Posted by on November 12, 2015 - 1:47pm

Currently, 60% of women are using birth control (with over 99% of women having used it in their lifetime)--from the pill, hormone shots, and non-hormonal methods (like the diaphragm). But now, more and more women are turning to intrauterine devices (IUDs) as their choice of contraception. The Centers for Disease Control and Prevention recently released a survey that showed between 2002-2013, the number of women using the pill, condoms, and female sterilization has dropped and the number of women using long-acting contraceptives (IUDs or contraceptive implants) has more than quadrupled!

Once inserted, IUDs can be reliable for years without having to be replaced or tampered with. The convenience with IUDs is that there is little or no room for human error--no pill to remember, no contraception device to travel with--it just stays in your body to prevent pregnancy. The rise of IUD use is a little surprising, given that women in the United States have been slower to accept implants than women in other countries. This hesitancy was due in large part to misconceptions regarding IUDs being difficult to implant and causing infections. Despite these misconceptions (which have been around for over 30 years), women are starting to trust IUDs as the most effective form of birth control. It's important to remember that while IUDs are effective in reducing the risk of pregnancies, IUDs do not protect against sexually transmitted infections.

An IUD is a T-shaped device implanted into the uterus for the purpose of contraception by preventing sperm from reaching the egg. There are four different IUDs available in the United States. Three of them, Liletta, Mirena, and Skyla, release a small amount of progestin similarly to a birth control pill, which usually makes periods lighter. One of them, ParaGard, also known as 'the copper T IUD,' is hormone free and lasts longer than the hormonal options, but can cause heavier periods. IUDs are more than 99% effective, but, again, do not protect against STIs.

The growing trust of IUDs is good news for women! It's important to offer many birth control options so that women may choose the method that works best for them.

Posted by on September 4, 2012 - 1:50pm

A growing number of U.S. women may be opting for intrauterine devices (IUDs) as their birth control method, a national survey finds.  That's good news, researchers say, since IUDs and contraceptive implants are the most effective forms of reversible birth control.

In the U.S., though, they are still far from the most popular, with use lagging well behind birth control pills and condoms.   In the new study, researchers found that in 2009, 8.5 percent of U.S. women using birth control chose an IUD or implant - with the large majority going with the IUD.

That was up from just under four percent in 2007, according to findings published in the journal Fertility and Sterility.

"We saw some pretty notable growth," said lead researcher Lawrence B. Finer of the Guttmacher Institute in New York, a sexual and reproductive health organization.  Some of the possible reasons given:    medical societies, like the American College of Obstetricians and Gynecologists (ACOG), have endorsed IUDs and implants; and an increase in advertisements for IUDs.

ACOG says the devices should be offered as "first-line" options for most women, because of their effectiveness and safety.

IUDs are implanted in the uterus, where they release small amounts of either copper or the hormone progestin to prevent pregnancy.   It is estimated that with IUDs, between 0.2 - 0.8 % of women will have an unplanned pregnancy.  It is effective for 5-10 years depending on the device.   The contraceptive implant, about the size of a matchstick, is inserted under the skin of the arm, where it releases controlled amounts of progestin.  The rate for unplanned pregnancy with implants is 0.05% and it works for 3 years.

"They are basically ‘set and forget' methods," Finer said.

In contrast, the Pill and condoms must be used perfectly to be most effective. And with the way people typically use them, the unintended pregnancy rate is about 9.0%  per year.    With condoms alone, it's between 18 and 21 percent.

More could be done to encourage U.S. women to opt for IUDs and implants, according to Finer.    In some other countries, the devices are much more popular: in France and Norway, for example, about one-quarter of women on birth control use IUDs or implants. And in China, a full 41 percent do, Finer's team says in its report.


When IUDs first came out, there were concerns that they might raise the risk of pelvic infection and jeopardize women's future fertility. So the original IUD labeling said the devices were contraindicated for women who'd never had children.   But it's now known that IUDs do not carry those risks.     "Many doctors continue to have outdated ideas about who can and cannot use an IUD," Finer said.

Cost may be another issue keeping women from using IUDs and implants.   The devices have a big upfront cost: the price of an IUD is $500-900 which does not include the doctor's charges for putting them in.    The Implanon implant costs between $400 and $800, with all charges considered.

Since the devices last for years, they are cost-effective in the long run, Finer said.

Birth control pills, for instance, cost anywhere from about $10 to $50 per month, depending on whether a woman uses generic or brand-name pills.   Finer said that may change, though, with healthcare reform. The new law considers birth control part of preventive healthcare, and most health plans must cover it without co-pays and deductibles.

IUDs and implants can have unwanted side effects, however. With the implant, irregular menstrual bleeding is most common; some women stop having their periods altogether.

"There's no one best birth control method for all couples," Finer said.    But he added that now that many couples are putting off having children until their 30s, more women may want to consider long-acting birth control options.

SOURCE: Fertility and Sterility, online July 13, 2012.

Reuters Health
Posted by on July 19, 2011 - 7:28am

Sample IUD

Long-acting reversible contraceptive ( LARC ) methods—namely intrauterine devices ( IUDs ) and implants—are the most effective forms of reversible contraception available and are safe for use by almost all reproductive-age women, according to a Practice Bulletin released  by The American College of Obstetricians and Gynecologists ( The College ). The new recommendations offer guidance to ob-gyns in selecting appropriate candidates for LARCs and managing clinical issues that may arise with their use.

"LARC methods are the best tool we have to fight against unintended pregnancies, which currently account for 49% of US pregnancies each year," said Eve Espey, MD, MPH, who helped develop the new Practice Bulletin. "The major advantage is that after insertion, LARCs work without having to do anything else. There's no maintenance required."

More than half of women who have an unplanned pregnancy were using contraception. The majority of unintended pregnancies among contraceptive users occur because of inconsistent or incorrect contraceptive use. LARCs have the highest continuation rates of all reversible contraceptives, a key factor in contraceptive success.

IUDs and contraceptive implants must be inserted in a doctor's office. Two types of IUDs—small, T-shaped devices that are inserted into the uterus—are available. The copper IUD, which effectively prevents pregnancy for 10 years, releases a small amount of copper into the uterus, preventing fertilization. In addition, copper interferes with the sperm's ability to move through the uterus and into the fallopian tubes. The device can also be used for emergency contraception when inserted within five days of unprotected sex.

Women using the copper IUD will continue to ovulate, and menstrual bleeding and cramping may increase at first. Though data suggest that these symptoms lessen over time, heavy menstrual bleeding and pain during menstruation ( dysmenorrhea ) are main causes of discontinuation among long-term copper IUD users. Women considering IUDs should be informed of this adverse effect beforehand.

The hormonal IUD releases progestin into the uterus that thickens cervical mucus and thins the uterine lining. It may also make the sperm less active, decreasing the ability of egg and sperm to remain viable in the fallopian tube. The hormonal IUD may make menstrual cycles lighter and is also FDA-approved for the treatment of heavy bleeding. The hormonal IUD prevents pregnancy for five years.

Contraceptive implant

The contraceptive implant is a matchstick-sized rod that is inserted under the skin of the upper arm and allows the controlled release of an ovulation-suppressing hormone for up to three years. It is the most effective method of reversible contraception available with a pregnancy rate of 0.05%.

Despite the many benefits of LARC methods, the majority of women in the US who use birth control choose other methods. Fewer than 6% of women in the US used IUDs between 2006 and 2008. According to The College, lack of knowledge about LARCs and cost concerns may be to blame. "Women need to know that today's IUDs are much improved from earlier versions, and complications are extremely rare. IUDs are not abortifacients—they work before pregnancy is established—and are safe for the majority of women, including adolescents and women who have never had children. And while upfront costs may be higher, LARCs are much more cost-effective than other contraceptive methods in the long run," Dr. Espey said.

According to a December 2009 Committee Opinion released by The College, LARCs should be offered as first-line contraceptive methods and encouraged as options for most women. "The benefits of IUDs and the contraceptive implant in preventing unplanned pregnancy could be profound with widespread adoption of these methods, and ob-gyns are in a great position to effect change," Dr. Espey said.

Practice Bulletin #121 "Long-Acting Reversible Contraception: Implants and Intrauterine Devices" is published in the July 2011 issue of Obstetrics & Gynecology.