North Dakota Health Dept. - Division of Family Health

Family Planning Program ● Division of Family Health ● Community Health Section

Intrauterine Device (IUD)
(Copper T, Levonorgestrel and Progestasert)

Intrauterine Device

What is an IUD?

The IUD is a medicated, plastic device that is placed into the uterus. A string attached to the IUD hangs down into the vagina.
The ParaGard (Copper T 380A) contains copper.
The Progestasert releases the hormone progesterone.

How does it work?

The IUD inactivates the sperm and/or egg, preventing fertilization.
It creates an inflammatory condition in the uterus, preventing implantation of fertilized egg.

How is it used?

The IUD requires a simple medical procedure for insertion and removal.
The device is placed into the uterus, where it remains until it is removed.
The woman can check the correct placement of the device by feeling for the string.

How well does it work?

The ParaGard (Copper T 380A) is effective for up to 10 years. Typical use results in a 99.2 percent rate of protection against pregnancy. Perfect use, where the woman checks the strings of the IUD, results in a 99.4 percent rate of protection against pregnancy.
The Progestasert is effective for one year. Typical use results in a 98 percent rate of protection against pregnancy. Perfect use, where the woman checks the strings of the IUD, results in a 98.5 percent rate of protection against pregnancy.

Does it reduce risk for HIV/AIDS sexually transmitted diseases (STDs)?

IUDs do not reduce risk for HIV/AIDS or STDs.
IUDs may increase the risk of HIV/AIDS transmission.
Using a male, latex condom reduces the risk.
IUDs may increase the risk of pelvic inflammatory disease (PID) soon after insertion.
IUDs should only be used by women at low risk for HIV/AIDS and STDs (those who only have sex with one uninfected partner).

What are the advantages?

IUDs are a reversible contraception method.
They do not interfere with sex.
There is nothing to remember (except checking the string).
They are long-acting (up to 10 years with the Copper T 380A).

What are the disadvantages?

Up to 10 percent of women expel the IUD during first year of use.
Insertion requires a minor medical procedure which may be somewhat uncomfortable.
The IUD must be removed by a clinician.
There is a possibility of uterine perforation at time of insertion.
IUDs may cause menstrual problems, heavy bleeding and cramps. These symptoms are decreased if you use the Progestasert IUD.
There is an increased risk for PID that may lead to infertility. IUDs may not be a good choice for women who have not had children.
IUDs should not be used by women who are at high risk for HIV/AIDS and STDs.
IUDs should not be used by women with diabetes, HIV infection, other impaired immune conditions or anemia.
The IUD may not stay in place (may fall out, move out of reach or become imbedded).
Your partner may feel the string during sex.

What is the Copper T IUD?
The Copper T IUD is a small device that is placed inside the uterus. The vertical and horizontal arms of the Copper T 380A IUD contain copper that is slowly released into the uterine cavity. Copper stops sperm from making their way up through the uterus into the tubes, and it reduces the ability of sperm to fertilize the egg. It also prevents a fertilized egg from successfully implanting in the lining of the uterus if fertilization has occurred. Among typical couples who use this IUD, just less than 1 percent will experience an accidental pregnancy in the first year. Complete information about this contraceptive is available from your clinician or the package insert accompanying the Copper T 380A.

What are the advantages?

The Copper T IUD is the most effective reversible method of birth control currently available in the United States.
This IUD is effective for at least 10 years.
Only two out of 100 women using a Copper T for 10 years will become pregnant.
The IUD prevents ectopic pregnancies.
This method is far more readily reversible than tubal sterilization or vasectomy.
There is a very low cost over time. Use of an IUD is convenient, safe and private.
All you have to do is check for the strings each month.
The IUD may be used by women who cannot use estrogen-containing birth control pills.
It may be used by breastfeeding women.
The IUD may be inserted immediately following the delivery of a baby or immediately after an abortion.
Some studies of IUDs have shown a decreased risk for uterine cancer. There is also evidence that IUDs protect against cervical cancer.

What are the disadvantages?

There may be cramping, pain or spotting after insertion.
The number of bleeding days is slightly higher than normal and you may have somewhat increased menstrual cramping. If your bleeding pattern is bothersome to you, contact your clinician. There are medications that may give you a more acceptable pattern of bleeding and cramping.
The IUD provides no protection against sexually transmitted infections. Use condoms if there is any risk.
There is a high initial cost of insertion. However, after two years, it is the most cost-effective birth control method.
The IUD must be inserted by a doctor, nurse practitioner, nurse midwife or physician's assistant.
A small percentage of women are allergic to copper.
Some men can feel the IUD strings during intercourse.

What is the Levonorgestrel IUD?
The FDA approved Mirena, the levonorgestrel-releasing intrauterine system, in 2000. Mirena is as effective in preventing pregnancy as tubal ligation (better than 99 percent) and lasts for five years, or until removed. This method has been available for 10 years in Europe and has been used by about 2 million women worldwide. The vertical arm of this IUD contains levonorgestrel. This hormone is a progestin much like the progesterone a woman's ovaries produce during each monthly cycle. Each week the Levonorgestrel IUD gives off about the same amount of levonorgestrel as a woman gets when she takes one or two of the mini-pills called Ovrette. The levonorgestrel causes the cervical mucus to become thicker so sperm cannot reach the egg. Among typical couples who use this IUD, one in 1,000 will experience an accidental pregnancy in the first year.

What are the advantages?

It is the most effective reversible method ever developed.
It prevents ectopic pregnancies and pelvic inflammatory disease; it decreases menstrual cramping and dramatically decreases menstrual blood loss (a 97 percent reduction in menstrual blood loss in one study). Some women experience an absence of menstrual bleeding after one year.
This IUD may be left in place for at least five years (probably effective for eight or more years).
IUDs are safe, inexpensive over time, and provide extremely effective long-term contraception from a single decision.
One of the costs of any contraceptive is the cost to you should your contraceptive fail. Given the extremely low failure rate of Mirena, a person using this method is far less likely to have the emotional and financial expenses associated with an unintended pregnancy.
All you have to do is check for the strings each month.
This may be used by postmenopausal women on estrogen therapy to protect against endometrial cancer.
Once Mirena is removed, fertility returns rapidly. About eight out of every 10 women who want to become pregnant will do so in the first year after Mirena is removed.

What are the disadvantages?

Use of an IUD often changes the menstrual cycle. There may be more bleeding days than normal for the first few months and less than normal after six to eight months. If your bleeding pattern is bothersome, contact your clinician. There are medications that can help you have a more acceptable pattern of bleeding.
The IUD provides no protection against sexually transmitted infections. Use condoms if there is any risk.
There is a high initial cost of insertion.
Women who have a recent history of pelvic inflammatory disease (PID) are not appropriate candidates. Use of IUDs has been associated with an increased risk of PID.

What is the Progestasert IUD?
The Progestasert IUD is shaped like a "T," and its vertical arm contains progesterone. This hormone is exactly the same as the progesterone a woman's ovaries produce each monthly cycle. The progesterone causes the cervical mucus to become thicker so sperm cannot get to the egg. The progesterone also changes the lining of the uterus so implantation of a fertilized egg cannot occur. Among typical couples who use this IUD, about 2 percent will experience an accidental pregnancy in the first year. The Progestasert IUD is not as effective as the Copper 380A IUD or the new Levonorgestrel IUD called Mirena. Complete information about this contraceptive is available from your clinician or the package insert accompanying the Progestasert IUD.

What are the advantages?

This IUD provides effective contraception for one year (approved for 18 months in France).
There is decreased menstrual cramping and decreased menstrual blood loss with use of this IUD.
There is nothing to do at the time of intercourse.
IUDs are reversible, whereas male or female sterilization is not.
All you have to do is check for the strings each month.
This IUD may be used by postmenopausal women on estrogen to protect against endometrial cancer.
This IUD may be used by some women who cannot take estrogen.
Some women may stop having periods completely.

What are the disadvantages?

Use of the IUD commonly leads to irregular periods and increases the number of days some women have spotting. While there is less overall blood loss, the number of bleeding days is greater than normal. If your bleeding pattern is bothersome to you, contact your clinician. There are medications which can be given to you that may give you a more acceptable pattern of bleeding.
There may be some cramping or pain at the time of insertion.
This IUD has to be replaced in one year; other IUDs can be left in longer.
It is costly to remove and reinsert a new one each year.
This IUD offers no protection against sexually transmitted infections.
There is a slightly increased risk of pelvic inflammatory disease at the time of insertion.

Where do I get an IUD?

You can get an IUD from your doctor, nurse practitioner, nurse midwife or health department. Not all clinicians insert IUDs. Check in advance.
Most clinics insert IUDs when a woman has her period or within seven days after her period starts. If the risk of pregnancy can be excluded it may be possible to insert an IUD at other times.

What if I have sex and don't use birth control?
Did you know that for 72 hours after sex, you can take emergency contraceptive pills to avoid becoming pregnant? Did you know that for five to seven days after sex, you can have an IUD inserted so you won't become pregnant? Not all clinicians know about these options.

If you want more information or would like the phone numbers of clinicians near you who prescribe emergency birth control, call the toll-free number 888.NOT2.LATE or 800.584.9911. Some of these sources of help are free.

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