This myth arose out of concerns about the smaller uterine cavity and cervical diameter of teens and nulliparous women. Today we know that an intrauterine device can be inserted safely in this population and beneficial especially for adolescents who are at high risk for unintended pregnancy. The American College of Obstetricians and Gynecologists (ACOG) recommends that the intrauterine device should be a "first-line" option for all women of reproductive age.
For many years, it was assumed that an IUD should be inserted after childbirth only after uterine involution was completed. However, in 2010, the Center for Disease Control and Prevention (CDC) published the following recommendations for breastfeeding or non–breast-feeding women with respect to contraceptive use:
|Method||Time of Insertion||Recommendation|
|Hormonal intrauterine system||Within 10 minutes after placenta delivery||Level 2 (Advantages outweigh risks)|
|Copper IUD||Within 10 minutes after placenta delivery||Level 1 (No restrictions)|
|Hormonal intrauterine system||10 minutes to 4 weeks after childbirth||Level 2 (Advantages outweigh risks)|
|Copper IUD||10 minutes to 4 weeks after childbirth||Level 2 (Advantages outweigh risks)|
|Hormonal intrauterine system||Beyond 4 weeks after childbirth||Level 1 (No restrictions)|
|Copper IUD||Beyond 4 weeks after childbirth||Level 1 (No restrictions)|
Benefits of inserting IUDs immediately after childbirth:
1. A reduction in the risk of unintended pregnancy in women who are not breastfeeding
2. Providing new mothers with a long term reversible contraception.
This myth arose from concerns about Pelvic Inflammatory Disease (PID) and insertion-related pain. However, a review found no benefit in the use of antibiotics prior to insertion of the copper devices or the levonorgestrel intrauterine system to prevent PID. Data indicates that the incidence of PID is low among women who are appropriate candidates for an intrauterine device. Similarly another finding by Allen & colleagues indicates that nonsteroidal anti-inflammatory drugs (NSAIDs) did not improve symptoms of cramping during or immediately after insertion of an intrauterine device.
In reality, both the copper intrauterine device and levonorgestrel intrauterine system are easy to insert.
In the small percentage of women in whom it is difficult to pass a uterine sound through the external and internal os, cervical dilators may be beneficial. Gentle, progressive dilation can be accomplished easily with minimal discomfort, easing intrauterine device insertion dramatically.
Uterine perforation occurs in approximately 1 in every 1,000 insertions. If perforation occurs with a copper intrauterine device, the device needs to be removed to prevent the formation of intraperitoneal adhesions. Levonorgestrel intrauterine systems do not produce this reaction, although most experts agree that they should be removed when a perforation occurs.
Intrauterine devices do not terminate a pregnancy. They prevent fertilization. The levonorgestrel in Eloira increases cervical mucus and suppresses the endometrium.
Intrauterine devices have a monofilament string that does not increase the risk of pelvic infection. Eloira may actually have a protective effect against PID. Compared to copper T the levonorgestrel intrauterine system had a cumulative gross rate of Pelvic Inflammatory Disease that was one fourth that of the women with the copper intrauterine device. Theoretically, this may be a result of the thickening of cervical mucus, thinning of the endometrium or decreased bleeding caused by the levonorgestrel intrauterine system.
Intrauterine devices have not been shown to cause infertility. There may be some delay in return to fertility after the removal of the levonorgestrel intrauterine system, but all women who remove the system to get pregnant do get pregnant within a reasonable amount of time.
Intrauterine devices lower the risk of ectopic pregnancy just as they decrease the risk of pregnancy overall. In the unlikely event that a woman becomes pregnant using an intrauterine device, she may have an increased likelihood of having an ectopic pregnancy. Levonorgestrel intrauterine systems have been shown to decrease the risk of ectopic pregnancy to one tenth that of women not using contraception.
The most common change in menstrual pattern with the levonorgestrel intrauterine system is a decrease in bleeding. Studies vary in the percentage of women who experience amenorrhea, showing 20% to 50% at six months to two years of use. A systematic review of the literature on menstrual effects found that all included studies demonstrated a significant reduction of menstrual blood loss or “menstrual disturbance score” and most showed improved iron levels.
Women sometimes have concerns about pain with insertion or pain with continued use of an intrauterine device. Studies show that both nulliparous and multiparous women have low pain scores; with nulliparous women sometimes reporting more pain with insertion than multiparous women. Pain associated with the continued use of intrauterine devices appears to decrease over time.
In contrast to the concern about these long acting methods causing pain, the levonorgestrel intrauterine system is frequently used for treatment of pelvic pain. Small studies have demonstrated the efficacy of the levonorgestrel intrauterine system in the treatment of pain and bleeding related to endometriosis.
Weight gain is considered a hormonal side effect of some birth control methods. Hormonal side effects are thought to be due to the presence of circulating hormones. In the case of levonorgestrel intrauterine systems, these circulating hormones are significantly lower than the circulating levels associated with combined oral contraceptive pills. Some studies have shown weight gain during the use of the levonorgestrel intrauterine systems, while others have not shown any significant weight gain. Pregnancy results in significantly greater weight gain for the majority of women than do hormonal contraceptives.
Some women may express concerns about the size of the intrauterine device for nulliparous women, but studies have shown no difference in the risk of complications according to the size of the device. Smaller or frameless devices have been evaluated to see if they reduce pain or bleeding, but available evidence does not support changing the size of the device to reduce side effects. Current copper intrauterine devices and levonorgestrel intrauterine systems are designed to fit comfortably into the uterus in all women.
There is no evidence to suggest that intrauterine devices must be inserted during menstruation. Some clinicians may suggest this technique to reduce the risk of insertion during an early pregnancy. Intrauterine devices and systems can be inserted at any point in the menstrual cycle if it is reasonably certain that the woman is not pregnant.