Q: I’d love to have a reliable form of contraception that requires very little involvement on my part. I’ve been considering an IUD but I’ve heard horror stories about IUDs and pelvic infections. Are they true?
A: It’s amazing how information on the one IUD that in the 1970s was found to cause infection lingers to this day. I think more women know about that IUD than about the election results in that same decade!
I’m talking, of course, about the Dalkon Shield, an intrauterine contraceptive device that had a multifilament tail string (in other words, the string used to retrieve it was composed of multiple fibers gathered together). It was this tail that caused the problems: Bacteria adhered to it and used it as a kind of climbing rope to get up to the uterine cavity where they were able to multiply and begin their destructive, infectious course, resulting in possible miscarriage, tubal scarring and infertility.
Once the Dalkon Shield was taken off the market, all subsequent and current IUDs have been appropriately designed with monofilament tails. Medical studies conducted over the last two decades on these newer IUDs have shown that any increase in pelvic inflammatory disease (PID) occurring in users of IUDs later than one month after insertion was to be blamed on a sexually transmitted infection (an STD), rather than the IUD itself.
Having said this, we know that the actual insertion of the device is not completely sterile. The IUD is passed via a plastic sheath through the vagina, cervix and intrauterine cavity, and during this process bacteria can be pushed upward. However, the uterine lining sterilizes itself regularly and infection is extremely rare. In fact, the risk of pelvic infection for an IUD user is similar to non-IUD users beyond the first 20 days after insertion.
Just to be safe, most doctors prescribe a short course of antibiotics at the time of insertion. And obviously, you shouldn’t use an IUD if you have a pre-existing cervical or vaginal infection.
There are currently two IUDs available in the U.S. The first, ParaGard, contains copper. Copper ions seem to have a direct, toxic effect on sperm, and also create a hostile environment for sperm in the cervical mucous and in the fluid in the fallopian tube. Once inserted, the ParaGard provides 10 years of worry-free contraception.
The newer product on the market is Mirena, a hormone IUD (more correctely called an intrauterine system or IUS). It releases small amounts of progestin, which prevents fertilization by making the mucus in the cervix thick and sticky, so sperm can't get through to the uterus. It also affects release of an egg and makes the “inner workings” of the tubes and uterine lining nonconducive to fertilization.
Mirena is good for five years. An added benefit: it has a calming effect on the uterine lining, preventing heavy buildup of tissue, so periods become lighter and less painful. Many doctors use it to help treat menorrhagia (excessive menstruation) and bleeding from fibroids. Because it slowly excretes progestin into the uterine cavity, it has also been used “off-label” to offset the effects of estrogen-only replacement therapy and thus diminish risk for endometrial cancer.
There will be an informed consent form you should read if you decide to have an intrauterine system inserted. It will include a warning that if you’ve had an ectopic pregnancy, pelvic inflammatory disease or STDs, there is a concern that the device may cause complications. (The company and doctors are probably most worried about the fact that you may already have had tubal scarring and might later blame it on the IUS.)
The IUS product labeling indicates that it is most appropriate for women who’ve had babies. Having had children does often make the IUS easier to insert, but it’s been found to be safe once inserted, even if you’ve never given birth.
Dr. Reichman’s Bottom Line: An IUD (or more appropriately called an intrauterine system, or IUS) is probably the most effective form of contraception — paralleling sterilization — and previous concerns about pelvic infections and future fertility problems are not warranted. STDs are spread not by the IUS, but by an infected partner.
Dr. Judith Reichman, the “Today” show's medical contributor on women's health, has practiced obstetrics and gynecology for more than 20 years. You will find many answers to your questions in her latest book, "Slow Your Clock Down: The Complete Guide to a Healthy, Younger You," which is now available in paperback. It is published by William Morrow, a division of .