Women in America have been nervous about IUDs for many years. This is mostly due to the backlash from the Dalkon Shield, an IUD available from 1971 to 1974 that caused many pelvic infections, spontaneous abortions and even a few deaths. That device had a multi-filament string with an outer sheath that broke down in the body. This left an open pathway from the vagina, which normally contains many kinds of bacteria, to the uterus, which is sterile. After insertion, many women quickly developed Pelvic Inflammatory Disease from the introduction of bacteria into the uterus. This led to painful chronic infections, scarring, infertility and occasionally, death. The new generation of IUDs is very different from the Dalkon Shield. There are currently 2 IUD’s available in the United States. The Mirena is a device that releases levonorgestrel slowly into the body over a period of 5 years. The Paragard is a copper barrier device that maintains a physical barrier for 10 years. Is there a really a need for long-term birth control in the US? Consider the statistics:
- There are approximately 3 million unintended pregnancies in the US every year
- In almost half of these pregnancies, the woman undergoes an abortion
- Almost 50% of women have an unintended pregnancy by age 45
- 54% of women who have an abortion were using contraception during the month they became pregnant, usually a condom or oral contraceptive
So are they safe? Let’s look at some of the major concerns with IUDs:
Risk of Perforation of the Uterus During Placement: This risk comes primarily from the amount of training your physician has had. Overall, the risk of perforation has been reported as zero to 1.3%, very low when compared to the risks you face with pregnancy.
Risk of Expulsion (your body rejecting the IUD and forcing it out): In a recent study, the rates of expulsion for levonorgestrel releasing IUDs and copper IUDs were compared. The rates of copper IUD expulsion were zero to 1.2% per year. The hormone releasing IUD expulsion rates were zero to 0.2% per year. There were no differences between women who had already had children and nulliparous women. It should be noted that these studies were done in Europe and did not use the Paragard copper IUD. A separate study of the Paragard showed a much lower expulsion rate.
Risk of Pelvic Inflammatory Disease: The risk of PID in IUD users is negligible; in fact, the Mirena may have a protective effect against infection. You don’t need prophylactic treatment of anti-biotics during insertion as once thought, and in fact, patients that test positive for Chlamydia and gonorrhea after insertion can be treated safely without removal and without increasing their risk of PID.
Infertility: The risk of infertility has been linked to PID, which has been not been shown to be a concern with modern IUDs. American women have chosen the IUD at very low rates, about 5.5% for both types of IUD compared to 20% of women in France, primarily because of fear stemming from outdated information. Educate yourself on the birth control options available to you and speak to your physician about your choice.