Intrauterine Devices (IUDs)

Written by: Lisa Cheng

Intrauterine Devices

Copper and progestin-releasing intrauterine devices (IUDs) are available and both are reversible, long-acting forms of birth control. There is currently one copper-bearing IUD and four options for hormonal levonorgestrel-releasing IUDs. IUD insertions are performed by physicians or nurses; they use an instrument to open the vagina and place the inserter through the opening of the cervix and into the uterus.

Downsides and Side Effects

Although intrauterine devices are highly effective, they come with a major downside: the pain during and for some time after the insertion process. This may be addressed by inserting a medication to relax and soften your cervix (to widen the opening of the cervix) or applying of a numbing cream prior to the appointment to help with the pain. Common side effects within the first three to six months of getting an IUD are dizziness, cramping, pain, backaches, and spotting/changes in bleeding patterns. Women who experience unbearable or uncommon side effects should contact the doctor to discuss future steps.

IUDs are unlikely to slip out of the uterine environment (2 to 10%), but there remains a possibility that it will come out with the greatest probability within the first three months of insertion. Women can check if the IUD is still in place by checking for the string attached to the IUD or checking their tampons, pads, or menstrual cups. An appointment needs to be made with the clinic as soon as possible if it is suspected that the IUD has fallen out, as fertility returns immediately after IUD removal.

These devices do not protect against sexually transmitted infections and therefore, it is recommended that they are used with condoms. Women with gonorrhea or chlamydia (both are sexually transmitted infections) need to discuss potential health risks with their doctor, because there is a small chance of infection known as pelvic inflammatory disease.

Copper-Bearing Intrauterine Devices

IUDs are T-shaped pieces of plastic where parts are wrapped with copper coil/wire. Copper IUDs prevent fertilization by inducing changes to the reproductive tract environment. The addition a foreign object (i.e., copper IUD) into the body will trigger a protective response from the body. An immune response triggers release of molecules and white blood cells into the uterus to rid of sperm. Secondary to targeting sperm viability, the copper ions will act as a spermicide in the cervical mucus leading to decreased or no sperm motility. The sperm will not be able to pass through the mucus and reach the egg, meaning that it cannot fertilize the egg. Additionally, some studies have suggested that the presence of copper can also impair fertilized egg implantation. Altogether, these effects prevent pregnancy.

The copper-bearing IUD can also be used for emergency contraception if it is inserted up to 120 hours after unprotected intercourse or failure of another birth control method. After insertion, there may be follow-up appointments, but a second visit to the clinic is not required unless the woman wants the IUD taken out or until after five to twelve years. There is variation in the time which a copper IUD needs to be replaced because the design of the IUD is continually improving to enhance the duration of effectiveness, which is dependent on the rate at which the copper ions dissolve in the uterine environment. An IUD is much less effective if the copper ions are dissolving quickly than if it were dissolving slowly over time.

Some women using copper IUDs have found that their periods have a heavier flow and increased menstrual cramps. These side effects are typically resolve within three to six months, as do the common side effects mentioned above, but if they cause for concern, it is not uncommon to remove the IUD. Studies have shown that, in the United States of America, 4 to 15% of women report irregular and heavy bleeding as the reason for IUD removal. Anemic women need to consult their physician because copper IUDs may contribute to anemia. Interestingly, mothers are less likely to experience these adverse effects in comparison to women who have never given birth. This may be attributed to a larger uterus in women who has given birth. Mothers, regardless of their breastfeeding status, can use copper IUDs as a birth control option anytime within 48 hours of or four weeks after giving birth (vaginal or caesarean delivery).

Levonorgestrel Intrauterine Device

Levonorgestrel IUDs are also T-shaped, but they differ from copper IUDs in that levonorgestrel (a progestin) is released in small amounts daily.

Levonorgestrel IUDs can provide benefits to women with iron-deficiency anemia because this method is known to help with lighter and fewer days of period bleeding. Unlike copper-bearing IUDs which are effective as birth control as soon as it has been inserted, hormonal IUDs are immediately effective only if they are inserted during the first seven days of the period. When hormonal IUDs are inserted later in the cycle, another form of birth control (e.g., condoms) are advised for the first seven days. As such, hormonal IUDs are not a form of emergency contraceptive.  

Last comments: Healthcare and Accessing Birth Control

Some methods or devices of contraception can be purchased over-the-counter at pharmacies, while others may require a prescription. It is advised that questions about your approach birth control be directed towards your healthcare provider. You may want to choose a method that suits your lifestyle and birth control options are developed with consideration of optimizing end users’ convenience.

Some provincial governments in Canada pay for the cost of prescription birth control pills depending on your age or health insurance plan subscription. Specifically in Ontario, Ontario Health Insurance Plan (OHIP) will subsidize the cost of prescribed oral contraceptives if the patient is under 25 years old and does not subscribe to other health insurance plans. Health insurance plans would include those purchased from their school or if they are recorded as dependents under their parent’s plan. In addition to government plans, there are local centers (e.g., health center or clinics) are likely to provide free condoms and provide resources relating to sexual health and safe practices.

Most health insurance plans will cover a baseline cost for prescribed birth control pills. Their coverage between generic and brand name birth control pills may differ and this is information that can be found in your insurance contract agreement. With hormonal regulation, there is an abundance of medicines that may be prescribed by a doctor to find the one that is most suitable for you and fits your financial budget.

Generic medication is a drug that contains the same active ingredient as the already existing brand name drug -- generics are essentially a copy of the brand name. The main differences between generic and brand name drugs are the inactive ingredients that are used to make the pill. Theoretically, the active ingredient is providing the therapeutic effect and there should be no difference in patient-reported outcomes; however, it is possible that patients experience side effects from generics or brand name drug and need to specify the brand of prescribed medications.

Conclusion

There is no one-size-fits-all approach to birth control. Stay informed about the different options of birth control and select one that is appropriate for your lifestyle and needs!