Intrauterine Devices IUDs are a popular and effective form of long-term contraception. Here's a comprehensive overview of IUDs, including their history, how they work, composition, side effects, and general use as contraceptives.
History of IUDs
The history of IUDs is extensive and dates back to the early 20th century. Dr. Ernst Gräfenberg played a significant role in their development. During the 1960s, major advancements were made, such as the introduction of the Lippes Loop. The discovery of the contraceptive effect of intrauterine copper by Dr. Jaime Zipper in 1969 revolutionized IUD effectiveness. In 1970, the T-shaped device with progesterone was introduced, leading to the development of hormonal IUDs. The 1980s and 1990s saw a decline in IUD popularity due to safety concerns, but they regained popularity in the 2000s with the introduction of newer models like Mirena and Skyla.
How IUDs Work
IUDs are small, T-shaped devices inserted into the uterus. There are two primary types: copper-containing IUDs like ParaGard and hormonal IUDs like Mirena, Skyla, Liletta, and Kyleena. The copper IUD releases copper ions toxic to sperm, preventing fertilization. Hormonal IUDs release levonorgestrel, a progestin hormone, which thickens cervical mucus to prevent sperm from reaching the egg and, in some cases, prevents ovulation.
Types of IUDs
There are two main types of IUDs:
- Copper IUDs e.g., Paragard: These do not contain hormones and can prevent pregnancy for up to 10-12 years. They work by releasing a small amount of copper, which is toxic to sperm.
- Hormonal IUDs e.g., Mirena, Kyleena, Liletta, Skyla: These release a hormone called progestin, similar to progesterone produced naturally by the body. Hormonal IUDs can prevent pregnancy for 3 to 8 years, depending on the brand.
Insertion and Removal
IUD insertion is performed by a healthcare provider and can cause discomfort or cramping. Removal is generally less uncomfortable and can be done at any time, with immediate return to fertility.
Side Effects and Precautions
- Copper IUDs: May cause heavier menstrual bleeding and more severe cramping.
- Hormonal IUDs: Can lead to irregular vaginal bleeding in the initial months, with some women experiencing a cessation of periods.
- General Precautions: Not recommended for women with certain cancers, Wilson disease for copper IUDs, or liver diseases for hormonal IUDs.
IUDs are highly effective, with a typical one-year failure rate of less than 1%. They can also be used as emergency contraception if inserted within five days after unprotected sex.
- Hormonal IUDs may reduce the risk of endometrial and ovarian cancers but have conflicting data regarding breast cancer risk.
- Copper IUDs can be used as emergency contraception if inserted within five days after unprotected intercourse.
Though rare, complications can include expulsion of the IUD, perforation of the uterus during insertion, and increased risk of pelvic inflammatory disease.
IUDs do not protect against sexually transmitted infections, so the use of condoms is still recommended for STI prevention. Hormonal IUDs have also been used to treat symptoms of conditions like endometriosis and PCOS.
General Synopsis as a Contraceptive
IUDs are among the most effective forms of birth control, with a failure rate of less than 1%. They are long-acting, reversible, and don't require daily attention. Fertility typically returns quickly after removal. IUDs are suitable for a wide range of women, including those who have never been pregnant and are breastfeeding.