Why the Modern IUD Might Be the Best Birth Control for You
The practice of contraception has an interesting history dating back thousands of years. Although more modern methods didn’t begin to emerge until the 1800s, the message is crystal clear: having some control over pregnancy isn’t exactly a novel idea.
The first oral contraceptive wasn’t developed until the 1960s, with the first intrauterine device (IUD) following 8 years later. Thanks to decades of advanced scientific and medical research, women and men are fortunate to have more choices than ever. Each form of contraception has different benefits and risks. We often get questions about long-acting reversible contraception (LARC) and would like to help you learn more about whether this form of birth control is right for you.
What is LARC?
LARC includes the copper or progestin IUDs and the implant, which are all methods of contraception that women can use for an extended length of time. Unlike the pill, which a woman must remember to take at the same time every day, LARC is inserted (or implanted) once and is highly effective for 3, 5, or up to 10 years without any daily effort. LARC is more error-proof, more effective, and often better tolerated than the hormonal birth control pill.
How does an IUD work?
Function:The progestin-containing IUDs (Mirena or Skyla) prevent pregnancy by:
- Thickening the cervical mucous so the sperm cannot penetrate
- Slowing down the sperm's movement in the fallopian tube so the egg and sperm are less likely to meet
- Thinning the uterine lining to prevent fertilization
- Suppressing ovulation
The copper IUD (Paragard) contains no hormones, but interferes with sperm movement and egg fertilization and possibly prevents implantation.
Insertion: An IUD is a small T-shaped device that has tiny threads at the bottom. In this in-office procedure, a sterile IUD is inserted into the uterus and the threads, which hang out of the cervix, are trimmed. The 2-3 minute process can be crampy, but taking ibuprofen prior to leaving home is an excellent way to reduce discomfort. Removal of the IUD is even easier; the IUD is pulled through the cervix by grasping the threads.
Side Effects:The most common side effect of the progestin IUD is irregular bleeding for the first 3-6 months while the body is getting used to the hormone. Although it’s not usually heavy, it may be persistent, annoying, or last for a prolonged period of time. Some users of the progestin IUD may not menstruate at all. Rarely, women complain of bloating, weight gain, headaches, or acne.
The copper IUD doesn’t regulate your period because it doesn’t contain hormones. So the most common side effect is a slightly heavier period.
Rarely, an IUD can move outside of the uterine cavity and into the muscle of the uterus or through the uterine muscle into the pelvic cavity, although completely falling out is especially rare (2-10%).
How does the insert work?
Function: The progestin insert (Nexplanon) is a 4 cm rod that prevents pregnancy using the same strategy as the progestin IUD. It lasts for up to 3 years and provides greater than 99% protection against pregnancy.
Insertion: In this in-office procedure, the area inside the upper arm is numbed with lidocaine and the sterile rod is inserted just under the skin. Removal requires a small incision.
Side Effects:Patients often complain of an unfavorable change in their bleeding patterns or the same side effects described earlier for progestin-containing IUDs (headache, bloating or weight gain, acne, depression). Because side effects are more common with the insert, I personally recommend the IUD for most women interested in LARC.
Who should use LARC?
LARC is a fantastic choice for teens. The World Health Organization has recommended LARC as first-line contraception in adolescents because it’s safe with few side effects and provides long-term control for an age group that's especially vulnerable to unplanned pregnancy.
For other reasons, LARC is also a great option for perimenopausal women. Many women in their late 30s to 50s are interested in alternatives to sterilization (like tubal ligation) that are low maintenance, near permanent, and cause minimal side effects. Furthermore, hormonal fluctuations are common at this age and can produce irregular or heavy menstrual cycles, for which the progestin-containing IUD is particularly effective. LARC can even be specifically prescribed for cycle control to women in their 40s who experience heavy or painful periods, even if they have had a tubal ligation.
Peri- and post-menopausal women who need endometrial protection can also use progestin-containing IUDs in conjunction with hormone replacement therapy (estrogen patch, gel, or spray). The progestin IUD is also an option for women with abnormal endometrial cells who required prolonged progestin treatment.
For further information, it’s always best to contact your doctor. Your gynecologist is there to answer questions, help you make the right choices, and ensure that you are making the best possible decision for your health.
Updated April 23, 2018