Selected Podcast

FAQs on IUDs

Use of IUDs as birth control has been increasing recently.

In the 1970s and 80s, certain faulty IUDs caused bad side effects and, understandably, caused most women to avoid even considering them as an option.

Listen in as Addie Ketelsen, CNP gives the facts about today’s IUDs, their advantages and disadvantages, so that you can make an educated decision about using one.
FAQs on IUDs
Featured Speaker:
Addie Ketelsen, CNP - Family Medicine and Obstetrics
In addition to pursuing her passion to make a healthy difference with her patients,  Addie Ketelsen is a wife and mother to three young children.  She savors precious every day moments with her family and looks forward to exercising more together with her children. Her love of people and building relationships brought her to a career as a nurse.
Transcription:

Melanie Cole (Host):  The use of IUDs as birth control has been increasing greatly recently, and in the 1970s and ‘80s, certain faulty IUDs caused bad side effects and understandably caused most women to avoid even considering them as an option. My guest today is Addie Kettleson. She’s a certified nurse practitioner. Welcome to the show, Addie. Tell us a little bit about an IUD. What is it? How does it work? 

Addie Kettleson (Guest):  Well, an IUD is a device that’s placed in the uterus by a healthcare provider for contraception. There are three IUDs available at this time. There’s a copper IUD, and that is known as ParaGard. There are two that can contain a progestin, Mirena and Skyla. The copper IUD works by inhibiting and interfering with the movement of the sperm and egg fertilization, and the hormonal IUDs work by thickening the cervical mucus and keeping the uterine lining thinner.  

Melanie:  When we talk about IUDs, for a little while there in the ‘70s and ‘80s, women were afraid of them. Now, these do release hormones, correct? Are they safe for all ages, including teens, or is this something that you do in your little bit later life? 

Addie:  Generally, IUDs are safe for women and teenagers and they’re actually recommended by the American Academy of Pediatrics, American College of Obstetrics and Gynecology as well for birth control for women of all ages. They don’t protect against STDs, so we still recommend your traditional screenings and exams. There can be disruption in the normal menstrual cycle. As I mentioned before, the progestin-only [IUDs] keep the lining thin. Sometimes with those they’ll see lighter periods, or with Mirena, sometimes no periods at all. Pediatricians might not have as much experience with IUDs, so if the teen is interested, they should talk to an OB/GYN provider. 

Melanie:  Are they permanent? Do they go in and out very easily? Are they something that’s difficult to use? 

Addie:  No, not at all. They’re not permanent. We place them here in the office depending on which type of IUD you get. The copper is effective for 10 years. The two progestin-only IUDs are effective for five and three years. They can be removed sooner if the patient chooses to have them removed sooner. Or if they’re trying to conceive, we can take them out sooner. So, not permanent. 

Melanie:  Now, what’s changed since the ‘70s and ‘80s, Addie? Why is use increasing? 

Addie:  I think that in the 1980s there were a lot of issues with IUDs causing infertility, injury, infections, and lots of problems. They kind of got a bad rap. But since then, they’re much safer. They are approved by the US Food and Drug Administration and are considered very safe and effective for birth control. Currently, I think the trend is definitely increasing for IUD use. 

Melanie:  How long can you use one? 

Addie:  The ParaGard can be in place for 10 years, and the Mirena is five years, and the Skyla is three years. They all can be removed sooner if the patient desires removal or desires to conceive. 

Melanie:  Is there ever a time when they fall out? 

Addie:  They can. There is a small risk of them falling out of the uterus. In that case, I would think that the woman would have some cramping, irregular bleeding, and may notice the IUD itself come out. It doesn’t happen a lot. There’s also the risk that the IUD could perforate the uterus, meaning move through the uterine wall and out of the uterus itself. That doesn’t happen a lot, and usually, it doesn’t cause any permanent damage. 

Melanie:  Now, because these have hormones involved, when a woman does want to get pregnant—and you said they can be removed easily—how far in advance should she have it removed before she can then safely try and get pregnant? 

Addie:  With all of them, they can be removed and you can try immediately to conceive. There is no window of time that you have to wait. What’s really nice about them is you can conceive immediately following removal. 

Melanie:  What are the disadvantages to them? It doesn’t sound like there’s really very many at all. 

Addie:  Not a lot. I’m a big fan of the IUDs. But cost could be an issue. But I think a lot of insurance companies are covering them well now. I would encourage people to check with their insurance company prior to having an IUD placed. There’s also, during placement and maybe for the day after placement, you could have some moderate cramping, some initial bleeding. With the Mirena and the Skyla IUDs, you may have a couple of months of irregular bleeding as that lining thins. But once the lining thins, especially with Mirena, we see a lot less bleeding, and sometimes no periods. So that is nice for a lot of people. I would say the initial cramping plus irregular bleeding at first could be a disadvantage, but it’s usually worth it once you get past that first few months. 

Melanie:  Then, what would be the disadvantage over other types of birth control—the pill or other methods out there, diaphragm? 

Addie:  I would say convenience. For patients, there’s nothing that they need to remember. Once it’s placed, some come back in about a month just to make sure everything is going okay, and we do a quick string check in the office. But you don’t need to go to the pharmacy to pick up refills. It’s just kind of a… you get it placed and you don’t have to think about it. That’s really nice. It’s very effective, over 99 percent effective, which is higher than other methods that are available. It’s surgeon-free. For women who have side effects, they can’t have estrogen due to other medical conditions, it’s a good option for them. It really delivers a low dose of progestin just to the uterus, so we don’t really believe that it has a systemic effect at all. It’s reversible. And right away, when you pull it out, it’s reversible immediately. Then I would say the fact that it can be used long-term is an advantage. Mirena is also used to treat heavy periods. For people who are having heavy bleeding, just heavy periods, crampy periods, it’s a good option to treat them as well. 

Melanie:  What symptoms should women who use an IUD be on the lookout for? And when they have their annual exams, is that affected at all when they’re using an IUD? 

Addie:  No. There are a few things that -- if they were having persistent abdominal pelvic pain, heavy bleeding, bad cramping, that sort of thing, I would encourage people to come back into the office for. Most people do very well, and after that first initial four-week visit after placement, as long as they come back for their annual exam, we just kind of do a string check when we’re doing their annual exam, and that’s usually sufficient as far as followup. 

Melanie:  What’s your best advice for women that are looking, Addie, at all the different types of contraception out there and your best advice on women considering an IUD? 

Addie:  I would encourage people to talk with their provider about which method they feel is best for them and which method would work the best for them and consider the pros and cons of all the methods. And you can decide that with your provider, and… I think though that an IUD is a great option if you want a long-term, reversible option. 

Melanie:  Thank you so much for great information. You’re listening to the WELLcast with Allina Health. For more information, you can go to allinahealth.org. That’s allinahealth.org. This is Melanie Cole. Thanks so much for listening.