Informed Consent: IUDs
Informed Consent: IUDs
A breakdown of IUD contraceptive options, how they work, and what to expect when using them. Contraceptives are often marketed to us as consumers, and this means that we aren't given all the facts, or the chance to fully consent to the use of these drugs and devices.
Hormonal IUD - Mirena, Kyleena, Skyla, Liletta
What it is: A polyethylene plastic T-shaped device, inserted into the uterus. The center stem holds a reservoir for the progestin drug, which slowly releases locally in the uterus. The IUD also contains barium sulfate so it can be more clearly seen on a CT scan or Xray.
How it prevents pregnancy: The mechanism of action in all IUDs occurs mainly in the uterine cavity, where it activates a localized immune response to a foreign body. The white blood cells sent to this area create a sterile inflammatory response, and results in an environment that is spermicidal. This chronic low grade inflammation is considered the main mechanism of action. Because the hormonal IUD includes a progestin, it also thickens cervical mucus to prevent sperm entry to the uterus, and thins the uterine lining which does not allow for implantation. The lack of build up of uterine lining is why many people stop bleeding altogether, as the cycle of estrogen is halted and no uterine lining is being built. There is still no conclusive explanation for exactly how they work, but it is a combination of these that prevents pregnancy.
Failure rate: <1%
Ovulation Preserved?: Questionable. The inflammation as well as the progestin itself may partially suppress ovulation (and therefore periods may stop completely during use), but we don’t have data to support how often this happens. There are situations where pregnancy occurs with an IUD, so we know sometimes you do continue ovulating while using it.
Side effects: The pain of IUD insertion is well known, but goes largely unrecognized and often unmedicated. Inflammation can affect the whole body, so IUDs have side effects that are wide ranging and not limited to the reproductive tract. General warnings included in IUD pamphlets include the risk of ectopic (outside the uterus) pregnancy, intrauterine pregnancy, group A streptococcal sepsis, pelvic inflammatory disease, alterations in bleeding patterns such as continuous bleeding or irregular spotting, perforation of the uterus, IUD expulsion or migration outside the uterus, ovarian cysts, anemia, moderate to severe pelvic cramps and pain, back and hip aches, pain with sex, and septic shock. Users may also experience headaches, nervousness, dizziness, anxiety, confusion, depression, mood swings and erratic moods including rage, as well as vomiting, bloating, breast tenderness and pain, weight gain, hirsutism (stubble type hair growth), alopecia (hair loss), acne, especially around the chin, cheeks and jaw. The IUD may cause changes to the vaginal flora and increase risk of vaginal sores and foul smelling vaginal discharge. Other issues include decreased libido, gastrointestinal disorders, jaundice, sensitivity to light, numbness or weakness, fever, chills, or other signs of infection. Some people develop pseudotumor cerebri/idiopathic intracranial hypertension which puts pressure on the skull, resulting in migraines and vision loss. Death, though rare, can occur from sepsis, ectopic pregnancy, and infection. Other serious issues have been reported, but not yet confirmed through clinical trials which include arterial thrombotic and venous thromboembolic events, pulmonary emboli, deep vein thrombosis, increased blood pressure, breast cysts, autoimmune disease, cranial pressure, hand eye coordination problems, pseudo seizures, tremors, memory loss, and involuntary muscle movement. After 5 years of use, your risk of ER/PR positive ductal and lobular breast cancers increases.
Body systems that may be impacted: 11/11 Body systems. Reproductive system, cardiovascular system, digestive system, endocrine system, exocrine system, immune system, nervous system, muscular system, renal system, respiratory system.
How long it should be used for: Between 3-7 years. Most people discontinue before the device expires. In one study, after about 10 months, 19.4% of IUD users had discontinued use, with 69.4% citing side effects like bleeding and pain as the reason why.
Copper IUD - Paragard
What it is: A polyethylene plastic T-shaped device wound with pure electrolytic copper, inserted into the uterus. A silver core within the copper sheath is included to prevent fragmentation of the copper.
How it prevents pregnancy: Contrary to the way this device is marketed, the Copper IUD does not use copper directly to kill sperm. The 1987 study by Leroy-martin concluded that copper ions do not have direct contraceptive effects. Instead, copper causes a localized inflammatory response, which activates the immune system and brings thousands of white blood cells to the area. It is your own white blood cells which are responsible for killing and immobilizing the sperm. Copper ions also affect the endometrium to the point that implantation is hindered. The copper IUD is used as a post-fertilization emergency contraceptive for this reason.
Failure rate: 2.2% [WHO]
Ovulation Preserved?: Most likely. Because there is no progestin in the copper IUD, ovulation may continue uninhibited. However, localized inflammation in the reproductive tract may still result in disrupted or suppressed regular ovulation. We do not have enough data to know for sure how often this occurs.
Side effects: Pain with insertion and vasovagal reactions including fainting may occur. Side effects include pelvic pain, back and hip aches, heavy bleeding, painful menstruation, irregular spotting, pain, and cramping, vaginitis, expulsion, IUD migration outside the uterus, uterine perforation, intrauterine pregnancy, ectopic pregnancy, pelvic infections including pelvic inflammatory disease, embedment, hair loss, issues with vaginal flora such as chronic yeast infections or bacterial vaginosis, and weight gain. There are other effects including anxiety, depression, chronic fatigue, and panic attacks. Many have also reported the effects of copper toxicity. Copper is a trace mineral and an excitotoxin which causes overstimulation and weakening of the adrenals. Copper is stored in soft tissue, and when its binding protein is unable to bind to excessive amounts of copper, this causes build up in liver and eventually the blood stream. Racing thoughts, hypothyroidism, burnout, depression, hair loss, headaches, brain fog, schizophrenia, insomnia, concentration issues, irritability, loss of sex drive, constipation, mood swings, despair, joint aches, and lowered immunity are all associated with copper toxicity. Because the copper in the IUD erodes, it is useful for patients to know the signs of copper toxicity while using the device. Estrogen causes copper accumulation, and the feedback loop between them may cause additional symptoms of estrogen excess.
Body systems that may be impacted: Reproductive system, immune system, nervous system, renal system, endocrine system, digestive system
How long it should be used for: Up to 10 years. 4-15% will discontinue use because of pain and heavy bleeding in the first year, and 50-55% will remove it after 5 years. Under 20 years old, the risk of discontinuation is higher.