Birth Control - IUD

IUD

What it does: Intrauterine devices are very small objects, made today from plastic or plastic wrapped with copper wire, that are inserted into your uterus. Once there, they prevent pregnancy, most likely by changing the chemical makeup of the fluid in your uterus and fallopian tubes. Small changes in that fluid can severely impact sperm's fertility and its ability to swim. These changes can also make it difficult for eggs to properly move as well. It's also possible that IUDs prevent fertilized eggs from sticking to the uterine walls, but this hasn't been proven.

The basic concept of an IUD is probably one of the oldest forms of birth control in the world, dating back to ancient times in the Arabian Peninsula, where traders first discovered that they could keep camels from breeding on long trips by inserting small pebbles into the camel's uterus. Over the years, IUDs have come in a wide variety of shapes. Today, both kinds available in the U.S. are T-shaped. Of these, the Mirena IUD contains a progestin that releases slowly over time and can be kept in place for up to five years. The Paragard IUD, on the other hand, contains no hormones. Instead, it has thin copper wire wrapped around its ends; the metal has been shown to increase the effectiveness of the IUD by further changing the fluid chemistry. This IUD can be left in for up to 10 years.

What it doesn't do: Protect against STDs. In fact, if you do contract an STD, wearing an IUD can make it more likely that the infection will travel to your fallopian tubes and ovaries, resulting in pelvic inflammatory disease. PID can potentially make you infertile—and, until the later stages, it has no symptoms. It's incredibly important that IUD users either maintain a monogamous relationship or use condoms as backup.

How to get it: IUDs must be prescribed and inserted by a professional.

Is it reversible? Yes. As soon as an IUD is removed (or, occasionally, naturally expelled by your uterus) you can get pregnant at any time.

Side effects: Far fewer than hormonal birth control methods. Even the Mirena, which does release a progestin, has fewer complications because the dosage is much, much lower. During the first few months of use, some women experience heavier periods and cramping.

Who might benefit most: Women who want reliable, long-term protection against pregnancy. IUD is frequently used as a less-invasive substitute for sterilization. The risk of pregnancy is less than 1 percent. The Paragard can also be extremely useful for women who dislike the side effects of hormonal methods or who should not use those methods for health reasons.

Who should consider a different method: It's not an immediate reason to switch to a different method, but if you have an infection in your vagina or cervical canal, you will have to wait until that's healed before you can get an IUD put in. If an IUD is inserted while an infection is present, the infection can end up being introduced into the uterus and can cause pelvic inflammatory disease. Women who have incurable STDs are entirely ruled out as candidates for the same reason.

If you have more than one sexual partner or your partner sleeps with other people, IUDs may not be an ideal choice simply because of the increased risk of PID. In addition, women with copper allergies or a rare disorder called Wilson's disease shouldn't use the Paragard, as the copper can cause a negative reaction.

Patch and Ring

What it does: Both the ring and the patch function about the same as a regular combination pill form of birth control. They both carry synthetic estrogen and a progestin and keep you from getting pregnant by preventing ovulation and, to a lesser extent, thickening the mucus on you cervix to prevent sperm from getting to your uterus at all. The main difference in these two relatively recent options lies in the delivery system. Instead of a daily pill, patch and ring users have a weekly or monthly regimen. For the patch, a new one must be applied to one of several specific areas of the body once a week, for three weeks. In the case of the ring, one ring is inserted each month and left in for three weeks, then taken out. Both forms have a break week during which the user gets her period.

Researchers have been studying and testing patches and rings for many years. In the case of the ring, the studies date back as far as the 1970s. But these methods only became available to the public in the last seven years. Currently, only one brand of each is available. The patch is known as Ortho-Evra and the ring is called NuvaRing.

What it doesn't do: Protect against STDs. If you or your partner have multiple partners you'll need backup protection, like a condom.

How to get it: Both are available by prescription. You do not need a health professional to insert the ring or to fit it to your body. One size fits all, and it can be easily popped in and out at home.

Is it reversible? Yes, fertility begins to return at about the same speed as with the combination pill.

Side effects: Again, similar to combination pill. Some women experience breast tenderness, headaches, nausea, or mood swings. With the patch, it's possible that you may experience an itchy, red rash at the spot where you apply it. To avoid this, some users place their weekly patches in different spots over the course of a month.

Who might benefit most: Women who prefer a hormonal method or a method that can be easily and quickly stopped, but who don't want to deal with the daily regimen of the pill or mini-pill. The patch and the ring have not yet been extensively studied for effectiveness, but there is some evidence to suggest that they may have slightly lower failure rates than the pill—on the order of about 1 percent if used correctly.
Who should consider a different method: Smokers—as as with the pill, smoking can increase your risk of dangerous cardiovascular side effects, particularly if you're also over the age of 35—and women taking certain medications that can decrease the effectiveness of the hormones, particularly St. John's Wort, certain classes of antibiotics and antifungals, and anti-seizure drugs.

You might not know: You don't take the ring out during sex. For the most part, your pelvic muscles keep the ring in place and, usually, your partner can't feel it during vaginal intercourse. If the ring does happen to fall out during sex, you should wash it and re-insert it within three hours. If you leave the ring out longer than that, you run the risk of hormone levels reverting to normal enough that you can ovulate—and possibly become pregnant.