Contraceptive Throwdown: What’s in YOUR Uterus?

IUD

Now that I am a mom, and a very proud member of 20+ mom support groups on Facebook, one of the most common questions I notice being posted is some version of “What kind of IUD should I get?” (IUD stands for intrauterine device. It’s a small device that gets placed in your uterus to prevent pregnancy.) It’s not a super exciting topic, but I always end up reading the responses because I’m intrigued by how different everyone’s experience is, and I’m always a bit surprised/bewildered by how many people have never had an IUD. I’m a fairly young mom, but my uterus has been around the block a few times. It has had not one, but TWO different IUDs placed in it. I know! So I’m going to let “her” share some wisdom with you all, but I’ll try to include some peer-reviewed research as well.

The Background

It’s what most of us use to make our decision on what birth control we will choose. Our past experience, our medical history, etc. For me, I had spent a good year and a half trying to get pregnant the first time. I was convinced it was the fault of those evil hormones in the birth control pills I used to take. So after I had my twins, I was very interested in a non-hormonal contraceptive. My doctor suggested a copper IUD (non-hormone releasing IUD, also known as ParaGard). I was excited about this option and my uterus happily housed it for three years. I had very little discomfort during insertion, and besides a slightly heavier period than normal, I experienced no side effects.

Fast-forward to six weeks after my last child was born, I was having to make a similar decision. I was planning on getting another copper IUD placed. Like I mentioned, I had very few side effects and had been happy with it. BUT, I was very tempted at the idea of a lighter period, which a levonorgestrel (LNg) releasing IUD could possibly provide. (LNg is a progestin hormone that is released from IUDs most commonly known as Mirena, Skyla, Kyleena, or Liletta.) I had even heard beautiful stories of women who just stopped having their period altogether on a LNg IUD. As someone with a short cycle (a.k.a. many periods), this sounded amazing. So yes, I got an LNg IUD. Again, there was very little discomfort during or after insertion. I had some light spotting for about three months, which was annoying, but then it happened. Or should I say, it DIDN’T happen. EVER. AGAIN.  I can’t remember the last time I had a period — it has been at least a year!  A couple months ago my toddler got deep into my bathroom cabinet and started playing with tampons, and it was an amazing moment of realization that I DON’T NEED THOSE ANYMORE!

The Facts

These are important! Because while I could write the most beautiful love song to my LNg IUD, I know some women who have hated it. So here is some peer-reviewed, evidence-based research on the LNg and copper IUDs. I’ve tried to summarize points that I thought would be most wide-serving when comparing the two types of IUDs. Not all issues/concerns with IUDs will be covered. Regardless, please consult your doctor with any questions you may have.

Effectiveness: The amount of hormones released varies among the different LNg IUDs, but they are all over 99% effective at preventing pregnancy. The LNg IUDs are approved for 3-5 years of use by the FDA (depending on which LNg IUD you go with). A copper IUD (non-hormonal one) is approved for 10 years of use by the FDA. It is also over 99% effective in preventing pregnancy — the copper acts as a spermicide. Neither the LNg or copper IUDs release estrogen. All IUDs are deemed to be immediately effective upon insertion with a few exceptions based on where you are in your cycle, so it is recommended to use back-up contraception for the first seven days. All IUDs are rapidly reversible (women can become pregnant within the first month after removal).

Side Effects: The LNg IUDs can reduce anemia, menstrual cramps, length of periods, cervical cancer and pelvic inflammatory disease. It is an FDA approved treatment for heavy menstrual bleeding. Data shows that LNg IUDs, specifically the Mirena, can cause amenorrhea (absence of menstruation) in 20-40% of women. In the first several cycles, over 50% of women with a Mirena LNg IUD experienced prolonged and/or unscheduled bleeding. These symptoms improved significantly after three to six months.  There is a small chance of progestin-related side effects such as weight gain, acne, and depression with all LNg IUDs. A copper IUD does not disrupt the menstrual cycle, however, it caused menses to be heavier, longer, or more painful, particularly in the first several cycles, for 41%-71% of women. These symptoms improved significantly at six months. A copper IUD can also reduce cervical cancer. There are no hormonal side effects with a copper IUD.

Summary: If you are hoping to decrease menstrual pain and bleeding, and the thought of kissing your period goodbye brings you joy, give an LNg IUD a try! If you are trying to avoid hormones, you like consistency in your cycle or you are looking for a longer-lasting contraceptive solution, a copper IUD might be your jam!

You know your body best. If you are looking for new contraception, speak with your doctor, tell him or her what you want out of your birth control and how your body has handled it in the past.

And share your stories with us! What have your experiences been with IUDs?

*All data was gathered from UpToDate, an evidence-based, physician-authored clinical decision support resource. More than 6,500 world-renowned physician authors, editors, and peer reviewers use a rigorous editorial process to synthesize the most recent medical information into trusted, evidence-based recommendations that are proven to improve patient care and quality. This specific information came from the “Intrauterine Contraception” series by Tessa Maden MD, MPH.

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