Want to avoid another pregnancy? The intrauterine device offers effective and reversible protection against it
Srikumari has just had a beautiful baby girl. She and her husband want to avoid another pregnancy. Being a working woman, she feels she may not remember to take a birth control pill everyday, while juggling between her duties as a mother and a busy professional. What is a safe alternative? The intrauterine device (IUD) offers safe, effective, and reversible protection against pregnancy for many women and is a popular method of birth control throughout the world. It is more effective than most other forms of birth control. For a woman who has already had a child, the IUD is a good choice. The advantage is that most of the IUDs can be left in for five years or more and have very few side effects. Whenever a woman decides to go ahead with a pregnancy, she can have it removed. It must be remembered that the IUD does not protect against sexually transmitted diseases (STDs).
Types of devices
Currently two types of IUDs are most commonly used: the copper and the hormonal. The copper IUD can remain in the body for 5-10 years. The hormonal IUD must be replaced every five years. The copper IUD costs around Rs. 300-400 whereas the hormonal IUD costs approximately Rs. 7,500.
How does an IUD work?
Both types of IUDs are T-shaped, but they work in different ways. The copper IUD releases a small amount of copper into the uterus. A copper IUD does not affect ovulation or the menstrual cycle. The copper in the IUD reduces the sperm's ability to fertilize an egg. It also prevents the embryo from attaching to the wall of the uterus. The hormonal IUD releases a small amount of the hormone progestin into the uterus. This thickens the cervical mucus, which blocks the sperm from entering the cervix. It may make the sperm less active. It also thins the lining of the uterus, preventing an embryo from attaching. With the hormonal IUD the monthly bleeding becomes very scanty (an added advantage for many women).
Inserting the IUD
Your gynaecologist will insert the IUD and remove or change it when necessary. The IUD is usually inserted immediately after the menstrual period. The IUD comes in a slender plastic tube, which is inserted through the mouth of the uterus into the uterine cavity. The tube is withdrawn after the IUD is in place. Insertion of the IUD does not require anaesthesia although there may be some discomfort. Each IUD comes with a string made of thin plastic threads. The placement of the IUD is checked by the location of this string. It is important to check the string regularly, soon after each menstrual period. Once a year, your gynaecologist will also check the position of the IUD. If you do not feel the string you will need to see your gynaecologist to make sure that the IUD is in place.
During the first year of use, only about eight out of 1,000 women using the copper IUD will become pregnant. This makes it one of the most effective forms of birth control available. It is easy to use. Once it is in place, nothing else needs to be done to prevent pregnancy. It does not interfere with intercourse, daily activities or menstruation. A tampon can be used with it. Physical activity will not dislodge the IUD.
It is rare to have serious complications with an IUD. However, some problems can occur. The IUD may be expelled out of the uterus. It happens within the first year of use in about 5 per cent of users. This rate decreases with length of use. Very rarely, (two out of 1,000 insertions), the IUD can perforate (or pierce) the wall of the uterus during insertion. Very rarely, infections in the uterus or fallopian tubes can occur. This may cause scarring in the reproductive organs, making it harder to become pregnant later. Rarely, pregnancy may occur while a woman is using an IUD. If the string is visible, sometimes the IUD can be removed. If the IUD is removed soon after conception, the risks caused by having the IUD in place are decreased. However, a pregnancy may be allowed to go to term with an IUD in place.
Menstrual pain and bleeding may increase with the copper IUD but can be treated with tablets. With the hormonal IUD, the advantage is that the menstrual flow will get scanty. It is common to have some cramping and spotting during the first few weeks after the IUD is inserted. Some women might experience an increase in the normal vaginal discharge. GITA ARJUN
(The author is a Chennai-based obstetrician and gynaecologist with a special interest in women's health issues)