The IUD Debate: Experienced Providers Weigh In

Erica Sackin

Conflicting messages on IUDs abound. How do you know who’s right, and why are so many people telling you different things? Providers at Planned Parenthood of New York City, who regularly do IUD insertions, weigh in.

With Slate.com declaring IUDs the best form of birth control, and the writers at Rewire weighing in on their experiences with IUD insertion, we’ve been getting a lot of questions about IUDS as a birth control method. There seem to be conflicting messages being given out there – with some publications touting them as the saving grace of birth control even as many providers are calling them unsafe or refusing to insert them in women who haven’t yet had children. How do you know who’s right, and why are so many people telling you different things? Our providers at Planned Parenthood of New York City, who are experienced in providing IUDs, weigh in. 

The History

As many of you may now know, the original design of IUDs was, less than perfect. The devices, among other things, had strings that would act like a wick – pulling any infection a woman contracted up into her uterus. This had possible detrimental effects, one of which was infertility. For years, doctors would refuse to insert the device in women who hadn’t had children, considering the risk of infertility too great. 

However, the design of IUDs started changing about 10-15 years ago, giving it a non-absorbent string and refining the device to make it safe and keep it effective. While there are hundreds of different kinds out there (interestingly China has actually been at the forefront of the development of the device), the two main types are the ParaGard (contains copper but no hormones) and the Mirena (does not contain copper and releases the hormone Progesterone locally into the uterus).

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What are the facts?

About five or so years ago, a series of studies were done on the new kinds of IUDs, to determine how great their risks were and what side effects women might experience. What did they find?

First of all, yes, it’s true if you contract Chlamydia or Gonorrhea and let it go untreated, it can cause scarring that will affect your ability to have children in the future. But, that risk is the same whether or not you have an IUD.  A large body of research has found that having an IUD in this day and age has no impact on whether or not an STD will cause infertility. What determines your risk of infertility is whether or not you let an infection such as Chlamydia or Gonorrhea go untreated. An IUD does not change that.

The most up-to-date evidence on IUDs: you are slightly more susceptible to contracting an infection for about three weeks after an IUD insertion – although after those three weeks your increased susceptibility goes away. There is always the minimal risk that the uterus will become perforated during insertion In most cases, a perforation will heal on its own , and your provider may give you antibiotic treatment. ParaGard, the type of IUD that does not contain hormones, will make you have heavier periods so might not be best for some women. There are other, uncommon, side effects as well – of your body rejecting the device and trying to expel the device, of not being able to locate the strings from the device, etc. Plus, IUDs don’t protect against STDs, so it’s important you still use a condom or other barrier method while you’re sexually active. But, the old beliefs about infertility or increased risks of Chlamydia or Gonorrhea are, according to the latest research, unfounded. 

So why won’t my doctor insert one?

Obviously, PPNYC can’t speak for other providers or to their reasons. It’s always possible that there are individual factors that have gone into their decision – depending on your health, circumstance, lifestyle and history. But if your provider has a blanket policy about not considering IUDs for women who haven’t yet become pregnant, there are a couple of reasons why:

  1. S/he might still be reading old research.. It’s possible that your doctor simply isn’t familiar with the latest research or is following older clinical protocols.
  2. S/he might think it’ll be too difficult. It’s also possible that your provider is under the impression that an IUD isn’t possible to insert into a woman who hasn’t had children because their cervix and uterus hasn’t yet had to expand for childbirth. This also doesn’t mean you can’t insert an IUD into a woman who hasn’t had children, it just means it might be a little more difficult. Plus, it’s different for every woman — our providers have sometimes had an easier time inserting a device into a woman who’s never had children than one who’s had four children.
  3. They might be worried about STDs. Since IUDs don’t protect against STDs, some providers might be hesitant to give them to women who aren’t married or in serious, long-term monogamous relationships. It goes without saying that while you should always be safe and protect yourself against STDs, this isn’t a reason for a provider to refuse an insertion.

So what should I do?

Of course, only you and a trusted provider can make the decision if an IUD is right for you. But from what we’ve heard when it comes to IUDs, it sounds like some people are having trouble finding a provider they trust. Ask your friends who have one who they’d recommend, or you can always go to your local Planned Parenthood health center –we’re a national, IUD-friendly provider (go to www.plannedparenthood.org to find the health center closest to you). But if it sounds interesting to you, we’d recommend looking into it. IUDs are more than 99% effective at preventing pregnancy – making them one of the most effective non-permanent forms of birth control around. They’re a method it’s hard to screw up – you can’t forget to take it or not use it. Don’t you think you deserve an honest assessment about whether or not an IUD would be right for you?

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