Intra-Uterine Device

What is the Intra-Uterine Device (IUD)?

There are two IUD's that are approved for use in the United States, the Copper T (CuT 380A) and the Progesterone T (Progestasert).

How does the IUD work?

The way an IUD prevents pregnancy is not completely understood. It was once thought that the IUD worked by changing the lining of the uterus and making it unable to support a fertilized egg. If an egg had been fertilized during the cycle, it would be sloughed away with the woman's menses. Today, a little more is known about how the IUD works. It is suspected that the IUD not only changes the environment of the uterus barring implantation of a fertilized egg, it also affects the sperm and the egg itself, before fertilization can take place. Researchers are unsure of how, but it is apparent that the IUD changes the sperm or the egg prior to fertilization making fertilization impossible. The IUD is thought to either make sperm immobile, preventing them from reaching an egg in order to fertilize it, or that it makes the egg's journey into the uterus faster than usual, creating a timing problem in the process of fertilization.

Do you need a prescription?

A woman must go through a complete gynecological examination before insertion of the IUD. The exam should include a Pap smear, tests for gonorrhea, chlamydia, and syphilis, as well as a thorough physical exam. Once the results of the tests have been received and read, the doctor or nurse practitioner will be able to insert the IUD when the woman has her next menses. This is done in the doctor or nurse practitioner's office or clinic.

How effective is the IUD in preventing pregnancy?

The failure rate for a first year user of the Copper T (Cu T 380A) is 0.8% and for the Progestasert it is 2%.

What are the risk factors associated with the IUD?

There is a higher incidence of Pelvic Inflammatory Disease (PID) in women who use the IUD that is associated with IUD insertion. This is primarily due to vaginal infection present during the insertion procedure. There is also an increased risk of PID in women who have more than one sexual partner or who are at higher risk of contracting an STD. The IUD can advance the infection higher up the reproductive track.

There is also speculation that the IUD may make the uterine lining more susceptible to HIV. This could be related to increased bleeding that the IUD may cause. However, this correlation has not been studied enough to make any definite conclusions.

Menstrual problems are occasionally associated with IUD use. Increased bleeding during menstruation is a possible complaint; however, most users only report a minor increase in bleeding.

Expulsion of the IUD from the uterus is another concern for IUD users, yet only 2-10% of IUD users report this occurrence during the first year of use.

If pregnancy occurs while the IUD is in place, approximately 50% (Treiman: 1988) of these pregnancies are miscarried (spontaneous abortion).

Cost: approximately $200 - $300 in a clinic, more in a private M.D. setting