Lesson 1: Begin at the Beginning
Hormonal and Non-hormonal IUDs

A hormonal IUD (Intrauterine Device) works by slowly releasing progestin, which thins the uterine lining, as well as making the cervical fluids hostile to sperm. The device also interferes with sperm movement. The only hormonal IUD available in the US currently is Mirena made by Berlex Labs. The progestin in Mirena is levonorgestrel, also found in some birth control pills, but it does not contain any estrogens. The other type of IUD is made with plastic and copper. ParaGard T 380A, also known as the Copper T IUD, releases copper into your uterus which interferes with the sperms ability to swim and fertilize an egg. It also irritates the uterine lining, which interferes with fertilization as well. Both types of IUD work in similar ways, but with different ingredients.

Mostly the side effects are the same for both types of IUD; tearing of the uterus (rare), imbedding of the IUD into the uterine lining (rare), partial or full expulsion of the IUD (rare), increased risk of PID (pelvic inflammatory disease), ectopic pregnancy, and an increased risk of contracting an STD if you are not in a monogamous relationship. The hormonal IUD's possible side effects also include possible ovarian cysts, missed periods, or irregular bleeding and spotting for the first three to six months of use, usually with longer use very light or no periods will be present at all. The copper IUD's possible side effects include heavier periods, cramping, and possible backache during menstruation.

In 1971 the Dalkon Shield became available in the US. By June of 1974, after millions of the devices had been distributed, the manufacturer voluntarily stopped supplying them. By 1980 the manufacturer, A.H. Robbins Company, informed doctors that all patients that still had a Dalkon Shield, should have it removed as soon as possible due to an increased risk of infections. To say that this scared women is an understatement. Women were terrified, but not just of the Dalkon Shield, they were terrified of all IUDs. The Dalkon Shield, it has been said, was defective from the start. At the time of its approval by the FDA, the clinical testing required to approve it was not as strict or all encompassing as it is today. The Dalkon Shield was doomed to fail; unfortunately, it injured thousands of women, both physically as well as emotionally, before it was removed from the market. Today's IUDs are significantly safer. For example, the ParaGard T 380A IUD began clinical testing in 1972, and was approved by the FDA in 1984, and was not marketed until 1988. When the FDA first approved it, it was for 4 years of continuous use; in 1989, the length of usability was extended to six years due to continued testing and studies. Finally, in 1994, the FDA approved the ten-year usability of this IUD. These are not anything like the IUDs available in the early 1970s; they are safe and very effective.

Mirena IUD is over 99% effective. ParaGard T 380A effectiveness is more than 99%. Because it is next to impossible to 'misuse' an IUD, there are no "Typical" and "Perfect" effectiveness rates. An IUD is almost as effective as surgical sterilization, but it is fully reversible for those that want to have additional children later.

Cons of both hormonal and copper IUD include the initial cost of the device (between $150 to $300), it must be prescribed, increased risk of PID, ectopic pregnancy, uterine tearing, embedding in the uterine lining, and partial or full expulsion. Although the risk of the above happening is slight, it is still a risk. The other main risk is that of side effects. Pros of using the hormonal IUD include that it is highly effective, fully reversible, almost impossible to use it wrong, can be used for five years before needing to be replaced, and costs between $30 and $60 a year if used for the full 5 years. Additional pros of the copper IUD include that it can be used up to ten years before replacing, and that it costs between $15 and $30 per year if used for the full 10 years.