“The major advantage of LARC compared with other reversible contraceptive methods is that they do not require ongoing effort on the part of the patient for long-term and effective use. In addition, after the device is removed, the return of fertility is rapid.”1
The superior effectiveness of LARC methods, including IUDs and implants, to other hormonal methods is demonstrated by studies such as the Contraceptive CHOICE project, the largest cohort study of LARC use published to date, Doctors Natalie Whaley and Anne Burke reported in Intrauterine Contraception (published in Women’s Health 2015, Vol.11, Iss.6).2
They further reported that when the burdens of cost are removed, women are more likely to select IUDs. “The WHO estimates that over 160 million women worldwide use IUDs. In addition to their efficacy in preventing unintended pregnancy, the benefits of IUDs – including their use for emergency contraception (EC) and treatment for menorrhagia and endometrial hyperplasia – are also being realised,” Whaley and Burke said.2
HOW DOES AN IUD WORK?
“The copper-coated IUD prevents pregnancy by not allowing the sperm to fertilise the egg,” explained Johns Hopkins All Children’s Hospital. “It may also make it harder for a fertilised egg to implant in the uterus.” The copper T 380 A IUD is a T-shaped device of polyethylene wrapped with copper wire around the stem and arms.
“An IUD coated with progestin works in a similar way, but also thickens the cervical mucus and thins the uterine lining. In some cases, it stops ovulation. This prevents sperm from fertilising the egg and implanting.” 3 A hormonal IUD is a T-shaped device of polyethylene coated in progestin.
THE POSTPARTUM IUD
The IUD is safe for use by most postpartum women, including those who are breastfeeding. It is also relatively inexpensive and convenient and has a very low rate of complications. Something that may be of particular interest to your pregnant patients is that, according to the Postpartum Intrauterine Contraceptive Device (PPIUD) Services. A Reference Manual for Providers, the postpartum IUD can be inserted within 10 minutes of giving birth. “And although the IUD will protect her against pregnancy for 12 years (with the copper T 380 A), she can have it removed at any time, for any reason, with immediate return to fertility.” Furthermore, it:
- Has no effect on the amount or quality of breast milk;
- Is safe for use by HIV-positive women;
- Does not require any daily action on the part of the user to be effective; and
- Does not require a separate visit to the facility or, if inserted within 10 minutes of the birth, a separate procedure.4
1. Long-Acting Reversible Contraception: Implants and Intrauterine Devices. Number 186 (Replaces Practice Bulletin Number 121, July 2011. Reaffirmed 2021) American College of Obstetricians and Gynaecologists. https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2017/11/long-acting-reversible-contraception-implants-and-intrauterine-devices
2. Whaley NS, Burke AE. Intrauterine Contraception. Women’s Health. November 2015:759-767. doi:10.2217/whe.15.77 https://journals.sagepub.com/doi/10.2217/whe.15.77
4. Postpartum Intrauterine Contraceptive Device (PPIUD) Services. A Reference Manual for Providers. 2010. https://www.glowm.com/pdf/Global%20PPIUD%20Reference%20Manual.pdf