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Should I use an IUD for birth control? Add to ...

The question

I'm considering getting an IUD as a (non-hormonal) alternative to the pill. What are the pros and cons?

What are the pros and cons?

The IUD or intrauterine device, is a form of birth control that is available to woman of any reproductive age seeking long-term, non-hormonal, safe and effective contraception.

In Canada, there are two types of IUDs - the Nova-T and the Flexi-T. The IUD is a small (3cm in length) T-shaped device with plastic arms, a copper wrapped stem and a nylon string at it’s base.

Neither the plastic, the copper or the strings can be felt or seen outside of the vagina. IUDs are thought to work by interfering with sperm mobility and by irritating the lining of the uterus which makes it difficult for an embryo to implant.

Choosing a birth control option is a very personal choice and depends upon the potential risks, benefits and efficacy of each method. For the IUD, there are several pros and cons to consider:

Pros

1. It's one of the most effective forms of birth control: 96-98 per cent effective

2. It's hormone-free

3. It's convenient and reversible: After inserted, you do not have to do anything, there's no need to take a daily medication and it doesn't interrupt sex because it is always in place.

While it can remain in place for up to 5 years, it can be removed at any time.

4. It can be private: Because it can’t be felt or seen, it’s a woman's choice and her choice to share if she chooses to.

5. It's cost-effective: An IUD costs $90-160, so over five years - it is significantly less than the cost of birth control medication for the same amount of time.

Cons

1. It doesn't protect against sexually transmitted infections

2. It can cause irregular bleeding, and heavier, longer and more painful periods. Generally this will improve over a few months after insertion, but if it persists or continues in between periods - check in with your doctor to ensure that it is not related to infection. If you already suffer from severe period pain or heavy periods, an IUD may not be the best option for you.

3. There is a slightly increased risk of infection within the first month of insertion: In the past, there was a strong concern about pelvic inflammatory disease because of a design flaw in the IUDs used in the 1970s. This has changed and today's IUDs have a very low rate of infection. To minimize this risk - your healthcare provider would check for infection prior to insertion.

4. Insertion can be uncomfortable: For some it is an easy insertion, for others it can be very painful. There are some options to help decrease pain that your doctor can offer prior to insertion that may help.

5. If you have a copper allergy, this is not a safe option.

Complications associated with the IUD are rare but may occur. These include perforation (puncturing the wall of the uterus), bleeding, or it can fall out.

To decrease the risk, insertion should be done by a trained clinician and they should review these risks with you prior to insertion to ensure that this is a safe option for you.

It is important to mention a device similar to an IUD called Mirena - an intrauterine system or IUS which is also T-shaped and inserted in the uterus, but it contains a hormone. It works by thinning the lining of the uterus and making it difficult for sperm to fertilize an egg. This option is popular for those who want the convenience of not taking a pill daily and who do not mind having a hormonal method of contraception. The progesterone effect can reduce menstrual bleeding and for some - menstruation completely stops.

For this reason, Mirena is also used for those who suffer from heavy menstrual periods. Side effects can include similar risks as the copper IUD (apart from heavier, crampier periods) and also progesterone related effects such as change in mood and libido, and spotting after insertion. The Mirena is slightly more effective than the copper IUD (99%) and it costs approximately $350-400 which is covered by most private health insurance plans.

There are many options for contraception and the choice will depend on what feels right for you and your partner(s) and what will be most effective, safe and convenient for you. Whether you choose the oral contraceptive pill, the IUD or IUS - use a condom as well to protect against sexually transmitted infections.

Send family doctor Sheila Wijayasinghe your questions at doctor@globeandmail.com. She will answer select questions, which could appear in The Globe and Mail and/or on The Globe and Mail web site. Your name will not be published if your question is chosen.

Read more Q&As from Dr. Wijayasinghe.

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The content provided in The Globe and Mail's Ask a Health Expert centre is for information purposes only and is neither intended to be relied upon nor to be a substitute for professional medical advice, diagnosis or treatment.

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