The whole truth about intrauterine devices

Health Tips

There is no consensus either among mere mortals or in a professional environment. And our expert, obstetrician-gynecologist Natalya Artikova, reveals all the cards so that you can make the right decision for yourself.

While in some countries almost half of all women choose intrauterine contraception (IUD), in others adherence to the gadget tends to a measly 2%. Scientific gynecological men attribute the striking heterogeneity of opinion to the prevailing myths and prejudices. However, myths are not born in a vacuum. The mental barrier in relation to VMK arose in the 60-70s of the last century. The triumphant start of sales of intrauterine systems, similar in shape to a fish, led to the rapid conquest of the contraceptive market and the same rapid (after 6 years) sales ban. The device has caused inflammatory diseases, perforation of the uterine wall (rupture) and death. 200,000 lawsuits from victims and relatives of the victims. Several reasons were found, but the main ones are the massiveness of the device and braided antennae, which facilitate the access of infection to the uterine cavity.

Modern VMK fundamentally differ from their predecessors in a constructive way. But the residue remains…

What changed

The dimensions of modern IUDs vary from 3×2.5 cm (mini) to 3.5×3.5 cm (maxi), the antennae have become monolithic and smooth – microorganisms do not stick to them as they stick to twisted ones. Therefore, the percentage of risks and complications is completely different. The greatest likelihood of developing metroendometritis (inflammation of the uterus) and adnexitis (inflammation of the ovaries) exists in the first 20 days after the introduction of a contraceptive – about 1 case per 100 women. The chance of serious inflammation then decreases dramatically (1.4 per 1,000 women with ICH) and no longer changes over the course of use. And these things serve flawlessly for 12 years. The chance of getting pregnant within a year is 1 in 100 carriers. But the chance of loss (expulsion) of the device is high in the first year of use – this happens in 3-10% of IUD carriers.

How it works

The mechanism of action of the IUD is still the subject of fierce debate.

The process of the origin of life is multi-stage. First, millions of sperm need to get to the egg that has begun its movement, this process is reliably blocked by condoms and hormonal contraceptives: some catch sperm, others do not allow the egg to ripen and leave the follicle towards a brighter future.

If this does not happen, the fertilized egg needs to be introduced (implanted) into the wall of the uterus. The action of the IUD is aimed at preventing this: due to a foreign body, chronic inflammation develops in the uterine cavity, the mucosa changes its structure and reduces the possibility of implantation. Opponents of intrauterine devices say that since we do not know exactly how the devices work, we cannot exclude their abortive effect … That is, your next menstruation is probably an early miscarriage.

Types of spirals

  • inert – devices made of polyethylene. In most civilized countries, their use has long been abandoned. Mainly due to the fact that they are poorly visible on ultrasound and x-rays, barium salts must be added to make the system radiopaque. And in case of perforation of the uterine wall (the risk is minimal, but it exists), then this thing cannot be found in the abdominal cavity.
  • Copper-containing. It is believed that copper is toxic to sperm – that is, it provides an additional contraceptive effect. The main side effect of copper-containing devices is heavy and prolonged menstruation. The average monthly blood loss increases by 55%.
  • Containing the hormone levonorgestrel. They, on the contrary, contribute to a sharp decrease in blood loss during menstruation – and in this they are comparable to COCs. In the first year of use, the rhythm of menstruation may be disturbed up to prolonged, constant small bleeding (spotting). Over time, amenorrhea can occur – the complete cessation of menstruation. However, it is unlikely that any of the women has a tender attachment to their monthly blood loss. Due to the container with hormones, such spirals are more massive than copper and inert ones, and they serve half as long (5 years).

The scariest question

A lot of people are afraid to use IUDs because they supposedly increase the risk of ectopic pregnancy. Actually the situation is this:

Women who do not use any contraceptives are 10 times more likely to experience an ectopic pregnancy than IUD users.

But if the pregnancy did occur against the background of contraception, then the risk that it will be ectopic is quite high: 1 in 2 pregnant women on the background of a hormone-containing IUD, 1 in 16 on the background of a copper device, and 1 in 50 who do not use an IUD .

Photo: shutterstock and legion-media

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