IUD Basics

 

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
     Mirena

 

Skyla

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

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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.

 

 


[1] 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. Accessed from: http://www.ncbi.nlm.nih.gov/pubmed/22795639

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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

  • IUDs are 99% effective in preventing pregnancy. They are one of the most effective forms of birth control.[iii]
  • IUDs do not require daily compliance or attention like oral contraceptives (the pill).[iv]

 

WOMEN WANT IUDS and LIKE IUDs once they have them

  • 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.[v]
  • In a recent study in St. Louis among 10,000+ women who received counseling about the most effective forms of birth control and were provided any contraceptive method free of charge, 67% of women chose LARC methods (56% IUDs, 11% implants).[vi]
  • The same study found that at 24 months after choosing their birth control method, women continued using IUDs longer than any other birth control method: 77% and 79% for Paragard and Mirena, respectively, compared to 43% for the pill.[vii]

 

IUDs are SAFE and RECOMMENDED for use by most women

  • The American College of Obstetricians & Gynecologists (ACOG) recommends that LARCs be offered as first-line contraceptive methods and encouraged as options for most women,[viii] including adolescents.[ix]
  • Skyla and Paragard are FDA-approved for use among women who have never had children (referred to clinically as nulliparous women).[x],[xi] Mirena is FDA-recommended for women who have had at least one child and women seeking a birth control method that helps treat heavy menstrual bleeding.[xii] 
  • IUDs can be safely inserted directly postpartum and postabortion.[xiii]  Inserting an IUD or implant immediately after an abortion significantly reduces the risk of subsequent abortions.[xiv]
  • Infertility is not more likely after discontinuation of an IUD than after discontinuation of other reversible methods of contraception.[xv]
  • In 2013, the CDC developed the United States Selected Practice Recommendations for Contraceptive Use, which provides guidance on how contraceptive methods can be used and how to remove unnecessary barriers for patients in accessing and successfully using contraceptive methods.[xvi] The report offers guidance on when to initiate IUDs and clinical guidance on special considerations, advisable testing, routine follow-up and IUD management.
  • In 2010 the Centers for Disease Control and Prevention (CDC) developed the United States Medical Eligibility Criteria for Contraceptive Use, which provides guidance on the safety of contraceptive methods, including IUDs, for women with specific characteristics and medical conditions.[xvii]
     

IUDs can be LONG-LASTING, but are easily removed at any time

  • IUDs can last from 3 to 10 years, depending on IUD type,[xviii] and can be easily removed at any time by a healthcare provider.
  • Rates of continuation and removal of IUDs are similar for adults and adolescents.[xix]

 

IUDs can be AFFORDABLE

  • Under the Affordable Care Act,[xx] all contraceptive methods (including IUDs) and associated services (insertion, removal, and maintenance) must be covered by a health plan without cost-sharing.
  • The National Women’s Law Center[xxi] and Bayer HealthCare Pharmaceuticals (manufacturer of Mirena and Skyla) [xxii]  have developed materials to help women and providers navigate obtaining health insurance coverage of IUDs without cost-sharing.
  • IUD manufacturers (Teva Women’s Health and Bayer HealthCare Pharmaceuticals) provide IUDs at reduced cost[xxiii],[xxiv] to medical facilities that qualify for the 340B federal drug pricing program.[xxv]  IUD manufacturers also have patient assistance programs that offer IUDs free of charge for those who qualify and are uninsured.[xxvi] 
 

[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

[xxv] HRSA. “340B Drug Pricing Program & Pharmacy Affairs”. U.S. Department of Health and Human Services – Health Resources and Services Administration. N.d. Accessed from: http://www.hrsa.gov/opa/

[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/

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  • 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

[ii] Hubacher, D,Grimes D. “Noncontraceptive health benefits of intrauterine devices: a systematic review.” Obstet Gynecol Surv.  57, 2(2002):120-8. Accessed from: http://www.ncbi.nlm.nih.gov/pubmed/11832788

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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 

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Despite a documented need and evidence of IUD effectiveness, women face numerous barriers to obtaining IUDs.

  • Provider Bias and Public Skepticism: Many patients and health care providers are misinformed about the benefits and potential risks of modern IUDs. A 2009-2010 study of office-based providers and Title X family planning providers found that 30% of those surveyed had misperceptions about the safety of the IUD for nulliparous women.[i] These misperceptions were more common among providers receiving medical training before 1985 and among providers working at facilities that did not keep IUDs on-site.
  • Restrictive Provider Protocols: IUDs can be inserted on the same day as contraceptive counseling, but two-visit insertion protocols are common due to perceived cost, supply, and screening issues.[ii], [iii]
  • Misinformation and lack of knowledge among patients: In a 2009 survey of 1800 unmarried, young people aged 18-29, 75% reported having heard of IUDs; however, most reported that they knew little or nothing about IUDs.  Nearly half of young people believed incorrectly that IUDs could migrate to other parts of the body and cause infections.  Additionally, 34% of young people reported incorrectly that birth control pills were more effective than IUDs for preventing pregnancy.[iv]

 


[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

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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:

  • Provide counseling on all contraceptive options, including implants and IUDs, even if the patient initially states a preference for a specific contraceptive method.
  • Encourage implants and IUDs for all appropriate candidates, including nulliparous women and adolescents.
  • Adopt same-day insertion protocols. Screening for chlamydia, gonorrhea, and cervical cancer should not be required before implant or IUD insertion but may be obtained on the day of insertion, if indicated.
  • Avoid unnecessary delays, such as waiting to initiate a method until after a postabortion or miscarriage follow-up visit or to time insertion with menses.
  • Support efforts to lower the up-front costs of LARC methods.
  • Advocate for coverage of all contraceptive methods by all insurance plans, both private and public.
  • Become familiar with and support local, state, federal (including Medicaid), and private programs that improve affordability of all contraceptive methods, including implants and IUDs."

Source: 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


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

CDC.gov (www.cdc.gov) is your online source for credible health information and is the official Web site of the Centers for Disease Control and Prevention (CDC).


Additional Resources

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Click here to download the IUD Basics Factsheet. 

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