User:DoctorH02/Intrauterine device

INTRODUCTION

An intrauterine device (IUD), also known as intrauterine contraceptive device (IUCD) or coil, is a small, often T-shaped birth control device that is placed into a woman's uterus to prevent pregnancy. IUDs are one form of long-acting reversible contraception (LARC). In 2014, about 12% of birth control users in the United States chose to use the IUD, which totals about 4.5 million women.^[1] Women who use the IUD are usually very satisfied with this method of birth control.

IUDs are classified into two main types—hormonal and non-hormonal. They differ by how long they can be used and in the ways they affect menstrual bleeding. Copper IUDs (non-hormonal) may increase menstrual bleeding and can cause cramps with periods. Hormonal IUDs frequently reduce menstrual bleeding, and some women experience no menstrual period. Copper IUDs are used for 10 years and have a failure rate of about 0.8%. Hormonal IUDs contain the progestin hormone levonorgestrel. There are four different levonorgestrel IUDs available in the U.S. These are FDA-approved for 3, 5, or 6 years of use, depending the specific device.

The IUD is a good birth control option for most women. They are safe and effective in adolescents and young women and in women who have not previously been pregnant. Fertility returns to normal rapidly after an IUD is removed. More serious potential complications include expulsion (2–5%) and rarely perforation of the uterus (less than 0.7%). IUDs do not affect breastfeeding and can be inserted immediately after delivery of a baby. They may also be used immediately after an abortion.^[2]

The failure rate (chance of getting pregnant while using a birth control method) is 0.8% for the copper IUD and 0.2% for the hormonal IUD. In comparison, female sterilization (tubal ligation), male sterilization (vasectomy) and male condoms have estimated failures rates of 0.5%, 0.15%, and 13%, respectively. ^[3]Copper IUDs can also be used as emergency contraception within 5 days of unprotected sex.

In the United States, the use of IUDs has increased in recent years. In the 1960s and 1970s, a commonly used IUD model called the Dalkon shield was associated with an severe pelvic infections. It was removed from the market, and it took many years for the IUD to regain popularity. Newer, modern IUD models do not cause pelvic infections (except in women who already have infections at the time the IUD is placed).

IUD INSERTION AND REMOVAL

Placement of an IUD is a simple procedure, performed in a provider's office. In the U.S., various types of health care providers can be trained to place IUDs, including physicians and advanced practice providers in gynecology, primary care, and pediatrics. The procedure usually takes about 5 minutes to complete. The provider uses a speculum to find the cervix (the opening to the uterus), places a tenaculum to hold the cervix, and uses a specialized inserter to feed the IUD into the uterus. The inserter is then removed, and the IUD remains in place, with the strings trailing out of the cervix. The provider trims the strings, such that the length of the string visible outside the cervix (at the top of the vagina) is about 3 cm. The purpose of the strings is to allow removal of the IUD, which involves simply grasping the strings with an instrument and gently pulling the IUD out.

Traditionally, many providers recommended that IUD placement occur while during the menstrual period. This practice is not required. An IUD can be placed at any time, as long as the provider is certain that the woman is not pregnant. ^[1]

IUD placement is uncomfortable for some women. Some women describe the insertion as cramps, some as a pinch, and others do not feel anything. Fear of pain during the IUD insertion keeps some women from choosing to use the IUD. Researchers have studied several different ways to treat or reduce the pain associated with IUD placement. Some of these methods include medications to soften or open the cervix, pain medications, and anesthestics for numbing the cervix and uterus. Many treatments did not improve pain substantially, but some studies reported decreased pain with naproxen (pain medication) and lidocaine cream or spray. ^[2][3]