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| |    The Oft-Ignored IUD as Birth Control by Marjorie Greenfield, M.D. reviewed by Marjorie Greenfield, M.D. The intrauterine device, commonly called an IUD, is a small device that is inserted into the uterus, with a short string, or tail, that hangs down just outside the cervix. While it's used widely in other countries, the availability and advantages of this method of birth control remain largely unknown to couples in the United States. This may be due in part to its reduced availability in the U.S.--a consequence of the bad rap given IUDs after some women suffered significant complications from one particular brand in the 1970s. However, current IUDs offer highly effective protection against pregnancy with little risk of complications. In the United States, two types are available: a copper-containing IUD and a hormone-releasing IUD. How does an IUD work? This answer is not completely clear. Experts used to think that the IUD's contraceptive effects kicked in after fertilization took place, preventing the fertilized egg from implanting in the uterus, but new evidence shows that it actually works as a pre-fertilization method of contraception. (In fact, researchers found that very early pregnancy loss was more frequent in women using no method of contraception compared with those who used an IUD.) Studies have shown that the IUD creates an environment in the cervix and uterus that is toxic to sperm, killing them; and even if a few hardy ones survive long enough to reach the fallopian tubes, they appear to be incapable of fertilizing an egg. In addition, researchers learned that fewer eggs are found in the tubes of women wearing IUDs, which indicates that the IUD somehow is toxic to the egg as well. Pelvic infection While the most common complication of the IUD used to be pelvic inflammatory disease (or PID), women considering this method have good news: The new types of IUD don't pose the same high risk as their early predecessors. The elevated rate of pelvic infection seen in IUD users in the 1970s was caused by a problem in the design of the Dalkon Shield brand of IUD, in which the string that hung outside the cervix acted like a wick, drawing bacteria up into the uterus. Modern-day IUDs, on the other hand, have strings that do not harbor bacteria. A small risk of uterine infection does exist, related to insertion of the device, but once a few weeks go by, IUD users face no increased risk for PID. To minimize the likelihood of infection, some experts recommend a dose of antibiotic around the time of insertion to prevent ascent of harmful bacteria. Other complications Another complication of IUD insertion is perforation, or the puncture, of the uterine wall. This requires that the device be removed, although it's possible that another IUD can be inserted at a later time. Some women experience heavier menstrual periods and an increase in cramping when an IUD is in place, particularly if it does not contain the hormone progestin. For some users, a nonsteroidal medication like ibuprofen or naproxen can diminish blood loss, but others may become anemic and have to choose another method of contraception. In rare instances, the IUD may be expelled from the woman's uterus. Most women recognize when this happens, as it usually causes painful cramping, alerting the user that something is wrong. If you use an IUD, check once a month--usually after each period--to see that the string is in place by feeling for it with a finger. This will help to ensure that the IUD is correctly positioned before you reach the fertile time of your cycle.
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