Non-hormonal Contraceptives: The IUD

The IUD

 available from http://case.edu/affil/skuyhistcontraception/section4.html

available from http://case.edu/affil/skuyhistcontraception/section4.html

While I’ve no personal experience with this method, it’s the most popular method aside from FAM (The Fertility Awareness Method) among my friends. It’s low-maintenance, long-lasting and doesn’t affect your hormone cycle (although it may affect your periods). In the USA, Planned Parenthood (the leading contraceptives provider there) saw a 900% spike in IUD fittings in the first few weeks of Trump’s presidency as women were terrified their right to contraceptives would be taken away from them. (2)

What is it?

It’s a T shaped bit of plastic which is wrapped in a coil of copper (hence the name Coil). It has strings at the bottom of the plastic T which will dangle out of the cervix so that you know it’s still in place and it can be more easily removed. You should check they are in place regularly and if they’re not there one day, go to the doctor as it may not be working anymore.

An IUD is fitted by your gynaecologist and works immediately. How this T-shaped object actually is inserted into a hole which is likely to be less than 8mm wide continues to befuddle me. If you’re a gynaecologist with experience of fitting them I’d really love to hear the process. Perhaps the cervix is more flexible than I realise. It is more than 99% effective which means about 1 woman in 100 will get pregnant during a year of using an IUD.

How does it work?

The copper on the IUD acts as an antimicrobial which changes the make-up, ph and consistency of your cervical mucous thereby preventing sperm from surviving very long. The object itself acts as a minor local irritant, preventing the endometrial lining from thickening and therefore fertilised eggs from implanting (if the sperm ever made it past the inhospitable cervical mucous) (3) . Depending on the brand it will be effective from 5-10 years.

Potential side-effects 

-          The change to the cervical mucous could change your experience of sex. This isn’t something I’ve seen written or ever heard talked about but  I find (with 15 years of FAM experience)that change in mucous changes my experience of sex so it seems a sensible leap of logic. 

-          Infection is so rare with installation of the IUD it’s hardly worth mentioning but the actual rates were very hard to get hold of and this article reference explains why (4). If you experience a temperature, pain in your lower abdomen or smelly discharge after having yours fitted you must go to the doctor.

-          However, as we learn more about the benefits of healthy gut and vaginal flora I think it’s worth considering that the IUD’s impact on the microbiome of the vagina could create a predisposition for bacterial vaginosis, candida and possibly cystitis (5),(6) . The strings which hang into the vaginal cavity attract bacteria and are able to transport that bacteria into the uterus. Whereas, usually there is a coating of cervical mucous between these two places which prevents that.

-          Less than 1 in a 1000 women have a perforated uterus as a result of the IUD fitting (7)

-          Changes to your period are normal for 3-6months after having it fitted. For most women they will go away after that. But for others the changes could last as long as the coil is in. You may get heavier (or lighter) periods, they may get longer (or shorter) and they may get more (or less) painful. Sorry to be so vague but I’ve heard of all these effects in friends with IUD’s and while only the things not in brackets are usually listed as ‘side-effects’ it’s worth pointing out the opposites as sometimes less painful, or shorter, or lighter periods may be perceived as negative by some women! Bleeding between periods is also possible, if you experience this discuss it with your doctor. It’s normally not deemed to be a problem.

-          The IUD may embed into the uterine wall. This happens in up to 18% of women. But the degree of embedding can vary and often goes unnoticed.  Embedding doesn’t usually affect the effectiveness of the IUD as a contraceptive. (8)

-          It may be rejected by the body entirely and pushed out. My understanding is that this is rare. Exactly HOW rare, I still can’t find a good research paper on. If you have a reference to suggest please comment below. Your risk increases the younger you are and the worse your period pain is (9)

A bit of history

For centuries people have been shoving stuff up their vaginas to stop babies from coming out. The Intrauterine device takes that one step further by crossing the boundary of the cervix. In the 9th century a Persian physician recommended inserting into the cervix paper wound together into the shape of a probe, tied with string and smeared with ginger water (10).  

The initial IUD designs would dangle half in the uterus, half out (in the vaginal cavity) which made it a perfect vehicle for bacteria to traverse from vagina to uterus. In a time where gonorrhoea was rife, and antibiotics were non-existent, this was literally deadly.  As with most contraceptives they went through massive development during the 19th century when contraception became less taboo.

In 1909 a German physician created an IUD out of silkworm gut. The physician Ernst Grafenberg (who would later lend his name to the G-spot which he ‘discovered’) designed the Grafenburg ring which was released in 1926. It was a ring shape coiled in metal. His elimination of the string which had contributed so much to the movement of bacteria from vagina to uterus was a major break-through for the time.

Following that the IUD went through many incarnations and gained in popularity. However, the IUD took a massive nose dive in popularity during the 70’s thanks to a faulty model (The Dalkon Shield) finding its way onto market. It resulted in many pregnancies, miscarriages (often in the 3rd to 6th month) and infections which sometimes lead to death. This probably explains why the baby boomer generation didn’t recommend this form of contraceptive to their daughters. At the time the federal government in the USA hardly had any rules to ensure quality of these devices (as is the case now for tampons!) but since then regulations have changed significantly. Between 1976 and 1988 the more modern designs of plastic T shaped IUD's covered in copper and then the hormone progesterone was used instead of copper. This was because it helped to act as a local relaxant for the womb and stopped it from being expelled quite so often while also preventing embedding of an egg. This is seen as the most recent version of an IUD but many women are returning to the copper coil as a non-hormonal option.

What's your experience of an IUD? I'd love to collect anecdotes in the comments below. 

 

Notes

** Provided of course that the data was discovered in a non biased way. Which is basically impossible. 

References

  1. Is in another blog
  2. Frizzell, N. (2017) The coil isn’t just a great contraceptive, it’s a form of resistance for US women. The Guardian, 23 January 2017. [online] accessed 5/1/18: https://www.theguardian.com/commentisfree/2017/jan/23/contraceptive-american-women-coil-iud-womens-reproductive-rights
  3. Jonsson. B.1, Landgren, BM., Eneroth, P. (1991) Effects of various IUDs on the composition of cervical mucus. Contraception. May;43(5):447-58. [online] accessed on 5/1/2018: https://www.ncbi.nlm.nih.gov/pubmed/1914458
  4. Hubacher, D. (2014) Intrauterine devices & infection: Review of the literature. Indian J Med Res. 2014 Nov; 140(Suppl 1): S53–S57. [online] Accessed 5/1/18: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4345753/
  5. Elhag, K., Bahar, A., Mubarak, A. (1988) The effect of a copper intra-uterine contraceptive device on the microbial ecology of the female genital tract. Journal of Medical Microbiolgy. Apr;25(4):245-51. [online] Accessed 5/1/18: https://www.ncbi.nlm.nih.gov/pubmed/3357191

  6. Parewijck, W., Claeys, G., Thiery, M. van Kets, H. (1988) Candidiasis in women fitted with an intrauterine contraceptive device. British Journal of Obstetrics and Gynaecology. Apr;95(4):408-10. [online] Accessed 5/1/18: https://www.ncbi.nlm.nih.gov/pubmed/3382616

  7. Gov.uk (2015) Intrauterine contraception: uterine perforation—updated information on risk factors. [online] Accessed 5/1/18: https://www.gov.uk/drug-safety-update/intrauterine-contraception-uterine-perforation-updated-information-on-risk-factors
  8. Radiology Soceity of North America (2012) Migration of Intrauterine Devices: Radiologic Findings and Implications for Patient Care. RSNA. March-April; 32(2). [online] Accessed 5/1/18 http://pubs.rsna.org/doi/full/10.1148/rg.322115068
  9. J. Zhang, P. Feldman, I.Chi, M. Gaston Farr (1992) Risk factors for copper T IUD expulsion: An epidemiologic analysis. Contraception.  46(5): 427-433. [online] Accessed 5/1/18: http://www.sciencedirect.com/science/article/pii/001078249290146K

  10. M. Manisoff (1973) Family planning training for social service : a teaching guide in family planning. 
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