Some doctors still mistaken on IUD safety - study

Overall, about 30 percent thought the devices were unsafe for women who had never given birth or were unsure of their safety. Not surprisingly, they were also less likely to implant IUDs - six times more likely to say they “infrequently” implanted the devices in women who had never had a baby than compared to other providers.

But IUDs were not a popular form of contraception in general. More than 60 percent of all providers in the survey said they only occasionally provided them, often because of “patient preference.”

“Unfortunately, the U.S. is a little behind other countries in IUD use,” said Tyler. “Many women don’t really know they’re out there.”


Irregular menstrual bleeding among IUD users is not usually a sign of a health problem. Bleeding can, in fact, be a sign that the IUD is working properly. The copper released by the IUD interrupts the normal reproductive cycle and causes the endometrium to shed more frequently than during a woman’s normal menses.

However, due to the possibility of increased bleeding with IUD use, women should be carefully screened for risk of anemia prior to insertion. An Israeli study looked at 34 women using copper IUDs other than the Copper T 380: the Multiload 250 or the Nova T. Menstrual bleeding increased from 3.9 to 7.1 days after four months of use, and the ferritin levels - an indicator of anemia when levels are low - dropped by more than half (from 24 ng/ml to 9.3 ng/ml).4 Other indicators, hemoglobin and iron, remained the same. But since menstrual bleeding decreases over time, users may experience a slight increase in hemoglobin levels with extended IUD use.

During the first year of FHI’s multicountry trials, nearly half of all Copper T 380 users complained of bleeding and pain. However, only a small fraction of the women, 5.6 percent, had the device removed for this reason.

Rarely was the removal medically necessary; for most of the women studied, the choice of removal was a personal preference. In addition, FHI’s Farr found the acceptability of irregular bleeding varied from place to place. In Egypt, removals for bleeding were more common than elsewhere in Africa, at 17.3 per 100 users. By contrast, in Nigeria and Cameroon, irregular menses caused only 1.3 and 1.0 removals per 100 women using IUDs.

Side effects of irregular bleeding, spotting, or heavy bleeding decrease with time. Once women are accustomed to IUD use, removal rates go down. A four-year study of two brand-name Copper T 380s, the Gyne T 380 and Slimline, conducted from 1988 to 1992, showed that women who had previously used IUDs were one-third as likely to have their IUDs removed because of bleeding or pain, compared with women without previous IUD experience.

With more health-provider education, that could change, she added. Groups such as the American College of Obstetricians and Gynecologists (ACOG) say IUDs are highly effective and more women should be aware of that.

Like other contraceptives, IUDs can have unwanted side effects. The Mirena IUD may cause menstrual irregularities, but generally makes periods lighter and is also approved as a treatment for heavy bleeding.

What Are the Disadvantages of an IUD?
It’s important to think about the possible side effects of using an IUD.

You may have

- mild to moderate pain when the IUD is put in
- cramping or backache for a few days
- spotting between periods in the first 3-6 months
- irregular periods in the first 3- 6 months - with Mirena
- heavier periods and worse menstrual cramps - with ParaGard

Pain relievers can usually reduce bleeding, cramping, and other discomforts. If they are severe and do not seem to lessen, tell your health care provider.

The ParaGard IUD has the opposite effect: menstrual bleeding and cramping can increase, though that may go away over time.

SOURCE:  Health Care Provider Attitudes and Practices Related to Intrauterine Devices for Nulliparous Women

Obstetrics & Gynecology:
April 2012 - Volume 119 - Issue 4 - p 762–771
doi: 10.1097/AOG.0b013e31824aca39

Tyler, Crystal P. PhD; Whiteman, Maura K. PhD; Zapata, Lauren B. PhD; Curtis, Kathryn M. PhD; Hillis, Susan D. PhD; Marchbanks, Polly A. PhD

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