A national survey including nearly 1,000 US family physicians, conducted by researchers at Albert Einstein College of Medicine of Yeshiva University, has found that family physicians typically have gaps in knowledge about IUDs, are often uncomfortable discussing them with patients and frequently believe that their patients would not be receptive to talking about IUDs. The findings were published in the December 3 online issue of Contraception. Another national survey of family physicians reported that 99 percent dispense, prescribe or recommend oral contraceptives – but only 39 percent do so with IUDs.
Dr. Rubin, who was lead author in the study published in Contraception, says, "While we acknowledge that a number of factors contribute to the low utilization of IUDs in the US (only 5 percent of women using birth control), our study set out to determine what factors differentiate those family physicians who insert IUDs in their clinical practice versus those who don't."
Both doctors and women have misconceptions about IUD. According to Dr. Rubin, these are three most common IUD myths.
Fact: The IUD is safe, effective and completely reversible. For those reasons it's an appropriate option for any woman who is looking for a reliable, "forgettable" contraception option. There is, however, a slightly greater risk of IUD expulsion in women who have not given birth.
Fact: You can choose to keep an IUD in place for up to 10 years, and if/when you want to get pregnant, it can be removed quickly and easily. When the device is removed, fertility quickly returns to your baseline level.
Fact: IUDs do not cause infertility. Infertility is often caused by untreated STDs and subsequent pelvic inflammatory disease (PID). After the first month, women using an IUD may actually have a decreased PID risk if they use the hormonal IUD.
If the IUD is so safe and effective, why are women not talking to their doctors about it? "Since we often get our information about contraception from discussions with friends and family members, and since so few women use an IUD, women probably don't ask their doctors about it because they do not know about it," explains Dr. Rubin.
The national survey of physicians, headed by Dr. Rubin, indicates that only 24 percent of the doctors were "inserters," or doctors who had inserted an IUD in the past 12 months. She says there are a number of reasons why more doctors aren't regularly recommending the IUD.
"It seems as if many doctors view IUDs as somehow outside the usual, common methods for pregnancy prevention," explains Dr. Rubin. "These doctors may only offer the IUD as a contraception option to be used after pregnancy or childbearing or when a woman is unable to use other methods."
Other doctors would like to discuss and offer IUDs, but access to the intrauterine device itself presents a barrier. Doctors may not discuss it in this case because it's not an option with easy access.
The device is expensive and the cost is not always covered by insurance plans; many offices do not stock the IUD because of the high cost. If prescribed by her doctor, a woman can purchase the IUD herself and have it inserted by her doctor, but that presents an expensive up-front cost for a woman.
The IUD is not risk-free. As with most contraceptive methods, it does not offer protection against STDs and there is an increased risk of PID in the first 20 days after insertion of the IUD. Dr. Rubin says that risk is likely due to an STD present at the time of insertion and that doctors can largely reduce a woman's risk of developing PID by testing for current STDs.
"The IUD is safe, completely reversible and is the most effective reversible form of contraception," says Dr. Rubin. "Depending on the type of IUD a woman chooses, she can have five to 12 years of reliable pregnancy prevention." The doctor also adds that there is an IUD for women who would like to avoid hormones, and there's another type with hormones that can help women minimize their menstrual flow. "For all those reasons it's an appropriate option for a woman who is looking for a reliable, 'forgettable' contraception option." While the IUD may be expensive initially, it's cost-saving in the long run.
There are now two types of IUDs are available in the US. Both are good options. Each has different benefits and side effects.
The levonorgestrel-releasing intrauterine system (marketed as Mirena) is a progestin hormone-releasing device. Most women have irregular spotting and bleeding the first few months they have the device, and most stop getting their period after about a year. This is not dangerous. This IUD is best for women with heavy menstrual flow, cramping and/or for women who prefer not to get their period. It can stay in for up to five years.
The Copper T 380A intrauterine device (marketed as Paragard) is a hormone-free device. It's a small plastic T-shaped device with copper wrapped around it. It's good for women who prefer to use a hormone-free option and who want a device that can stay in as long as possible. The main side effect with this IUD is heavier bleeding and more cramping with your period. The Copper T 380A can remain in place for up to 12 years.
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