The World Health Organization (WHO) considers the intrauterine device (IUD) one of the reversible contraceptives – those that do not affect fertility -, one of the safest and most effective methods today . Unlike the rest of the world, where the IUD is one of the most used contraceptive methods, in Brazil it is sought after by only 5% of women.
With its high success rate, low rate of side effects, and lower price than other methods – given that its effectiveness lasts 5 or 10 years – a lot of research tries to understand why the method is so unpopular around here. Interestingly, all these researches are reaching the same conclusion: the only barrier is the lack of knowledge regarding its real benefits.
Even though many people have already heard about the IUD, most are unaware of its main advantages or still believe in some widespread myths about this method .
The result is that many patients come to the clinics with the most diverse questions: what types of IUDs are, how they work, when they can be used and what needs to be done if you want to use them.
As we believe that information is the best way to take care of health, in this article you will find what you need to know about IUD.
We remind you that this information does not exclude a gynecological medical consultation , where you will be able to clear up any remaining doubts and decide which is the best contraceptive method in your case.
What is the IUD?
The IUD is a small intrauterine device , which is inserted into the uterus and works by making it difficult for the egg to be fertilized by the sperm. The method underwent the most diverse changes and, in 1962, it had its first clinically accepted version – known as the Lippes loop. Since then, the IUD has continued to evolve, and the models available today bear little resemblance to those used in the 1970s .
The IUD can be copper coated, the IUD copper, or be hormonal, also known as an IUS. In Brazil, both can be covered by health plans and the copper one is also free from the SUS.
How do copper IUDs and hormonal IUDs work?
The two types of IUDs – with and without hormones – have similar mechanisms of action. The difference is that, in the first, the active principle is copper; while in the second, the active ingredient is levonorgestrel, a hormone analogous to progesterone , which is released in very small doses and directly into the uterus.
One reason IUDs are so effective is that they work more than once to prevent pregnancy. Both promote:
- Changes in uterine mucus – this inhibits the mobility of sperm, making it difficult for them to reach the egg;
- Spermicidal effect – eliminating sperm;
- Changes in the endometrium – which make it difficult for the egg to implant in the uterus.
Intrauterine devices, therefore, initially work by preventing the sperm from meeting the egg. If there is a failure in this step, they also make it difficult for the egg to fertilize, and if there is also a failure at this stage, this method can prevent the fertilized egg from evolving or implanting in the uterus.
Advantages of the Copper IUD
The main advantages of the non-hormonal IUD over the hormonal one are that it is cheaper and can stay in the uterus for up to 10 years, whereas the hormonal IUD can stay for only 5 years.
The copper IUD is indicated for women who need to avoid external hormones, as in the case of patients with breast cancer and a history of other diseases.
Advantages of the hormonal IUD (IUS)
The effectiveness of the IUS is even greater than that of the copper IUD. Also, while the non-hormonal IUD can increase menstrual flow, the hormonal IUD usually causes its reduction and, as a consequence, the reduction of menstrual cramps as well .
Despite the use of levonorgestrel, a hormone analogous to progesterone , the IUS does not use estrogen in its composition . Estrogen, present in birth control pills, is the hormone associated with an increased incidence of thrombosis – which is the appearance of a clot in the bloodstream – in its users.
In addition, the hormonal IUD promotes the release of levonorgestrel directly into the uterus, which allows the amount of hormone released to be low . As a consequence, the chance of this hormone reaching the bloodstream is minimal – and if it does, it will be in really small amounts.
Therefore, the method has little chance of the occurrence of side effects related to hormonal contraceptive methods: the chances of decreased libido, weight change and the appearance of pimples are much lower.
How effective is the IUD?
The effectiveness of the copper IUD is 99.2% to 99.4%, and this rate rises to 99.8% for the hormonal IUD . To be aware, tubal ligation – an irreversible method that connects the tubes – is 99.5% effective .
The IUD is also a more effective method than the birth control pill . It turns out that the effectiveness of the pill depends on its correct use : all pills must be taken at the same time, and none can be forgotten. If one of these errors happens, the effectiveness of this method drops from 99.7% to even 91% .
In addition, the use of some antibiotics and antidepressants, the consumption of alcoholic beverages, the emergence of intestinal problems such as diarrhea and vomiting and several other factors can also reduce the effectiveness of contraceptive pills.
As with pills, the effectiveness of condoms also depends directly on their proper use. Its effectiveness is 98% in perfect use, but in typical use this effectiveness drops to 85% . Remembering that the condom is the only method that prevents STDs and the recommendation is to use it in combination with another contraceptive method.
This comparative table, made by the WHO , shows the differences between perfect use and typical use (common use) of the various contraceptive methods available:
Who can use the IUD?
Contrary to what many believe, most women can use the IUD: even teenagers and those who have not had children . In addition, this method is recommended for lactating women, as it does not interfere with breastfeeding.
By reducing menstrual flow, the IUS is also indicated for:
- women with endometriosis
- Women with dysmenorrhea (strong and painful menstrual flow)
- Those who suffer a lot from menstrual cramps
What are the contraindications of the method?
In most cases, there is no contraindication to its use. When there are restrictions, they are usually related to the anatomy of the uterus . It is necessary that the uterine cavity can accommodate the accessory, so people with malformations, or who have had some dysfunction in the organ, will probably not adapt well. These issues should be evaluated by the patient’s gynecologist.
Because it increases menstrual flow, the copper IUD is also not recommended for women who suffer from anemia or who have increased flow . In these cases, the hormonal IUD may be more suitable, as it usually reduces this flow.
How does placement and adaptation work?
Insertion of the IUD is simple and quick, with an average duration of 15 minutes . The procedure can be performed in the doctor’s office, without the need for sedation or hospitalization . However, depending on the patient, the insertion can also be performed with sedation.
The IUD can be inserted at any time during the menstrual cycle, as long as it is certain that the patient is not pregnant. Therefore, many doctors prefer to perform the procedure during the menstrual period. The effectiveness of the method is immediate, regardless of the time of insertion.
Although many women experience some discomfort during placement, less than 5% experience moderate or acute levels of pain . To reduce the chances of discomfort, the doctor may recommend that the patient take an anti-inflammatory or antispasmodic before the procedure. If the patient is very sensitive to pain, the placement procedure can also be performed under anesthesia.
The placement discomfort should pass in a few days. See your doctor if you continue to feel pain after the deadline set by him.
What exams should I take?
Before the procedure, the gynecologist must perform a gynecological examination to rule out pregnancy, the presence of anatomical changes and gynecological infections.
After insertion, a transvaginal ultrasound will be performed for the first 6 months . After that, it is necessary to carry out gynecological follow-up and exams and preventive tests annually, as should be done by any woman who uses the IUD or not.
Intrauterine devices have evolved a lot in recent years. Currently, they are among the most effective contraceptive methods, with fewer adverse effects and lower long-term costs.
Therefore, they are considered by the WHO as one of the most important forms of family planning today, and are the most used contraceptive method in many countries.
Today there are a large number of contraceptive methods, each with their pros and cons. That is why it is very important for patients to know all these possibilities well.
With this knowledge, the first step is to look for your gynecologist to clear up your last doubts and decide, together with him, which method will be most effective in your specific case .
After medical advice, did you decide to use the IUD? Then the next step is to perform an ultrasound to verify that there is nothing preventing the placement of the device.