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| |    IUDs: Copper vs. Hormonal by Marjorie Greenfield, M.D. reviewed by Laura Jana, M.D., F.A.A.P. Intrauterine devices are currently available in two forms in the United States: the Paraguard, which is a copper-containing IUD, and the Progestasert, a hormone-releasing IUD. The effectiveness rates listed below for both types are only possible with perfect use, meaning that the device is correctly in place, with its tail (or string) hanging just outside the opening of the cervix. Those IUD users who rarely or never check (and might have had an unrecognized expulsion of the IUD) may have a slightly higher pregnancy risk than those who follow all the instructions. Remember that pregnancy rates in a year are determined by subtracting the effectiveness rate from 100; so, for instance, the risk of getting pregnant while using the Paraguard would be less than 1 percent over the course of a year. Copper-containing IUD: 99.5 percent effective This IUD is effective for a remarkable 10 years after insertion. It occasionally leads to heavy bleeding and additional or more severe cramps, but the majority of users have normal cycles on the IUD and often are thrilled with the "no muss, no fuss" aspects of its use. While the device itself and the insertion costs can be fairly high, medical insurance may help cover it. And if you average out the cost over 10 years, it turns out to be one of the least expensive methods of birth control available. The presence of copper has a toxic effect on the sperm and egg, thus making the Paraguard a bit more effective than IUDs without this element. This copper has not been shown to have negative effects on the user. Advantages:
This IUD is impregnated (if you'll pardon the term) with progestin, a female hormone used in many contraceptives. The progestin-containing IUD must be inserted every year, which makes it a lot more expensive overall than its copper-containing cousin and slightly increases the risk of pelvic infection. However, because of progestin's localized effects on the uterine lining, most women using the Progestasert have lighter, pain-free periods. Advantages:
A new progestin IUD that lasts for five years is coming out soon in the United States. This will have some of the menstrual benefits (such as lighter periods) of the Progestasert, along with the long-lasting contraception of the Paraguard. If this choice appeals to you, ask your practitioner if it's available in your area. (For updates on the progress of this IUD's availability, check back here at drspock.com; as soon as more information is available, we'll share it with you.)
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