IUD: When Your Bumper Sticker Reads “Babies on Board and I Need a Break!”

You know when you are out on one of those awkward first dates that are not going well? There are endless uncomfortable silences, those pregnant pauses that are just yearning for some interesting conversation. And then someone breaks the ice and says, “What animal would you be if you could be any animal?” And in that moment, you know: we are never going on a second date! But while the relationship may be over, you probably spit out something like a dolphin, maybe a horse, or even a dog. Those animals that sort of elicit a positive emotion in all of us. Come on, who doesn’t like dogs? We highly doubt that anyone has ever said a camel. I mean they have humps, they walk in the desert, and they can shut their nostrils in a sandstorm. But if you have or have ever considered using an IUD, you may be surprised to find out that the first IUDs were used in camels. Yup, camels. Story goes that many, many years ago traders put stones into their camels’ uteri to prevent pregnancy. It worked. And that, ladies, leads us to IUDs…

Fast-forward several hundred years, and IUDs (intrauterine devices) are one of the most popular forms of long-acting reversible contraception. Given that they take almost no thought (after placement), they do a pretty good job at preventing pregnancy. They allow a pause between pregnancies or a pregnancy pause that can go on between five and ten years, depending on which type you use!

IUDs come in two basic “flavors” (think your local soft-serve shop in the summer)—the Copper T or the Mirena. Recently two more IUDs have come on the market, the Skyla and the Liletta (they are very similar to the Mirena). While the three hormonal options (Mirena, Skyla, and Liletta) differ in a few minor ways—size, the amount of progesterone they release, and the length of the time they will be good at putting baby making on hold, when it comes to the major stuff, they are pretty much the same!

The Copper T is a T-shaped device wrapped in copper. It does its job (a.k.a. no pregnancy) in a couple of different ways. First, it holds the SLOW DOWN sign to both sperm and egg. By slowing down the swimming of sperm as well as changing the speed at which the egg moves through the tubes, fertilization is delayed. However, it not only acts pre-fertilization but also post-fertilization, that is, it can damage or destroy the fertilized egg. Pretty smart, huh? It is important to remember that everything that the IUD does (both the hormonal and non-hormonal types) happens before an embryo implants. The Copper T is your steady eddy or your tortoise in the tortoise and the hare race…it is good for 10 years. But while it lasts and lasts, symptoms are not uncommon. Women often complain of irregular or heavy bleeding and occasional pain. However, the majority of women are pretty pleased with their selection and don’t even know that it’s there.

The other options on the table are the hormonal IUDs, the Mirena, the Skyla, and the Liletta (the levonorgestrel IUD). They are also T-shaped, but rather than being wrapped in copper they are wrapped in hormone: progesterone (levonorgestrel). Despite these differences, the two work in a similar fashion. Both limit egg and sperm movement and, thereby, fertilization. While the Mirena has a shorter half (five years) and the Skyla and Liletta even shorter (three years) they come with fewer side effects—primarily, less bleeding. The progesterone in these IUDs thins out the uterine lining, something that is particularly good for women who have a tendency to develop thick linings from irregular periods.

A thin lining = not so much to shed = fewer annoying bleeding episodes!

News flash: most women who use IUDs still ovulate. Therefore, when the time comes, and you get ready to pull it, pregnancy can potentially happen pretty quickly because ovulation is not suppressed.

Nobody is perfect; everyone and everything has their flaws. Trust us, we have several! The same goes for seemingly flawless medical devices and treatment plans. The IUD is pretty picture-perfect…it prevents pregnancy, you don’t have to remember to take it, and when you are ready to have a baby, you just remove it and are off to the races. What could be bad?

While IUDs are pretty easy to place (most OB/GYNS learn in their first year of residency), there are occasions where a uterine perforation (hole in the top of the uterus) can occur. The perforation rate is about 1/1000. So basically, you have about the same chance of an asteroid hitting the Earth in 2182! Bottom line, it is likely not going to happen. Additionally, there is a small risk of expelling the IUD—this happens more frequently (between 2–10% can dislodge in the first year). Last, if pregnancy should occur while an IUD is in place, calling all of you super-fertile women, you are at a slightly higher risk for an ectopic pregnancy. When things (eggs, sperms, embryos) move slowly down the tubes, they may get sidetracked and start to sightsee. This delay in transit (hello, subway system!) can increase one’s risk for an ectopic pregnancy. So while IUDs don’t cause ectopic pregnancies, if you get pregnant while an IUD is in place, the chance of an ectopic pregnancy is slightly higher. This caveat is not meant to scare you, but it is meant to have you take a pregnancy with an IUD in place seriously.

Historically, IUDs got a bad rap. When you mention, “Mom I am going to get an IUD,” she may have a visceral reaction. In the 1970s, they were blamed for everything from infertility to infection and got the “I definitely don’t want to use that” verdict from many women. However, changes in the design, particularly the string that comes off of the IUD, made them much more attractive to potential users. Now even women who have never had a baby (medically termed nulliparous) as well as adolescents are cleared for boarding. There is no good data that IUDs cause infection or infertility and as a result are “in play” for almost anyone. And bonus— routine antibiotics are no longer needed when placing an IUD.

IUDs are a great go-to for women who want an extended baby-free break. Whether these are young women who are not ready, women who have a baby and want a big-time breather, or women who are done and done, it works. Placement can be performed at any time of the cycle, although right after the period is usually preferable. While we may not have inspired you to use an IUD, we probably gave you some good dinner-party conversation (#camels) or a fighting chance when watching Jeopardy. When having kids or more kids or more and more kids feels harder than trekking across the Sahara Desert without water, think about that camel. And ask your OB/GYN about the IUD.