IUD is easy and effective birth control! Mirena vs Paragard, efficacy, side effects and pregnancy rate

The Mirena intra-uterine device
The Mirena intra-uterine device

Choosing a birth control method - the benefits of the IUD

These are good times we live in. Today, there is a whole slew of different birth control options to choose from, from the natural rhythm method to sterilization, depending on how much invasiveness you are willing to accept. This hub is only about the IUD though. Good as other options are, I am a big believer in the significant benefits to the IUD, and I find they are often overlooked. Very few women I talk to have tried or even considered using the IUD, which is a shame, as it could be one of the best options for a majority of women. This hub will go over the benefits and drawbacks of choosing an IUD for birth control.

So what are the benefits of using an IUD:

1) It is the most effective birth control method. In some studies, it is even more effective than having your tubes tied! (How’s that possible? Well, it turns out that tubal ligation is not as final as one may expect - occasionally the tubes grow back together, and there is also an increased chance of an ectopic pregnancy.) This is very interesting, considering that sterilization is a highly invasive procedure, not to mention not easily reversible. The pregnancy rate with an IUD is less than 1%. This means that out of a hundred women with an IUD, who have regular sex for a year, one will become pregnant.
2) It’s always on. This is part of what makes it so effective - the condoms can be unavailable, the pills can be missed, but the IUD is always there. You don’t have to think about it.
3) There is a non-hormonal model. While the pill may be the most popular option, not everybody can tolerate the unnaturally high levels of hormones that are delivered. Just the increased appetite is enough of a problem for many. Mood changes can also be an issue. With the copper-based IUD, this is not a concern.
4) It is quickly and easily reversible. It takes a minute to have it taken out, and fertility is restored instantly.
5) Many don’t know that, but an IUD can be used as a post-coital contraceptive. If it is inserted after unprotected sex, it prevents implantation, and thus can be used instead of Plan B. Also, right at the time of vaginal delivery or an abortion is a perfect time to have it inserted, as the cervix is already dilated.

This sounds pretty good, but there are of course some risks and downsides to using the IUD:

1) Risk of infection. This is most prominent at the time of insertion, so you would want to pay attention in the first week or so. Years ago, it was thought that the IUD raises the risk of pelvic inflammatory disease (PID), which can lead to infertility, but now it’s known that it is the pre-existing STDs that are to blame - the IUD just by itself does not raise the risk of STDs or PID.
2) Discomfort. It is quite a bit uncomfortable to frankly painful having it inserted, though it lasts only seconds. After that, the first few periods can be crampy and painful, and for some, this can go on until the IUD is taken out. If you are unlucky enough to have painful periods with the IUD, the downsides of the IUD may overcome the benefits.
3) The hormonal variant can give you the same side-effects as the pill, though the dose is much lower.
4) The IUD could be expelled. If this happens, you are not protected any more, obviously. That’s why you are supposed to check whether your IUD is in place after every period. You can tell by the presence of the string that is left to hang out of your cervix. This string is used to pull the IUD out when it’s no longer needed.
5) It does not protect against STDs. When in doubt, always use a condom!
6) It can cause miscarriage. In the unlikely event that you do become pregnant, having an IUD in your uterus could cause miscarriage. Removing the IUD after the pregnancy is discovered can also cause miscarriage, but overall, it is the safer option.

IUD for nulliparous women

Some doctors will recommend the IUD only if you have been pregnant already. (You don’t have to have had a child, though, having been pregnant with an abortion counts, too.) But many will insert an IUD in women who have not been pregnant (nulliparous). The main difference is that nulliparous women are more likely to expel the IUD, (though the probability is reduced with every month that goes by). Thus the IUD is an option even for younger women. Given the long effectiveness (5-10) years, it may be an especially attractive option.

Miranda vs Paragard: comparison of side-effects

This is the big question: which IUD should you choose? There are two types of IUDs on the market in the US: Miranda and Paragard, and there is a big difference between the two. Paragard is copper-based, while Miranda releases a low level of contraceptive hormones in the uterus, and this difference has a direct effect on the women’s periods. With both types, the first couple of initial periods will be heavier and more crampy. With Miranda though, the periods will become lighter over time, and for some women can go away completely. On the downside though, the same type of side-effects can show as when using the pill. Paragard generally causes periods to become heavier, sometimes more crampy and/or painful, but has the benefit of being non-hormonal. This, together with your bias for or against hormonal treatment, can guide your choice.

IUD and MRI

Both types of IUDs are safe for MRI in magnets up to 3T of field strength, (which is the highest currently available in clinical practice).

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