By JANE E. BRODY
After decades of sloppy research, bad publicity, lawsuits and widespread fears of health hazards, the intrauterine device is making a major comeback in the United States.
Although the IUD has long been the most popular reversible form of contraception worldwide, use of the device in this country, where oral contraceptives have always been far more popular, has lagged far behind that in other industrialized nations.
Now, according to Dr. David A. Grimes, professor of obstetrics and gynecology at the University of North Carolina School of Medicine, “the IUD is indeed enjoying a well-deserved renaissance.” In an interview with Medscape, a Web site for doctors, he noted that the IUD is increasingly seen as perhaps the safest, most convenient and most effective reversible form of contraception.
The number of women in America now using an IUD has more than tripled since 2002. In the 12 months ending in August 2011, IUDs accounted for 10.4 percent of contraceptives issued by doctors, up from just 1.7 percent in the 12 months ending August 2002, according to data from SDI Health, a health care research firm.
IUDs were once recommended only for women who were done having children, for fear of infertility from infections associated with the devices. But the guidelines were revised after better research showed these concerns to be groundless with currently marketed IUDs if proper precautions are taken when they are inserted.
As a result, IUDs are increasingly popular among young, unmarried and childless women, many of whom sing its praises in online chat rooms like IUD Divas.
Writing in Parlour Magazine, an online publication for women, Nakia, a reader, said, “I have an IUD and I love it. After trying many different contraceptive options over the years — the pill, the ring, the patch — I can finally say that I have found a birth control method that meets all of my needs with no noticeable side effects.”
Some experts suggest that the IUD’s growing popularity is owed in part to the high rate of divorce and remarriage in this country and the resulting reluctance of many women with children to permanently end their fertility through sterilization.
Among contraceptive users in this country, currently about 6 percent have an IUD, a hassle-free device that, like the pill, does not require a woman to do anything to avoid pregnancy at the time of a sexual encounter.
Given that nearly half of all pregnancies in the United States are unplanned, having a contraceptive in place when the mood strikes can reduce unwanted pregnancies and, consequently, the number of abortions. Not only is the IUD more than 99 percent effective in preventing pregnancy, but insertion of an IUD soon after a woman has unprotected intercourse is often effective as emergency contraception.
While no method of birth control is foolproof, the Association of Reproductive Health Professionals lists pregnancy rates among IUD users as 1 per 100 users a year at most, compared with about 3 per 100 for the injection of Depo-Provera, about 8 per 100 for the pill and about 15 per 100 for the condom.
Furthermore, IUD use has been found to reduce the risk of developing endometrial cancer. And a new study, published online by The Lancet Oncology in September, strongly suggested that IUD use can protect against cervical cancer as well.
But the lingering effects of a bad rep that IUDs no longer deserve may still be keeping millions of American women from choosing these devices from the cafeteria of contraceptive choices.
Two types of IUDs are available in this country: one, called ParaGard, releases tiny amounts of copper; the other, called Mirena, releases localized amounts of a synthetic hormone, the progestin levonorgestrel. IUDs do not disrupt the menstrual cycle and, unlike the pill, they do not prevent ovulation; rather, they interfere with fertilization and implantation.
With ParaGard, which can remain in place for 10 to 12 years, copper stimulates production of fluid in the woman’s reproductive tract that kills sperm. Should an egg become fertilized, copper-induced changes in the uterus prevent implantation.
The hormonal IUD, which can last for five years, prevents pregnancy by thickening the cervical mucus, making it difficult for sperm to get to the fallopian tubes, where fertilization takes place. The hormone also impedes changes in the uterine lining that are needed for implantation of a fertilized egg.
Not Right for Every Woman
The hormonal device is especially helpful for women who have heavy periods; it can reduce and sometimes halt menstrual bleeding and lower the risk of anemia and endometriosis.
Neither device is appropriate for women with abnormalities of the reproductive tract or those whose immune systems are suppressed by medication or disease. IUDs should not be inserted in women who are pregnant or who have cancer of the cervix or endometrium.
All IUDs must be inserted by a trained health professional using antiseptic techniques. When a woman no longer wants an IUD, it must be removed by a health professional as well.
Use of IUDs declined drastically in the 1970s and 1980s when one device, the Dalkon Shield, was linked to severe infections. Poorly designed studies blamed all IUDs for infections that damaged a woman’s tubes and caused infertility. The Dalkon Shield was taken off the market, but later studies that were better designed found that, all other factors being equal, there were no more cases of pelvic inflammatory disease among IUD users than occurred in nonusers.
Rather, researchers noted, some women already had sexually transmitted infections like chlamydia and gonorrhea at the time an IUD was inserted, and the process of insertion carried the infection higher into the reproductive tract. Now physicians know to screen women for such infections and treat any that are present before inserting an IUD.
IUDs are best suited for couples in a monogamous relationship. If a woman or her sexual partner has multiple partners, condoms should be consistently used even after an IUD is in place to reduce the risk of sexually transmitted infections. Thus, IUDs are not suitable for every woman, and it is important for women and their partners to be honest about their sexual behavior before an IUD is chosen for contraception.
Another potential impediment to IUD use is cost, which can exceed $1,000 for the hormonal IUD and about $300 for the copper IUD. The fees include an examination, the device and its insertion, although these are often covered in part or in full by Medicaid and many private insurance plans.
Of course, this is a one-time cost that can be amortized over five to 10 years. Costs are often lowest at Planned Parenthood clinics.