Take a free contraceptive test at BestMethodForMe.com
Managing Contraception Questions and Answers
Questions & Answers
Everything you ever wanted to know about managing contraception and weren't afraid to ask.

Click here to ask a question
Search the Questions & Answers Browse by Category
<< Return to questions


Can I leave my ParaGard IUD in for longer than 10 years? #202/9
Why can't I leave the ParaGard IUD in longer than 10 years? I would like to leave it in 12 or 13 years because I am 45 (it has been in 10 years).

I am willing to use a backup method if the effectiveness has dropped a little.

Please provide me with some data for my doctor, he wants to remove/replace it only because it has been 10 years.


ParaGard was originally approved for just 4 years.  Then this was increased to 6 years, then to 8 years and finally to 10 years.  This is what the package insert now reads, but the IUD is effective for more than 10 years.  On this website we have noted repeatedly that the copper T 380-A IUD (ParaGard) remains effective for at least 12 years.

 

The following paragraphs are from the IUD chapter in the 19th edition of Contraceptive Technology by Dr. David Grimes:        

Two highly effective intrauterine contraceptives are available in the United States: the Copper T 380A (ParaGardÒ, Duramed Pharmaceuticals, Inc., Cincinnati, Ohio), and the levonorgestrel intrauterine system (MirenaÒ, Berlex Inc., Montville, New Jersey).

 

Introduced in the United States in 1988, the TCu 380A is made of polyethylene with barium sulfate added to create x-ray visibility. Fine copper wire is wound around the vertical stem of the T. Each of the two horizontal arms has a sleeve of copper as well. The combined copper surface area of the wire and sleeves is 380 +/- 23 mm. The device measures 36 mm tall and 32 mm wide. The bottom of the vertical stem has a 3 mm bulb into which a monofilament polyethylene string is tied; these two strands enable easy removal of the device. Throughout the world, tens of millions of Copper T 380A IUDs have been distributed in 70 countries. The approved duration of use of the device is ten years, although data indicate high effectiveness as long as 12 years.

 

The levonorgestrel intrauterine system was approved for use in the United States in 2000 and first sold in 2001. This system has been available in Europe for a decade, and several million women have used it to date. The system releases levonorgestrel directly into the endometrial cavity at an initial rate of 20 mcg per day. This release rate was selected to provide high contraceptive effectiveness while minimizing side effects. The rate declines to about 14 mcg per day after 5 years, which is still in the therapeutic range.

 

The approved life span of the levonorgestrel system is 5 years, although the protection with the system in place may last at least 7 years. The product is based on a NOVA T model polyethylene frame, with a cylinder of a polydimethylsiloxane-levonorgestrel mixture molded around its vertical arm. The cylinder is coated with a membrane that regulates the release of the hormone. Measuring 32 mm in both height and width, the T-shaped frame contains barium sulfate for visibility on X-ray. The base of the vertical stem has dark monofilament polyethylene threads to assist with removal.

 

Small amounts of levonorgestrel are systemically absorbed, and, thus, some systemic side effects can occur. However, the daily dose of levonorgestrel is about 10% that with an oral contraceptive containing 150 mcg levonorgestrel, and the mean plasma concentration only 5%. Moreover, the plasma concentrations of levonorgestrel are lower than those achieved with either the subdermal levonorgestrel implants or the progestin-only pill.

 

EFFECTIVENESS

 

While contraceptive effectiveness is discussed in more detail in Chapter 27, a simple formula explains why today’s IUDs provide superior contraception. The effectiveness in the community of any contraceptive is related to a number of factors. These include the inherent ability of the method to prevent pregnancy (efficacy) and the user’s compliance (adherence to the regimen, such as pill taking) and continuation (ongoing use over time). Factors impairing effectiveness include a woman’s fecundability (reflecting age, body mass index, prior salpingitis, etc.) and frequency of coitus. Although combined oral contraceptives have excellent efficacy, compliance is only fair—as is continuation. Hence, the contraceptive effectiveness of combined oral contraceptives falls in the middle tier.  In contrast, IUDs have excellent efficacy and users exhibit high compliance and high continuation rates (about 85% to 90% at one year). This translates into superior protection against unintended pregnancy.


Both of the intrauterine contraceptives in the United States rank in the top tier of contraceptive effectiveness (along with surgical sterilization, implants, and injectable contraceptives).  In combined World Health Organization and Population Council trials, the first-year discontinuation rate of the TCu 380A for accidental pregnancy was only 0.7 per 100 women, and even lower rates occurred in years two through ten.8 In World Health Organization trials, the cumulative 12-year failure rate with the TCu 380A was 2.2 pregnancies per 100 women.  In three trials conducted by Leiras, the Finnish manufacturer of the levonorgestrel system, the first-year cumulative failure rate was 0.14 per 100 women, and the cumulative five-year failure rate was only 0.71 per 100 women. In the Population Council’s randomized trial of the levonorgestrel intrauterine system vs. the TCu 380A, the seven-year cumulative failure rates were 1.1 and 1.4 per 100 women, respectively.  In contrast, the overall ten-year failure rate with all methods of tubal sterilization in the United States is 1.9 per 100 women.  Thus, contemporary intrauterine contraceptives rival the effectiveness of tubal sterilization.

 

Please feel free to pass these paragraphs on to your clinician.

 

To learn more about the advantages and disadvantages of the ParaGard (copper T) IUD and all available contraceptives, go to our website: www.managingcontraception.com and click on Choices.  You can also order this wonderful new educational book from our website or by calling 404-875-5001.

 

Key Words:  ParaGard IUD, longer (10 years), backup contraception, data, remove, replace, effectiveness, approved, package insert, Dr. David Grimes, Contraceptive Technology, intrauterine contraceptive, levonorgestrel, side-effects, World Health Organization

 

Reference:

Grimes DA. Intrauterine devices (IUDs) IN Hatcher RA, Trussell J, Nelson AL. et al Contraceptive Technology 19th edition, pages 118, 199, 120: Ardent Media Inc. 2008


Posted 2-17-2009, Updated 2-20-2009, Updated 7-9-2011 

Robert A. Hatcher MD, MPH
Emeritus Professor of Gynecology and Obstetrics
Emory University School of Medicine
Atlanta, GA
---2011-07-9

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.
Visitor Comments
No visitor comments posted.

Post a comment
Post Comment
To post a comment for this question, simply complete the form below. Fields marked with an asterisk are required.
   Your Name:
   Email Address:
* Your Comment:
* Enter the code below:
 
Related Questions
No related questions were found.
Attachments
No attachments were found.

Suggestions, recommendations, questions, comments, data from the literature, interpretation of laboratory tests and other information provided on this site are for informational purposes only and are not intended to be relied upon as advice from or implied to be a substitute for the professional advice of a physician, nurse practitioner, nurse midwife, counselor or other healthcare professional. Always seek the advice of your clinician or other professional for any questions you may have regarding your health, medical condition, method of birth control and other family planning or personal/social issues. Periodic references to costs of birth control methods on this website are estimates only and your actual cost for any specific method of birth control may be more or less than the stated amount. Emory University School of Medicine, Bridging the Gap Foundation, and Bridging the Gap Communications Inc are not responsible for any damage or loss you may incur as a result of your use of or reliance on any material or information provided through this website.