Ladies, Is The Copper IUD The Right Contraceptive For You?

The copper IUD is a simple, cheap, convenient, reversible, long term and reliable contraceptive option. But is it right for you?

At the beginning of last year, when my younger one was about 3 months old, my period returned. Up until then, condoms were the only form of contraception I had ever used.

Condoms have many virtues. They are easily available and easy to use. They don’t require a prescription or a visit to the doctor. They protect against many sexually transmitted infections.

Having lived in the US for 8 years, birth control pills were the first thing that came to mind. But a 61% chance of failure, over the course of 10 years of typical use was not too reassuring. Also pills need to be taken regularly to be effective, and I found that inconvenient.

So I settled on the copper Intra Uterine Device (IUD). I had never heard of IUDs, till I started looking into methods of birth control. But I was impressed that they have only an 8% chance of failure over a 10 year period.

So what is this magical device?

A copper IUD is a plastic T or U shaped object with copper coiled around. The one I got is called Multiload. It looks like this:

IUD. Image source Shutterstock

There is another kind of IUD, called a hormonal IUD. It uses progestogen to prevent fertilization. It has many advantages but there have been some controversies concerning the leading brand; Mirena.

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In the rest of this article, when I say IUD, I mean copper IUD, unless I specifically say hormonal IUD.

How does the IUD work?

According to wikipedia, the copper IUD’s primarily prevents fertilization. Copper acts as a natural spermicide within the uterus. The presence of copper increases the levels of copper ions, prostaglandins, and white blood cells within the uterine and tubal fluids, which is hostile to sperm and fertilization. Some experts in human reproduction also believe there is sufficient evidence to suggest that IUDs with copper can disrupt implantation, which is why it can work as emergency contraception.

How is it inserted?

My doctor told me to come for the insertion specifically on the 5^th day of my period. You need to be sure you are not pregnant when the IUD is inserted. It may be good to take a pregnancy test too. My doctor, used the speculum to take a look, and inserted the multiload using a plastic tube. The insertion definitely hurt more than a regular PAP test, but the whole process took about 10 minutes. This article gives details about the insertion process with pictures.

What happens next?

Infections are not uncommon soon after an IUD is inserted, so my doctor prescribed an antibiotic for 5 days, as a preventive measure. I had mild spotting in the week after the insertion, and sporadic cramping for a month and a half after the insertion. But it was not severe enough for me to take a pain killer.

My first period after the insertion lasted 10 days, and I had heavier than usual bleeding. Subsequent periods have been 1 or 2 days longer than usual, but the bleeding on the first couple of days is very little. I think I bleed less than I used to per day, but for more days.

A month after the insertion, the doctor checked to ensure that the IUD was still in place.

What are the advantages?

• It is highly effective with only an 8% chance of failure over 10 years of typical use.
• It is very convenient. Once the IUD is inserted, no action is required from you. No need to remember to take your pills or have a condom at hand. It is fairly user proof. In my experience, it lends greater flexibility and spontaneity to your sex life compared to using condoms.
• The IUD does not mess with your hormones and you get your regular period. So just in case you do get pregnant, you’ll know as soon as you miss your period. It can also be used while you are lactating without any harm to the baby.
• It is reversible and fertility returns as soon as the device is removed.
• The IUD lasts for 2 or more years and requires a check up only every 6 months.
• There is some evidence that IUDs work as an emergency contraceptive.

What are the disadvantages?

• IUDs do not protect against sexually transmitted infections. So for casual sex, it is important to use a condom in addition.
• There is a risk of a transient, post insertion infection, but my doctor prescribed a preventive antibiotic.
• Some women find that it significantly increases their menstrual bleeding and makes periods a lot more painful. Some doctors prescribe medication to help IUD users cope with heavy, painful periods. Often the symptoms subside after 6 months of IUD usage. In India periods are still considered a taboo in may sections of society and for some women, prolonged periods may, psychologically and socially, be a problem. It is also more than an inconvenience for women doing manual labour or working on fields. The hormonal IUD on the other hand reduces menstrual flow and cramps and can be used while breast feeding. But there may be other problems associated with it.
• Sometimes an IUD may be expelled unnoticed, and no longer protects from pregnancy. This is more common among women who have never been pregnant or if the IUD is inserted soon after child birth. Most IUDs have string that extend out of the cervix in to the vagina. It is important to check for these strings after every period, to make sure the IUD is in place. The most likely time of expulsion is during a period.
• There may be some brown discharge between periods. I experience a minuscule amount of this. It is not painful.
• Extremely rarely, the uterus gets punctured during insertion of the IUD. Then it should be removed right away.
• If you do get pregnant with the IUD still in place, there is a small risk that it will be an ectopic pregnancy, i. e. the pregnancy is outside the uterus in the fallopian tubes. This is an uncommon complication, and it is less likely than it would be, if you did not use any contraceptive at all.

IUD bias

In the US some doctors are making it difficult to obtain IUDs when patients ask for it. According to this article the stigma dates back to the 70’s when a poorly designed IUD caused a lot of dangerous infections. Although IUDs have since been redesigned and are safe, the stigma associated with them remains.

To summarize, if you are in a committed long term relationship, then IUDs are a cheap, convenient, reversible, non-hormonal and reliable contraceptive option.

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