Which IUD is Best for Me? - Hormonal and Copper Implants
An intrauterine device (IUD) is a type of birth control which uses an implanted device to prevent pregnancy. While this may sound invasive, and technically it is, IUDs are becoming more commonly used as contraception. According to a 2015 study in the reproductive health journal Conception, 42% of sexual health workers use an IUD as their main means of contraception. This is compared to only 12% of the general female population. At oneHOWTO we look into how the IUD works, what types are available and what effect they have on both mind and body. In doing so, we hope to answer the question which IUD is best for you?
How does an IUD work?
Before we can better understand how an IUD works, we need to know there are two main different types of IUD. There are different brands which may have slightly varying standards, but the following two categories encompass them all:
- Hormonal IUD: also known as an intrauterine device with progestogen this is an IUD which releases the hormone group progestogen (commonly in its synthetic form and known as progestin). This is a group of steroid hormones which bind to the progesterone receptor and affect fertility. The main type of progestin found in hormonal IUDs is known as levonorgestral.
- Copper IUD: also known as an intrauterine device with copper, this IUD uses a coil of copper to prevent fertilization. Although all types of IUD are often referred to as ‘the coil’, it is only the copper IUD which is actually coiled.
Copper IUDs are inserted into the uterus and have a thin string which hangs down through the cervix. The presence of the IUD causes mild inflammation of the uterine lining. This sets off an immune response, providing cells which destroy sperm cells and prevent fertilization. Copper IUDs specifically increase copper ions in the uterus which also act as a spermicide. Most copper IUDs are produced in the same shape as other hormonal IUDs. However, some are made without a frame and availability depends on country.
Hormonal IUDs are inserted in the same way as copper IUDs. However, rather than using copper ions, they work by releasing progestin into the uterus and the rest of the reproductive organs. This means that the area now becomes uninhabitable for sperm. It does not prevent ovulation. It thickens the mucus inside the cervix, preventing sperm from entering and fertilizing the egg. When a fertilized egg enters the uterus, the uterine lining thickens to receive the egg and start gestation. However, progestins prevent the uterine walls from thickening and makes fertilization less likely.
When thinking of the best IUD for them, many women worry about hormonal IUDs because they fear a hormonal imbalance. However, there should be little evidence to support hormonal IUDs exacerbating mental health problems. Instead, general anxieties over pregnancy and sex are more likely to cuse issues. This is why is is most important to speak to a qualified sexual health professional when considering the best IUD contraception for you.
How is the IUD inserted?
Most IUDs come in a T-shape designed to fit neatly into the uterus. However, there are some without a frame and others which have a rounded shape. Both main types of IUD need to be inserted by a qualified medical professional. This is for a variety of reasons.
Firstly, a pelvic exam is carried out. This is so it can be determined whether the uterus is in a healthy condition for insertion. Also, it is advised that the patient is screened for STDs and their medical history is examined. Even if an STD has been cleared, it is advised to wait for 3 months before inserting an IUD. The patient's history will also be able to show if there are any complications which could hinder the effectiveness of the contraceptive or if there are any concurrent risks.
The medical practitioner will then insert the IUD with the help of a speculum. This helps to gain access and opens the vagina for insertion. This can cause cramping and be a little uncomfortable for the patient. The IUD itself is held inside a narrow tube before being inserted into the uterus. The tube is then removed, allowing the IUD (most commonly in a T-shape) to open out.
A thin string is attached to the IUD. This allows for eventual removal, but it also helps to know if the IUD has remained properly in place. Once the IUD has been inserted, some women will feel some discomfort. This discomfort should ease soon. If it does not, it is advised to seek medical advice. Action should also be taken if:
- Allergic reactions such as facial swelling or trouble breathing occur.
- There is excessive pain or breathing.
- Fever, chills or generally feeling unwell.
Once discomfort has alleviated, the individual should be able to return to normal levels of physical activity. The length of time this takes will depend on the individual. Spotting (small spots of blood appearing at the vagina) can occur for up to 6 months, but bleeding should not be a permanent issue. The first 3 months after insertion of an IUD are the time when it is most likely to be dislodged, although it can happen at any time.
How long does it take for IUDs to work?
This might be a good question since it could affect your choice over the best IUD for you. Copper non-hormonal birth control IUDs are effectively for birth control almost immediately after insertion. However, due to associated discomfort, a person may not want to engage in sexual activity right away.
With hormonal IUDs, there is a caveat. These types of IUDs will only prevent pregnancy immediately if they have been inserted during the first 7 days of a woman's period. If, after this time, the hormonal IUD is inserted, it is advised to wait for 7 days until it will be effective.
How long it takes for the person to feel physical comfortable and emotionally confident after insertion depends on the individual. Pain medication may be given to mitigate any discomfort, but there should not be much difference between either type of IUD.
Are copper or hormonal IUDs more effective?
The efficacy of IUDs in general is around 99%. This is why they are one of the most recommended types of birth control, although it will depend on the individual and their specific needs. Not only are they effective, but they are considered long acting reversible birth control. This means they have a low risk of causing fertility problems.
Hormonal IUDs are considered to be ever so slightly more effective than copper IUDs. However, this amount is a fraction of a percentage and it is impossible for statistics to represent the exact outcomes. When choosing the best IUD for you, you can look at how long they are effective.
Copper IUDs generally last longer. While it will depend on the manufacturer. In the United States of America, there mis only one brand of copper IUD and it is known as ParaGard. ParaGard should work as birth control for up to 12 years. This means, as long as the IUD is not dislodged or there are other complications, it should be effective for a long time. Other manufacturers may vary.
For hormonal IUDs, the progestin released depends on the brand. In the USA, there are four main brands. Here is a list of the brands with the amount of levonorgestral released and maximum effectiveness:
- Mirena: 20mg per day and lasts up to 6 years (some reports even claiming 7).
- Liletta: 20mg per day and lasts up to 3 years.
- Skyla: 14mg per day and lasts up to 3 years.
- Kyleena: 17.5mg and lasts up to 3 years.
While this chart might make Mirena the obvious choise for best IUD if you want to use hormonal contraception, this may not necessarily be the case. Each IUD comes in its own size and it will be up to your doctor to discuss which is the best for you and your uterus. Also, although the amount varies, it could be that less is more for you as an individual.
Side effects of IUDs
One way to help us decide on the best IUD for us is to look at the side effects of these two types of IUD.
Side effects of hormonal IUDs:
- Irregular menstrual pattern
- Cramping and pain
- Expulsion of the IUD
- Ovarian cysts
- Abdominal pain
- Vaginal discharge
Side effects of copper IUDs:
- Heavier periods
- Problems with the string
While many of these side effects will provide understandable concern for women considering birth control, it is important to note that something like perforation or infection is relatively rare. Still, it is important to be aware of any changes which occur after insertion. If bleeding or spotting continue after 3 months, then you should seek a doctor's advice. If you feel pain, more than discomfort, then this is also a sign there is a problem and perforation may have occurred.
There is one aspect you may need to consider when thinking of the best IUD for you. If you have heavy periods, then copper IUDs like ParaGard might increase the likelihood of having heavy bleeding or cramps. This is because the copper IUD increases the amount of blood flow a woman experiences during her period. According to the WHO, this can clear up after about 6 months, but some women will still experience heavier flow even after this time. If this is the case, and it is causing problems, a person may want to consider alternative contraception methods.
Hormonal IUDs, conversely, affect periods in the opposite way to copper IUDs. They can make a person's menstrual flow lighter and, for this reason, is often used as treatment for women with heavy periods. In fact, around 20% of women will experience having no period at all after one year of use. While some may find this concerning, in the majority of cases, there is no health risk to losing your period. If you lose your period only after 2 months of use, you may want to seek a doctor in case an unexpected pregnancy has occurred. After the hormonal IUD has been removed, periods should return to normal.
If you want to know more about the use of IUDs and weight gain, you can take a look at this article on birth control that doesn't cause weight gain to find out more.
What is the best IUD for me?
Hopefully this information on the different types of IUD have provided some insight on which is best for you. As you can see, both copper IUDs (only ParaGard in the US) and hormonal IUDs (Mirena, Liletta, Skyla and Kyleena in the US) have very similar rates of effectiveness. Both are over 99% effective at preventing pregnancy.
Neither, however, are very good at avoiding STDs. For this reason, many women prefer to use it as a method of contraception when in a relationship. Others may want to use it for extra security, but will still use a barrier method such as the condom when having sex.
When choosing the best IUD, it is important to consider your individual circumstances. The heaviness of your period is an important factor when choosing between copper and hormonal IUDs. The length of time for effectiveness is also a factor.
Choosing a brand of IUD will need you to consider how long you might need it for. If you know you are deferring pregnancy for a specific amount of time, the 3 year effectiveness of some IUDs might be good for you. If you don't ever plan on having children, the 12 year effectiveness of copper IUDs like ParaGard might be a better option. However, the size of the IUD will also have a bearing on your decision.
Whatever your individual circumstances, you need to speak to a qualified health professional before deciding on your choice of IUD or alternate contraceptive methods. Your doctor should be able to provide you this advice. However, you may also want to speak to an organization such as Planned Parenthood in the USA or a similar family planning clinic in your country. They will help guide you to your best decision for you.
This article is merely informative, oneHOWTO does not have the authority to prescribe any medical treatments or create a diagnosis. We invite you to visit your doctor if you have any type of condition or pain.
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