Conversation About Contraception: The IUD

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Couples considering birth control have many safe and effective options. The use of IUDs as birth control has been increasing recently. But many women still have a lot of questions about their safety and possible side effects. An intrauterine device (IUD) is a type of birth control that is inserted into your uterus. It is a small, flexible piece of plastic with a string on the end.

It is inserted and removed by your caregiver. IUDs prevent sperm from reaching or fertilizing an egg. IUDs also prevent a fertilized egg from attaching to the uterus and developing into a fetus.

Listen in as Sara Ackermann, DO explains the advantages of an IUD and how to choose the birth control method that's right for you.
Conversation About Contraception: The IUD
Featured Speaker:
Sara Ackermann, DO- OBY GYN
Sara Ackermann, DO is a board-certified obstetrician and gynecologist with professional interests in abnormal bleeding, contraception and menopause at Allina Health.

Learn more about Sara Ackermann, DO
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Transcription:

Melanie Cole (Host): Couples considering birth control have many safe and effective options. The use of IUDs as birth control has been increasing recently but many women still have a lot of questions about their safety and possible side effects. My guest today is Dr. Sara Ackerman. She's a board certified obstetrician/gynecologist at Allina Health Burnsville and Shakopee Clinic locations. Welcome to the show, Dr. Ackerman. Tell us first, what is an IUD?

Dr. Sara Ackerman (Guest): Certainly. An IUD is an intrauterine device and that is a long-term form of contraception that gets inserted into the uterus.

Melanie: Is this considered a non-permanent choice?

Dr. Ackerman: Correct. That's one of the great things about IUDs, is the rates of preventing a pregnancy are just about as good as getting your tube tied but is reversible. So, it's not permanent.

Melanie: So, what are some of the most common types of IUDs?

Dr. Ackerman: The three most common are the Mirena IUD, which does secrete progesterone hormone, Skyla which is a shorter version of the Mirena. It's only good for three years, whereas the Mirena is good for 5 years. And then, PARAGARD is a copper IUD and that is good for ten years.

Melanie: So, how does a woman go about deciding which of these to use?

Dr. Ackerman: I think there are a lot of different applications for using an IUD. For one example, immediately post-partum is the common time to go ahead and just use an IUD and then, a lot also depends on future fertility. So, for example, if you felt like you might be planning to have a pregnancy in the next 2-3 years, you may not want to choose a device that's good for 10 years.

Melanie: So, what copper? You mentioned and that would seem to be something women would question you about--having copper inserted. Talk about the safety and efficacy of these various types of IUDs.

Dr. Ackerman: Sure. So, for example, the copper or the PARAGARD IUD, really, one of the things that you wouldn't want to use is that if you had some medical condition where you couldn't be exposed to copper. Also, because it's non-hormonal, there are certain women that feel like they respond better in terms of side effects to the non-hormonal contraceptive options. They are all very, very good at preventing pregnancies greater than 99% effective. The Mirena and the Skyla are actually polymer or plastic, so they do not have any metals in them.

Melanie: Can you feel an IUD?

Dr. Ackerman: I would say that the only time that you would feel an IUD, typically, would be the insertion process. So, when you come into our office to have one placed, there is a little bit of pain and cramping that's typically very brief but overall, once the IUD is in place properly within the uterus, you shouldn't feel anything.

Melanie: How can you make sure it's still in place? Can it move around at all?

Dr. Ackerman: One of the ways that we determine whether or not the IUD is in a proper location is there are strings that will trail outside of the cervix, they do not come outside of the body and you're just asked to do what's called a “string check” once a month and as long as you're able to feel that and everything feels normal and isn't bothering you, then the IUD is likely in the correct location.

Melanie: Is there anything like a tampon or sexual intercourse that can move the IUD?

Dr. Ackerman: Most likely not. If you're inserting tampons, that's certainly something that you're able to continue doing and intercourse should not affect the positioning of the IUD.

Melanie: So, then, tell us why would a woman want to choose an IUD over some of the other methods of birth control, whether they're non-permanent choices or the newer minimally invasive procedures.

Dr. Ackerman: Sure. I think in terms of effectiveness; an IUD is certainly more effective at preventing a pregnancy than an oral contraceptive pill. The side effects profiled generally for the Mirena and Skyla devices include lighter bleeding, fewer systemic side effects that some women experience when they're using the combined oral contraceptive pills. The PARAGARD IUD does tend to make periods just a little bit heavier and so some women don't choose the PARAGARD for that option but it is, again, very effective and lasts for 10 years if you choose to leave it in place that long.

Melanie: Dr. Ackerman, what do you tell women about the fact that these types of birth control do not protect against sexually transmitted infections? Correct?

Dr. Ackerman: Correct. I always remind women who choose this for their contraceptive purposes that condom use is going to be best to continue for prevention of things such as HIV and other STDs, such as herpes and syphilis, which has been on the rise. So, contraceptive options do not treat or prevent sexually transmitted diseases. So, correct, you would need to continue using condoms if you're at risk for that.

Melanie: And, some of the other choices, we can just quickly go over a little bit. What is a vaginal ring, Dr. Ackerman?

Dr. Ackerman: That is a form of contraception that is released over three weeks' time and that's another option that is almost like a hybrid between the oral contraceptive pill and the IUD. So, a lot of women choose the IUD because they want freedom from taking a pill every day and the vaginal ring is inserted at the beginning of the month and stays in place for three weeks. You don't have to do anything, you don't have to take anything daily and then you just remove it after three weeks.

Melanie: And, the hormones that are released, whether from a vaginal ring or oral birth control or the IUD, the type that does have the progesterone, what do you tell women about those hormones? Should they be concerned about side effects or increased risk of certain diseases? What about those hormones?

Dr. Ackerman: I generally tell women that everyone responds differently to various hormones. However, if you have medical conditions such as migraine or other blood clotting disorders, you may not be a candidate for estrogen and so that's why sometimes progesterone options for birth control are a good choice.

Melanie: So, then, what do you tell women and couples in general about the feeling of ease if they are going to use an IUD and should you also recommend use of condom along with the IUD?

Dr. Ackerman: It's typically not necessary to continue using condoms unless you are concerned about ongoing exposure to sexually transmitted diseases, but PARAGARD can actually be used as emergency contraception, so there's no need to continue using condoms for any duration of time once that device has been placed. I typically tell women to continue using condoms for a couple of weeks following insertion of the Mirena and the Skyla just to be cautious but a lot of times that's not necessary.

Melanie: Are there any long lasting impacts to fertility if a woman decides to have her IUD removed? How soon can she try and get pregnant?

Dr. Ackerman: As long as everything has been normal before the IUD has been placed, it shouldn't affect your chances of conceiving.

Melanie: So, then wrap it up for us, Dr. Ackerman, with these different types of non-permanent choices of birth control, what you tell women every single day about how to make the choice that's right for them?

Dr. Ackerman: I think it depends on the time of life that women are in, whether or not they are planning on having another pregnancy and sort of the choice between whether they want a hormonal or non-hormonal device. But, typically, the progesterone, the Mirena or Skyla IUDs, you also get the added benefit of lighter to possibly no periods at all.

Melanie: Thank you so much for being with us today, Dr. Ackerman. It's great information. You're listening to The Wellcast with Allina Health. For more information, you can go to www.allinahealth.org. That's www.alinahealth.org. This is Melanie Cole. Thanks so much for listening.