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Can a woman who has never been pregnant, use an IUD? #1116/8

Q:        What’s the word on increased utilization of IUDs?


“An IUD for every uterus unless it wants to be pregnant!”

 

I came across this phrase recently. This is a phrase that might be discussed playfully as a mantra of sorts.  Here again are those amazing 11 words: “An IUD for every uterus, unless it wants to be pregnant!”  What a mantra!  Worth repeating as it is so far from where we are in the United States today, where only 2% of women use IUDs.

 

 


An IUD is an Intrauterine Device, a small T-shaped plastic device that is inserted into a woman’s uterus to keep her from becoming pregnant.  There are two IUDs in the United States.  One, called ParaGard, has 3 sleeves of copper placed onto the outside of the “T” shaped device.  ParaGard is also called the copper T.  This IUD remains effective for 12 (perhaps more) years.  It is as effective for those 12 years as female sterilization.  It is the most cost-effective reversible form of birth control.  Copper IUDs are also the most commonly used reversible contraceptive throughout the world.

 

The second IUD available in the United States is called Mirena.  It remains effective for 5 to 7 years, maybe even longer.  The Mirena IUD gives off very low amounts of a hormone, a progestin called levonorgestrel.  Not only is Mirena the most effective reversible contraceptive ever developed, but it has a number of desirable effects having nothing to do with contraception.

 

Physicians are now using the Mirena IUD to treat endometriosis, one of the important causes of infertility.  Endometriosis is the presence of glands from the lining of the uterus that are outside the uterus.  Endometriosis most frequently involves the surfaces of the ovaries, the fallopian tubes and other pelvic organs.

 

Endometriosis is a common problem; about 3 to 10% of reproductive-age women in the United States have endometriosis.  Nearly 25 to 35% of infertile women have endometriosis.  Rates may be twice as high in Asian women, in women who delay childbearing, and in women with a family history of endometriosis.  The other major problem with endometriosis is that it can cause so much pain.  The pain may occur during intercourse, just before or at the time of menstrual bleeding and sometimes with exercise.  The pain is often severe.

  

Several of the hormonal contraceptives may help women with endometriosis, but it may well be that use of a Mirena IUD turns out to be the best.  Other problems that may improve in women using the Mirena IUD (that gives off a progestin) are menstrual cramps and pain, heavy menstrual periods and uterine fibroids.  Fibroids are the most common problem leading to hysterectomies.  Fibroids are benign tumors of the uterine muscle.  Mirena IUD insertion causes fibroids to become smaller, bleed less and cause less pain.

 



Recently the student health service at the University of Georgia in Athens started offering both ParaGard and Mirena IUDs to students.  IUDs are inserted for students at the University of Michigan and students at UCLA and USC in Los Angeles. Now it is perfectly possible for a young woman who has never had a baby to ask for and receive an IUD.  Because of those non-contraceptive benefits mentioned above, women in their late teens and early twenties who choose to use an IUD most often choose to use the Mirena IUD.

 

DO THE MATH:  If 1,000 women were to use a Mirena IUD for 7 years, 11 of them would become pregnant.  This is so very low because once a woman chooses to use this contraceptive and is able to deal with any side-effects, then she has nothing to do.  So easy!

 



If 1,000 women were to depend on birth control pills each year for 7 years, 560 of them would become pregnant.  This is because in a population of women choosing pills there will be many who use pills incorrectly.  So each year about 8% of women initiating use of pills for a year of contraceptive protection – 8% or 80 of 1,000 will be pregnant by the end of that year.  Seven years at 80 pregnancies per 1,000 women per year is 560 pregnancies.  560 pill users vs. 11 Mirena IUD users would become pregnant in 7 years.  Small wonder some people across the country are suggesting “An IUD for every uterus unless it wants to become pregnant!”


Below from CHOICES on our website: www.managingcontraception.com are the advantages and disadvantages of Mirena IUDs:

WHAT ARE THE ADVANTAGES?

  • It is the most effective reversible method ever developed!
  • It prevents ectopic pregnancies (15 times lower than non-contraceptors.
  •  It decreases menstrual cramping and dramatically decreases menstrual blood loss (a 97% reduction in menstrual blood loss in one study). Some women experience an absence of menstrual bleeding after one year (about 20%).
  • This IUD may be left in place for at least 5 years (probably effective for 8 or more years).
  • IUDs are safe, inexpensive over time, and provide extremely effective long-term contraception from a single decision.
  • One of the costs of any contraceptive is the cost to you should your contraceptive fail. Given the extremely low failure rate of Mirena, a person using this method is far less likely to have the emotional and financial expenses associated with an unintended pregnancy.
  • All you have to do is check for the strings each month.
  • May be used by postmenopausal women on estrogen therapy to protect the endometrium against endometrial cancer.
  • Once Mirena is removed, fertility returns rapidly. Approximately 8 out of every 10 women who want to become pregnant will become pregnant in the first year after Mirena is removed.  

WHAT ARE THE DISADVANTAGES?

  • Do NOT start this method of birth control unless you will find it acceptable to have your periods change.  They WILL change a lot.
  •  There may be more bleeding days than normal for the first few months and less than normal after 6 to 8 months. If your bleeding pattern is bothersome, contact your clinician. There are medications which can help you have a better pattern of bleeding.
  • The IUD does not provide protection against sexually transmitted infections. Use condoms if there is any risk.
  • There is a high initial cost of insertion. 
     

Key Words:    IUDs, ParaGard, Mirena, copper T, prevent pregnancy, uterus, T-shaped device, effective, sterilization, cost-effective, birth control, reversible contraceptive, hormones, progestin, levonorgestrel, endometriosis, infertility, glands, lining of uterus, ovaries, fallopian tubes, pelvic organs, pain, intercourse, menstrual bleeding, exercise, uterine fibroids, hysterectomies, benign tumors, non-contraceptive benefits, birth control pills


Posted 12-10-2008, Updated 1-23-2009, Udated 2-10-2009 

Robert A. Hatcher MD, MPH
Emeritus Professor of Gynecology and Obstetrics
Emory University School of Medicine
Atlanta, GA
---2009-02-11


Managing Contraception for Your Pocket 2013-2014
  


Managing Contraception for Your Pocket 2013-2014
  

The directors and owners of this website and any publications and information concerning health matters offered here advise a person with a particular problem to consult a primary-care clinician or a specialist in obstetrics, gynecology, or urology (depending on the problem or the contraceptive) as well as the product package insert and other references before diagnosing, managing, or treating the problem.
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