IUDs are a safe and highly effective form of contraception but misinformation continues to make them an unpopular choice for women and doctors, Australian research has found.
An Intra Uterine Device is a small copper or plastic object inserted into a woman’s uterus to prevent sperm from fertilising an egg. They have been used for decades.
Despite being cheap and effective, myths around their safety prevail almost 40 years after several high profile cases linked them to infection and infertility, said Family Planning NSW’s Medical Director, Deborah Bateson.
“In particular, there’s an incorrect perception in the community and even among health professionals that they are not suitable for young women who haven’t had children,” said Dr Bateson, who is also a clinical lecturer at the University of Sydney.
Despite a public perception that IUD insertion can lead to complications, Dr Bateson and co-researcher Caroline Harvey from Family Planning Queensland said their research showed that the vast majority of insertions went off without a hitch.
Their 2010 survey of 996 attempted insertions found that 95% of attempts were successful and 90% were reported as easy by the inserting doctor.
Complications and difficult insertions were more common in the 254 women without prior vaginal delivery but overall rates were very low, the study found.
The findings, published in this month’s Australian and New Zealand Journal of Obstetrics and Gynaecology, will be presented at the inaugural National Sexual and Reproductive Health Conference in Melbourne today.
“The complications were very few. They were mainly around fainting, which is a known complication,” Dr Bateson said.
Data on IUD use is hard to get in Australia but it’s thought that less than 5% of Australian women use them, compared to 17% of French women and 21% of Swiss women, Dr Bateson said.
Painting an accurate picture of the relatively low risk of complications may help dispel some myths for both patients and doctors, said her co-researcher, Dr Caroline Harvey.
“Nearly 40 years ago there were some high profile cases in the US on pelvic infection and subsequent infertility which seemed to be related to the string on one type of IUD. Current evidence finds that modern devices do not increase the risk of infection for users but misinformation lives on,” she said.
Dr Bateson said it was important to remember IUDs did not prevent sexually transmitted infections but that they should be more widely promoted to prevent unwanted pregnancy.
“No method is for everyone but it’s about dispelling myths so young women are aware that it’s a safe and effective option,” she said.
Angela Taft, Associate Professor in Public Health at La Trobe University and one of the conference organisers, said Dr Bateson and Dr Harvey’s research was “incredibly important.”
“In the field of prevention of unwanted pregnancies, there is a real understanding and recognition that long acting reversible contraception is much, much more important than previously thought,” she said.
“There is still this myth that [insertion of IUDs] is too difficult, women won’t want them and GPs are much more commonly prescribing the pill,” said Dr Taft.
“It may be that GPs are not trained and confident but we do know we can do a lot better and that’s why this study is so important.”
Professor Danielle Mazza, a health expert from Monash University’s School of Primary Health Care, said more research was needed on women’s views on IUDs.
“I think the other group that requires questioning is the pharmaceutical companies that market IUDs to get their perspectives about what the barriers and solutions are,” she said.
“Cross country comparisons would also shed light on system issues — for instance, are countries with high IUD use those where there is widespread access due to increased number of specialised clinics or government subsidies?”
Craig Minns
Self-employed
They may be safe and effective, but they do fail. I have a good friend who is the father of a child he and the mother did not want, but which the mother decided not to abort after falling pregnant while she had an IUD implanted.
I look forward to the day that reversible male contraception is as freely and as simply available.
Regan Forrest
logged in via Twitter
All forms of contraception have a failure rate (including sterilisation techniques like vasectomy and tubal ligation). I gather the failure rate of IUDs is comparable to such surgical methods (from memory it's about 0.05%). The main advantage of IUDs are they are a "set and forget" type of contraception, unlike condoms or the pill. Hence greater reliability as the human factor is largely eliminated. However, the lottery of biology, unfortunately, is less easily managed.
It's very likely any male contraceptive will have similar failure rates. Thus while male-centred contraception may be a welcome and overdue option, I doubt it will be a panacea. Even when both partners use a reliable form of contraception, there will be the "one in a million" failures.
Craig Minns
Self-employed
Oh, I agree that nothing is foolproof, but if both partners are using contraception that is quite effective, such as the IUD undoubtedly is, despite my friend's experience, then the risk becomes almost negligible.
My grandfather, who was a Yorkshireman, was a great exponent of belt and braces "just in case, Lad". I find it hard to fault his logic.
Russell T
IT Consultant
My wife fell pregnant while on the pill. I surprised myself by feeling quite happy about the fact. We now have 5 children and I would n't give any up. I remember telling a lecturer at the time I would not be able to contine my studies at the time due to an unexpected pregnancy. Her reply was 'the world would be a very lonely place if not for unexpected pregnancies'.
I respect everyone right to choose; however you may surprise yourself when confronted with the choice.I think we both surprised ourselves.
PS the remaining pregnancies were expected.
Tom Hennessy
Retired
"Hi I had my second IUD put in nov 08 and havent had a period since"
Menses lower iron levels in the body and lack of menses have been found to be associated with increased iron levels. Increased iron levels are a bad thing.
Tom Hennessy
Retired
"Increases the "pool" of people harboring the bacteria, which in turn, may contribute to its spread to people susceptible to getting sick from an infection"
THAT is a snip about contraceptive pills increasing infection. Contraceptive pills too decrease menses , therefore causing increased iron levels and iron as been shown to be such a powerful factor in infection such that when iron levels rise to a certain point infection can NOW acquire the iron. So , logically , rather than having no adverse effects IUDs might increase infection due to their becoming depots of infectious disease. Couple that with the known , oxidation causing infection mutation , would leave us with , women who harbour infection and NOW copulate with willllld .. abandon ? That's using .. logic.
Regan Forrest
logged in via Twitter
I'm a regular blood donor. I'm sure that more than cancels out any iron accumulation...
Tom Hennessy
Retired
"I'm a regular blood donor"
Very few are though , like the daycare worker , and she wipes your kids nose. As an example.
Judith Olney
Ms
IUDs are not harmless, and safe for many women, neither are implants. This article fails to note why many women who have tried these methods of contraception have them removed.
It is also not just the insertion that is causing problems for many women.
There are a great deal of problems regarding hormonal imbalance, severe weight gain, mood swings, pelvic pain, discomfort during sex, intermittent bleeding and spotting, and for some women, continual bleeding. These are some of the most common…
Read moreRegan Forrest
logged in via Twitter
Judith,
I think it can be taken as read that, as with any medical intervention, "safe" is a relative term. The side-effects you describe for IUDs sound pretty much exactly like the ones I experienced on the contraceptive pill. That doesn't mean the pill isn't "safe", it just means it doesn't work well for women like me. One size doesn't fit all.
Of course the pros and cons of any contraception method should be discussed between a patient and GP, in order to reach an informed decision. Unfortunately, as has been reported on this site previously, knowledge among GPs of alternatives to the contraceptive pill is alarmingly low http://theconversation.edu.au/few-women-use-long-term-contraception-8272
Patients deserve GPs who are fully aware of all the options out there - and their respective risks and benefits. I think that is all this article is trying to say.
Judith Olney
Ms
Hi Regan, That is pretty much what I was saying, that these contraceptives are not harmless or safe to many women, but that is exactly what this article is not saying. You are correct though, that the contraceptive pill can cause the same symptoms, and these hormonal contraceptives are definitely not a one size fits all, again pretty much the point I was trying to make.
There is very little actual information in this article about the side effects of IUDs, and the title says that they are "safe…
Read moreTom Hennessy
Retired
Using logic. The pharmaceutical companies make more money the more people use their product. Thusly the pr men speak to doctors about the safety of their product and convince doctors that they are safe 'enough' to be mass marketed to all women of childbearing age to use with 'relative' safety.
When one considers the latest 'case' in which the researcher working with the plague vaccine dying because he had unknown high levels of iron in the body which activated the vaccine. Now with what we know about contraception , increased iron levels , and with their promotion of the HPV vaccine in all females of childbearing age or even younger and NOW all men , notorious for being in iron increase , would this vaccine NOW cause all those people to catch .. herpes ?
Sue Ieraci
Public hospital clinician
Using logic, Mr Hennessy, the answer is "no".
Tom Hennessy
Retired
I'll assume you would have told Malcolm Casadaban there is no problem working with the plague vaccine , too.
Sue Ieraci
Public hospital clinician
Mr Hennessy - the antigens in HPV vaccine are bio-engineered - the vaccine does not contain the virus. Therefore, using logic, one cannot catch herpes from HPV vaccine.
Tom Hennessy
Retired
"Elevated iron stores may put women at risk for persistent HPV infection"
If the IUD does stop menses enough to elevate the iron stores , as menopause and hysterectomy have been shown to do , then it would be a good thing they can't catch it because they'd never get rid of it.
Karen Malec
logged in via Facebook
Do a Google search using the term, "IUDs, complications." A plenitude of law firms will show up as a result of your search. That does not bode well for manufacturers of IUDs. These law firms indicate they will file lawsuits on behalf of women who have experienced: "perforation of the uterine wall, migration of the IUD to outside the uterus, expulsion of the IUD, infection, complications resulting in surgery needed to remove the IUD." Infections can result in infertility due to resulting scar tissue…
Read moreMary Payne
logged in via Facebook
Most of my friends and myself have an adversion to having a foreign object in our bodies. Plus the insertion process sounds hardly like a good time. I don't know why this aspect is not acknowledged more with the discussion of this form of contraception. My male doctor was very enthusiastic about the IUD. I wonder how keen he would be about having a foreign object shoved down his penis.
Also I have heard too many women who have been practically hounded to try this form of contraception by their doctors,try it, not like it and then have a hard time getting their doctor to remove it- some having to burst into tears before their doctors will acquiesce.