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Women's Health

A Renaissance It's not your mother's IUD. By Dr. Lisa KaramardianPublished: March, 2003

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A contraceptive renaissance is underway. Did you know that IUDs (intrauterine devices) are the most commonly used reversible contraceptive in the world today? Well, it's true. However, the U.S. is always behind when jumping on the bandwagon. Less than 1 percent of American women use the hassle-free IUD, compared with 25 percent who use the Pill. With a failure rate of well under 1 percent, the IUD is the single most effective reversible method of birth control. This means that a woman using the IUD is no more likely to get pregnant than a woman who has had a surgical tubal ligation. So here we are today with what is referred to in the contraceptive literature as a "global paradox." The most common method used in the world has the worst reputation...except among those who use it. The media have focused for years on the adverse effects of the older IUDs that used to be on the market. Gynecologists now are trying to point out that the newer forms are greatly improved and deserve a fresh look. Here's what you need to know about the new Mirena. The Mirena Intrauterine System (even the name has been changed) was FDA-approved in December 2000, but it has been in use for more than 10 years in other countries. This plastic T-shaped device works by releasing levonorgestrel (a common progesterone) from a reservoir found on its vertical stem. Some 20 micrograms of this progesterone are released daily over the five-year life span of the system, causing the cervical mucus to thicken, stopping sperm entry into the uterus. The device also prevents ovulation in about half of patients and also causes significant endometrial inflammation, which may interfere with sperm function. The intrauterine system provides effective birth control for five years or until you decide to have the system removed. The insertion of the device involves a simple office procedure where it is passed into your uterus. The insertion may cause some mild menstrual cramps. Your physician may offer you antibiotics if felt necessary to prevent infection. Whenever you decide that you are ready to get pregnant, the device can be removed by your health-care provider at any time. The effects of the system are quickly reversed and there is no adverse affect on your ability to get pregnant right afterwards. Sounds great, right? But what would your mother say if you told her you were considering this birth control option? No article on IUDs would be considered complete without mentioning some history. Despite the fact that the new devices now on the market have undergone and passed rigorous testing, the IUD image still bears the scars of its litigious history. Everyone remembers how in 1974 the infamous Dalkon Shield was pulled from the market in response to numerous lawsuits relating to pelvic infections due to the unique shape of this device and its particular tail. Today's version is not your mother's IUD. The two IUDs on the market now are completely different from the Dalkon Shield device of 30 years ago. There are advantages to the new hormone-releasing system. The progesterone released by the Mirena helps reduce period pain and decrease bleeding in women who suffer from endometriosis or adenomyosis. When the Mirena is placed, there is a significant decrease in the amount of menstrual blood flow due to the effect of the progesterone on the uterine lining. In fact, some gynecologists are beginning to prescribe it as an alternative to hysterectomy in women with heavy bleeding. By the end of the first year of use, 17 percent of all women will experience at least three months without any bleeding. Current off-label uses include treatment of menorrhagia (heavy vaginal bleeding), dysmenorrhea (painful periods) and use as hormone replacement therapy (for women who don't tolerate oral progesterone). Studies also suggest that users may experience a lower risk of endometrial cancer. What does the intrauterine system cost? IUDs cost around $400 (plus insertion). This may seem expensive, but over its life span, the IUD is less expensive than other types of contraception (such as birth control pills). And some insurers cover the cost. Most practitioners limit IUD use to women in monogamous relationships since it does not protect against sexually transmitted diseases. This is a decision that only you can make. The device is best suited for women who have already had a child and are currently in a committed relationship. You should not use the IUD if you or your partner have sex with other partners. Clinicians, and more importantly the media, now have an ethical obligation to inform women that IUDs are not only safe and effective contraception, but they also have important health benefits. Without this information, women cannot truly make informed decisions about their contraceptive choices. Dr. Lisa M. Karamardian is a board-certified OB/GYN and Fellow of the American College of Obstetricians and Gynecologists. She can be reached at 949.644.2722.

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