One of the most effective forms of contraception is very rarely used. The I.U.D. or intra-uterine device is a form of birth control that is put into the uterus through the cervix and prevents pregnancy by several mechanisms.

The I.U.D. acquired a bad name in the 80's because of the "Dalcon Shield" causing problems in many women who used it. This I.U.D. caused enough damage that the company that sold it was sued out of existence! The "shield" had a large surface area that gave bacteria a place to hide from the defense mechanisms of the body. It had sharp points on it's edge that created more uterine irritation than many other I.U.D.s and also the string of the Dalcon device behaved like a wick that drew bacteria from the patient's cervix up into her uterus. All this made infections more likely with "the shield".

There are two new safer I.U.D.s now on the market. The Progestasert,the ParaGard and the Mirena. The Progestasert has a progestin coating that is similar to one of the hormones in the birth control pill; it lasts for one year and then needs to be replaced. The ParaGard is coated with copper; it works for ten years before it needs to be replaced. The copper device is more expensive initially, but much less expensive over ten years. The Mirena lasts for five years and many women do not have menses with this device.

The advantages of the I.U.D. are that you do not have to remember anything, either before sexual activity or on a daily basis. If you can't take hormones because of the side effects, this may be a method that will work for you. When missed pills and poor bowel absorption are taken into account, the I.U.D. is as effective as the birth control pill in actual use. This method is also reversible by simply removing it.

The I.U.D. has some disadvantages. I only use it in women whom have had a baby (this increases the size of the uterus and makes the device less likely to injure the uterus or be expelled). Even in women that have had children, they must check the string regularly to see if the device is in place. Period cramps can also be worsened, but the biggest problem with this method of contraception is that if you are prone to infections, the LU.D. can make them much more severe. Therefore, I only put one in if the patient is in a monogamous relationship with a monogamous partner. A history of gonorrhea or chlamydia is also considered a reason not to use an I.U.D.

This is not for everyone, but it can be considered in women who are breastfeeding or who can't take the pill for whatever other reason and want long term contraception.


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