What will it take to make intrauterine devices sexy?
IUDs are highly effective forms of contraception, but fear of side effects, lack of training for doctors and costs can keep women away. Health organizations and private companies are trying to change that by breaking down misconceptions and broadening access.
The contraceptives are inserted into the uterus and can prevent pregnancy for years. And they’re reversible. Shortly after they’re taken out, a woman can become pregnant.
IUDs are more than 99 percent effective. The World Health Organization reports they are “the most widely used reversible contraceptive method globally.” But few women in the U.S. use them; the percentage is only in the single digits, in part because IUDs have a checkered past. The Dalkon Shield IUD, marketed nationwide beginning in 1971, was found to raise the risk of pelvic inflammatory disease. Medical complications and deaths sparked lawsuits with thousands of claimants.
"So we had a whole generation in the ’70s and ’80s … where doctors and clinicians weren’t trained and women didn’t have that option," says Dr. Jeffrey Peipert, a professor of obstetrics and gynecology at Washington University in St. Louis.
The two common intrauterine devices in the U.S. are ParaGard, which releases copper to interfere with sperm, and Mirena, which prevents pregnancy with the hormone progesterone. There is still a slight risk of pelvic inflammatory disease. But Bayer Healthcare Pharmaceuticals, the maker of Mirena, says fewer than 1 percent of users of its device get the infection. More common side effects for women using IUDs are irregular bleeding or cramping.
Upfront costs also limit access; the price of the device and getting it inserted can cost hundreds of dollars.
But Mirena works for up to five years, and the copper IUD up to 10. So over time, they can actually be cheaper than monthly payments for, say, the pill. And IUDs, like other contraceptives approved by the Food and Drug Administration, are expected to be covered for most users under the Affordable Care Act.