IUD 101: What is it, and what are the risk factors?

Intrauterine device or system (IUD/ IUS) is a long-term reversible form of contraception and is one of the most common forms of contraception in the world.

The IUD/IUS are T-shaped devices placed inside the uterus and release either cooper (IUD) or progesterone (IUS) to prevent pregnancy. Each device prevents pregnancy in different ways. The copper IUD releases copper ions to sperm from reaching and fertilizing the egg. Whereas the hormone IUS thickens the cervical mucus to prevent sperm from reaching and fertilizing the egg and also thins the uterine lining, so the egg is less likely to attach to the uterus.

What are the advantages of the IUD?

· Convenient – No need to remember to take pills or schedule appointments

· Long-term cost-effective – Although the upfront cost may be expensive, there is no cost for several until the need to replace the device.

· Reversible – At anytime you which to start or continue your family, you can have the device removed, and you can start trying straight away.

· Easier Periods – Many women have reported lighter periods or reduced cramps.

· Long-lasting – depending on the type, they can last between 3-12 years.

· Effective- they are recognized as one of the most effective birth control methods. It is over 99 percent effective, meaning that less than 1 out of every woman using an IUD will get pregnant every year.

What are the risks?

While IUD/IUSs are recognized as safe and effective for the long-term use of contraception. There are some commonly associated and potentially life-threatening risks to be aware of when choosing this form of contraception:

Commonly associated risks:

· Perforation of surrounding organs

· Irregular bleeding

· Abdominal/pelvic pain

· Severe infection or sepsis

· Breast tenderness

· Mood changes

· Acne

· Headaches

· Expulsion or Migration

Severe Risks include:

· Pseudotumor Cerebri/ intracranial hypertension (unexplained pressure in the skull, causing blurred version moderate-severe headaches and pain in the shoulders and back).

· Pelvic Inflammatory Disease (PID) is a bacterial infection that affects the reproductive organs and, if not treated promptly, can cause infertility or, in severe cases, surgery and potential risk of death (symptoms include severe headaches, pain during intercourse, sudden weakness/ numbness, vision problems, unusual or heavy bleeding, symptoms of an allergic reaction, severe pain and jaundice).

· Ectopic pregnancy (symptoms include lower pelvic or abdominal pain, abnormal bleeding, cramping, and lower back pain).

· Breast cancer

Other reported risks thought to be linked to the synthetic hormone (levonorgestrel) inside the hormone IUS include:

· Sleeping problems

· Depression/ anxiety, irritability/mood swings, and suicidal thoughts

· Fatigue

· Brain fog

· Migraines

· Hair thinning/ hair loss

· Unexplained weight gain

· Chest Pain

· Palpitations

· Bloating

Who is at risk?

While any woman can experience these symptoms, there are some factors that are thought to increase your risk of developing a complication; these include:

· Previous pelvic inflammatory disease (PID) in the past 12 months

· Taking anticoagulant medicine or issues with blood clotting.

· Diabetes

· Active infections or previous infections of the cervix or vagina

· Previous or have ovarian cancer

· Anemia

· Have had two or more previous STIs within the past two years

Making Choices for your Sexual Health

The IUD can be a safe, reliable, and convenient contraceptive choice for many people. However, as with all medical devices and prescription medications for birth control, there are risks and potential complications to be aware of when choosing this method of contraception. For more information, talk to your healthcare provider to help you make the right choice for your sexual health.

Sources:

WebMD. Mirena 20 Mcg/24 Hours (6 Yrs) 52 Mg Intrauterine Device Contraceptives Side Effects by Likelihood and Severity. https://www.webmd.com/drugs/2/drug-20420/mirena-intrauterine/details/list-sideeffects

Bayer HealthCare Pharmaceuticals Inc. Mirena®. July 2018. https://www.accessdata.fda.gov/drugsatfda_docs/label/2008/021225s019lbl.pdf

https://www.accessdata.fda.gov/drugsatfda_docs/label/2008/021225s019lbl.pdf

The ESHRE Capri Workshop Group, Intrauterine devices and intrauterine systems, Human Reproduction Update, Volume 14, Issue 3, May/June 2008, Pages 197–208, https://doi.org/10.1093/humupd/dmn003

Conz, Livia, et al. “Levonorgestrel‐releasing intrauterine system and breast cancer risk: A systematic review and meta‐analysis.” Acta Obstetricia et Gynecologica Scandinavica 99.8 (2020): 970-982.