The IUD (Intrauterine Device), a small T-shaped device (no larger than 32 mm x 36 mm), is inserted into the uterus by a healthcare provider to prevent pregnancy.[i] IUDs are categorized as long-acting reversible contraceptive methods (LARCs).[ii] There are three different types of IUDs in the U.S.:
|The Copper IUD
The Copper IUD, known as ParaGard, can stay in place for up to 10 years.[iii]
Two types of hormonal IUDs, known as Mirena or Skyla, can stay in place for up to 5 or 3 years,[iv] respectively. These IUDs continuously release a small amount of progestin (Levonorgestrel) to prevent pregnancy.[v]
(Photos courtesy of Love My LARC)
[i] Centers for Disease Control and Prevention. “Intrauterine Devices – Contraception – Reproductive Health” [website]. Accessed at: http://www.cdc.gov/reproductivehealth/unintendedpregnancy/contraception.htm
[ii] Reproductive Health Access Project, ‘IUD Facts’. Accessed from: http://www.reproductiveaccess.org/fact_sheets/iud_facts.htm
[iii] World Health Organization Special Program of Research Development and Research Training in Human Reproduction. Long-term contraception. Twelve years of experience with the TCu380A and TCu220C. Contraception. 1997;56:341-352. In Hatcher RA, Trussell J, Nelson A, Cates Jr., W, Kowal, D, Policar, M, Contraceptive Technology: Twentieth Revised Edition. New York NY: Ardent Media, 2011, pg.149, 184.
[iv] Hatcher RA, Trussell J, Nelson A, Cates Jr., W, Kowal, D, Policar, M, Contraceptive Technology: Twentieth Revised Edition. New York NY: Ardent Media, 2011, pg.149, 184.
[v] Centers for Disease Control and Prevention. “Intrauterine Devices – Contraception – Reproductive Health” [website]. Accessed at: http://www.cdc.gov/reproductivehealth/unintendedpregnancy/contraception.htm
Two-thirds of women of child-bearing age in the U.S. currently use birth control, and the use of IUDs is on the rise within this group: from 2% in 2002 to 7.7% in 2009.[i]
Learn more here.
[i] Finer, L. B., Jerman, J., & Kavanaugh, M. L. (2012). Changes in use of long-acting contraceptive methods in the United States, 2007-2009. Fertility & Sterility, 98(4), 893-897.
Based of the most recent estimate (2006), nearly half of all pregnancies in the U.S. are unintended (49%), and 43% of these pregnancies end in abortion.[i] In the U.S. each year, there are an estimated 1.5 million births resulting from unintended pregnancies.[ii]
IUDs are HIGHLY EFFECTIVE in preventing pregnancy
WOMEN WANT IUDS and LIKE IUDs once they have them
IUDs are SAFE and RECOMMENDED for use by most women
IUDs can be LONG-LASTING, but are easily removed at any time
IUDs can be AFFORDABLE
[i] Finer, L.B., Zolna, M. Unintended Pregnancy in the United States: Incidence and disparities, 2006. Contraception, 2011, 84, 5, 478-485. Accessed from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3338192/
[ii] Mosher WD, Jones J, Abma JC. Intended and unintended births in the United States: 1982–2010. National health statistics reports; no 55. Hyattsville, MD: National Center for Health Statistics. 2012. Accessed from: http://www.cdc.gov/nchs/data/nhsr/nhsr055.pdf; Martin JA, Hamilton BE, Ventura SJ, et al. Births: Final data for 2010. National vital statistics reports; vol 61 no 1. Hyattsville, MD: National Center for Health Statistics. 2012. Accessed from: http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_01.pdf
[iii] Trussell, J. “Contraceptive Failure in the United States.” Contraception 83 (2011): 397-404. Access from: http://www.kupferkette.info/downloads/contraceptive-failure-in-the-united-states---2.pdf
[iv] Grimes, D, “Forgettable Contraception.” Contraception, 80,6 (2009): 497–499. Accessed from: http://www.sciencedirect.com/science/article/pii/S0010782409003047
[v] Finer, L. B., Jerman, J., & Kavanaugh, M. L. (2012). Changes in use of long-acting contraceptive methods in the United States, 2007-2009. Fertility & Sterility, 98(4), 893-897.
[vi] Secura GM, Allsworth JE, Madden T, et al. The Contraceptive CHOICE Project: reducing barriers to long-acting reversible contraception. Am J Obstet Gynecol 2010;203:115.e1-7. Accessed: http://www.sciencedirect.com/science/article/pii/S0002937810004308
[vii] Peipert, J. F., Zhao, Q., Allsworth, J. E., Petrosky, E., Madden, T., Eisenberg, D., & Secura, G. (2011). Continuation and satisfaction of reversible contraception. Obstetrics & Gynecology, 117(5), 1105-1113. Accessed: http://www.ncbi.nlm.nih.gov/pubmed/21508749
[viii]ACOG. (2009). Increasing Use of Contraceptive Implants and Intrauterine Devices To Reduce Unintended Pregnancy. ACOG Committee Opinion No. 450. American College of Obstetricians and Gynecologists. Obstet Gynecol, 114, 1434–8. Accessed from: http://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Gynecologic_Practice/Increasing_Use_of_Contraceptive_Implants_and_Intrauterine_Devices_To_Reduce_Unintended_Pregnancy
[ix] ACOG. (2012). Adolescents & Long-Acting Reversible Contraception: Implants and Intrauterine Devices. Committee Opinion No. 539 American College of Obstetricians and Gynecologists. Obstet Gynecol, 129, 983-8. Accessed from: https://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Adolescent_Health_Care/Adolescents_and_Long-Acting_Reversible_Contraception
[x]Federal Drug Administration. “Skyla Prescribing Information” FDA Access Data.(2013). Accessed from: http://www.accessdata.fda.gov/drugsatfda_docs/label/2013/203159s000lbl.pdf
[xi]Federal Drug Administration. “Paragard Prescribing Information” FDA Access Data.(2013). Accessed from: http://www.accessdata.fda.gov/drugsatfda_docs/label/2005/018680s060lbl.pdf
[xii] Federal Drug Administration. “Mirena Prescribing Information” FDA Access Data.(2000). Accessed from: http://www.accessdata.fda.gov/drugsatfda_docs/label/2009/021225s027lbl.pdf
[xiii]Centers for Disease Control and Prevention. U.S. Medical Eligibility Criteria for Contraceptive Use, 2010. CDC MMWR, 2010, 59 (No. RR-4): 52-64. Accessed from: http://www.cdc.gov/mmwr/pdf/rr/rr59e0528.pdf
[xiv]Goodman, S., Hendlish, S., Reeves, M., Foster-Rosales, A. “Impact of immediate postabortal insertion of intrauterine contraception on repeat abortion.” Contraception 78 (2008): 143-148. Accessed from: http://www.ncbi.nlm.nih.gov/pubmed/18672116
[xv] ACOG. "Adolescents & Long-Acting Reversible Contraception: Implants and Intrauterine Devices." Committee Opinion No. 539 American College of Obstetricians and Gynecologists: Obstet Gynecol, 2012. 983-8. Vol. 129
[xvi]Centers for Disease Control and Prevention. U.S. Practice Recommendations for Contraceptive Use, 2013. CDC MMWR, 2013, 62(RR05), 1-46. Accessed from: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6205a1.htm?s_cid=rr6205a1_w
[xvii] Centers for Disease Control and Prevention. U.S. Medical Eligibility Criteria for Contraceptive Use, 2010. CDC MMWR, 2010, 59 (No. RR-4): 52-64. Accessed from: http://www.cdc.gov/mmwr/pdf/rr/rr59e0528.pdf
[xviii]Federal Drug Administration. “Skyla Prescribing Information” FDA Access Data.(2013). Accessed from: http://www.accessdata.fda.gov/drugsatfda_docs/label/2013/203159s000lbl.pdf; Federal Drug Administration. “Mirena Prescribing Information” FDA Access Data.(2008). Accessed from: http://www.accessdata.fda.gov/drugsatfda_docs/label/2008/021225s019lbl.pdf; Federal Drug Administration. “Paragard Prescribing Information” FDA Access Data.(2005). Accessed from: http://www.accessdata.fda.gov/drugsatfda_docs/label/2005/018680s060lbl.pdf
[xix] Yen, S., T. Saah, and P. J. Hillard. "IUDs and Adolescents--an Under-utilized Opportunity for Pregnancy Prevention." Journal of Pediatric & Adolescent Gynecology 23 (2010): 123-28.
[xx] US Federal Register. (2013). Coverage of Certain Preventive Services under the Affordable Care Act. U.S. Federal Register. Vol. 78, No. 127, Part III. http://www.gpo.gov/fdsys/pkg/FR-2013-07-02/pdf/2013-15866.pdf
[xxi] NWLC. Getting Coverage You Deserve: What to Do If You Are Charged a Co-Payment, Deductible, or Co-Insurance for a Preventive Service. National Women Law Center website. N.D. Accessed from: http://www.nwlc.org/resource/getting-coverage-you-deserve-what-do-if-you-are-charged-co-payment-deductible-or-co-insuran
[xxii] Mirena. Mirena and the Affordable Care Act: What it means for you. Bayer HealthCare Pharmaceuticals Website. Accessed from: http://hcp.mirena-us.com/ordering-and-reimbursement/coverage-news-for-mirena.php; Mirena. Getting Mirena for free. Bayer HealthCare Pharmaceuticals Website. Accessed from: http://www.mirena-us.com/how-to-get-mirena/getting-mirena-for-free.php
[xxiii] Securing Affordable Contraceptive Drugs and Devices for Title X Providers. National Family Planning & Reproductive Health Association – Policy Brief. Accessed from: http://www.guttmacher.org/pubs/gpr/13/1/gpr131310.html
[xxiv] Paragard Direct Application for 340b Eligible Organizations - https://www.paragarddirect.com/content/paragard/ParaGard_Direct_bus_print.pdf
[xxvi] ARCH Foundation: Patient Assistance Program for Mirena IUD -http://www.archfoundation.com/about.htm; Paragard IUD Patient Assistance Program - http://www.patientassistance.com/profile/duramedpharmaceticalsinc-426/
IUD as Emergency Contraception: A Copper IUD can be inserted up to five days after unprotected intercourse to prevent pregnancy. The Copper IUD is considered the most effective method of emergency contraception when other methods of contraception fail or were not used.[i]
Therapeutic Uses of IUDs: IUDs also offer important non-contraceptive health benefits. Copper IUDs are protective against the development of endometrial cancer. Levonorgestrel-containing IUDs (Mirena) are effective in treating a variety of gynecological disorders, including heavy menstrual bleeding and anemia, and have also been used effectively to reduce side effects associated with hormonal replacement therapy.[ii]
[i] Cleland, K., Zhu, H. Goldstruck, N., Cheng, L., Trussell, J. “The efficacy of intrauterine devices for emergency contraception: a systematic review of 35 years of experience” Human Reproduction 27,7 (2012): 1994-2000. Accessed from: http://humrep.oxfordjournals.org/content/27/7/1994
Currently available IUDs work by preventing sperm from fertilizing ova, although some aspects of the precise mechanism of action are not known. IUDs are not abortifacients; they do not interrupt an implanted pregnancy. Pregnancy is prevented by a combination of the ‘foreign body effect’ of the plastic frame and the specific action of the medication (copper or Levonorgestrel) that is released, which impairs sperm function and implantation, and prevents fertilization.[i]
[i] Hatcher RA, Trussell J, Nelson A, Cates Jr., W, Kowal, D, Policar, M, Contraceptive Technology: Twentieth Revised Edition. New York NY: Ardent Media, 2011, pg. 150. 184.http://books.google.com/books?hl=en&lr=&id=txh0LpjjhkoC&oi=fnd&pg=PA1&dq=IUD+mechanism+of+action+contraceptive+technology&ots=pXfNvS0xyy&sig=PkbHlRN7aUz_j_u9VsibsVgkQYE#v=onepage&q=mechanism&f=false
Despite a documented need and evidence of IUD effectiveness, women face numerous barriers to obtaining IUDs.
[i] Tyler, C.P, Witeman, M. K. Z., Curtis, K.M., & Kapp, N. “Health Care Provider Attitudes and Practices Related to Intrauterine Devices for Nulliparous Women. Obstetrics & Gynecology, 2012, 199(4), 9. Accessed from: http://journals.lww.com/greenjournal/Fulltext/2012/04000/Health_Care_Provider_Attitudes_and_Practices.11.aspx#
[ii] Bergin, A., Tristan, S., Terplan, M., Gilliam, M. L., Whitaker, A. K. “A missed opportunity for care: two-visit IUD insertion protocols inhibit placement.” Contraception 86, 6 (2012):694-7. Accessed from: http://www.ncbi.nlm.nih.gov/pubmed/22770798
[iii] Thompson, K. M.J., Speidel, J. J., Saporta, V., Waxman, N.J., Harper, C. C. “Contraceptive policies affect post-abortion provision of long-acting reversible contraception.” Contraception 83, 1 (2010): 41-7. Accessed from: http://www.ncbi.nlm.nih.gov/pubmed/21134502
[iv] Kaye, K., Suellentrop, K., and Sloup, C. “The Fog Zone: How Misperceptions, Magical Thinking, and Ambivalence Put Young Adults at Risk for Unplanned Pregnancy.” Washington, DC: The National Campaign to Prevent Teen and Unplanned Pregnancy. 2009: 36-38. Accessed from: http://thenationalcampaign.org/sites/default/files/resource-supporting-download/fogzone_0.pdf
American College of Obstetricians and Gynecologists (ACOG) Recommendations regarding Long-Acting Reversible Contraceptives (LARCs)
"Although lowering unintended pregnancy rates requires multiple approaches, individual obstetrician–gynecologists may contribute by increasing access to LARC methods for their patients. The following strategies can reduce barriers and increase use of implants and IUDs:
ACOG Committee Opinion and Practice Bulletins regarding IUDs/LARCs
Visit the ACOG LARC website to access the Committee Opinions and associated PowerPoint presentations.
Federal Clinical Guidance