THE MYTHS AND REALITIES ABOUT IUDs

Dr Steven R. Goldstein, a NYC Gyn writes the following about IUDs

I have spoken to many of my patients about my opinions about IUDs. Intrauterine devices, which is what IUD stands for, have been around for several thousand years. The first IUDs were actually stones put into the uteri of camels when nomads were crossing the desert in order to keep a camel from getting pregnant. These devices are not inducing an abortion. Apparently, in a survey of almost a thousand physicians in the United States, 17% believed an IUD was an abortifacient, which it is not.

There has been a huge push towards an increase in use of IUDs, especially in adolescents and young women. This comes under a category know as LARC (long-acting reversible contraception). The American College of Obstetrics and Gynecology as well as the American Academy of Pediatrics have endorsed the use of these devices very liberally. In many respects, this is somewhat paternalistic. Forty percent of the pregnancies in this country are unintended. Many of those will have an unintended baby.

 

The Risks associated with Intrauterine Devices

The IUD is definitely associated with an increased risk of pelvic inflammatory disease and subsequent tubal damage and diminution in fertility. Although this is not huge, it is real. However, from a public health point of view, if you prevent a large number of unintended births with a relatively small number of patients with tubal damage and compromised fertility, that is considered a public health victory especially if you are the Secretary of Health and Human Services. Not so for the patient who has compromised fertility.

When I trained, I was taught that the ideal candidate for an IUD would be someone who had had a child (the uterus grows some with childbearing) and is in a stable monogamous relationship. Most (but not all) single, young women will practice “serial monogamy.” It is unlikely that the boyfriend of the college sophomore is the man she will marry, although perhaps, sometimes it is. If one were to contract an STI (sexually transmitted infection) from a partner, the IUD can serve as a wick to help spread it up into the fallopian tubes and cause damage to one’s fertility.

 

Hormonal Intrauterine Devices

Hormonal IUDs, of which there are many different sizes as well as duration of use, contain the progestogen levonorgestrel. The hormone is delivered in a time-released fashion and will diminish over time. The progestin thickens cervical mucus which acts as a barrier to reduce sperms’ access thus preventing fertilization. It thins the endometrial lining. It does not inhibit ovulation on a regular basis. Nor does it affect erratic production of estrogen in perimenopausal women. It is often touted as being “local,” although some of the progestin is, in fact, absorbed.

There is a recent Danish study that looked at almost 80,000 women who used hormonal IUDs. There was a small but real increase in the incidence of breast cancer underscoring the concept that some of this progestin is absorbed into the blood stream. Some patients with progestin IUDs do report progestin-type side effects (breast tenderness, bloating, acne) although this is not common and fairly rare, but real, especially if it happens to you.

The copper IUD, approved for up to ten years, does not release any hormones. It causes some inflammatory response in the uterus which is toxic to sperm and thus prevents pregnancy that way.

Dr Steven R. Goldstein is a Gynecologist in NYC with offices on the East Side of Manhattan. He is considered one of the top gynecologists in NYC. If you have an IUD and are experiencing hormonal issues, then perhaps a consultation is in order.