideal for women who can’t or don’t want any additional hormones. Monthly periods still occur, and they might be a little heavier with cramps.

What’s the Big Deal? Are IUDs Safe?

When I met with my OB-GYN, she suggested I stay away from an IUD since 1) I have not had a child, and 2) she said there was potential for the implant to injure my uterus and cause infertility. This certainly scared me away, but Aretakis confronts these fears head on.

According to Aretakis, the controversy stems from the many infections, hospitalizations and even deaths that lead to a lawsuit against the IUD manufacturer in the 1970s. Today’s implant design bears no resemblance to that of the 70s, and because of the massive lawsuit, FDA approval is now required for medical devices like the IUD.

Some of the current IUD risks include:

• Perforating the uterus at the time of placement– There’s a 1 in 1000 chance that the IUD could go through the uterus wall and into the abdomen, which requires surgical removal.
• Pelvic infection – All women are screened for STDs before placement, because the presence of an STD can increase this risk.
• Your medical history – The IUD is suitable for most medical histories, but an abnormally shaped uterus may be unfavorable to an IUD placement.

Curious about your birth control options?

Speak with one of our OB-GYN providers – they can preform an exam, conduct STD testing and recommend a method that best suits you.

What’s the real reason many healthcare professionals avoid IUDs? “Research has shown that many providers don’t recommend LARC because of their lack of experience in using it and their lack of knowledge about it,” says Aretakis.

A Professional’s Suggestion

Food for thought: Approved in 1960, the birth control bill was revolutionary for its time. However, newer birth control methods, like the IUD, have been well-studied, tested, used and recommended. “Where else in healthcare would we counsel patients about a 50-year-old drug rather than a newer, safer one?” asks Aretakis.

Aretakis also has two suggestions for women considering all forms of birth control:

1. Choose a LARC method for greatest effectiveness and ease of use.
2. Always commit to dual protection, which means using a condom in addition to your hormonal contraceptive.

No matter what type of contraceptive you choose, make sure it’s right for you and your body. And speak with your provider about all alternatives and any questions you might have.