UnderstandingIUDs: Benefits,Risks& Realities
DrStevenR.Goldstein,NYCGyn
IntroductiontoIUDs
WhatAreIUDs?
•IUD=IntrauterineDevice
•Usedforcontraceptionforthousandsofyears
•Notabortifacients
“IUDshavealonghistory—believeitornot,ancientnomadsusedto placestonesincamels’uteritopreventpregnancyduringlong journeys.Fastforwardtotoday,andwhilethetechnologyisdifferent, theconceptremains.Animportantmisconceptiontoclearupright away:IUDsarenotabortifacients.Infact,nearly1in5U.S.physicians stillmistakenlybelievetheyare,whichissimplyincorrect.”
TheRiseofIUDUse
GrowingPopularityAmongYoungWomen
EndorsedbyACOG&AAP
Especiallypromotedforadolescents
PartofLARC:Long-ActingReversibleContraception
“Inrecentyears,IUDshavebecomeincreasinglypopular,particularlyamongyoungwomen andteens.BoththeAmericanCollegeofObstetricsandGynecologyandtheAmericanAcademy ofPediatricsstronglyendorsetheiruseunderLARC.Whilethiscanbeeffectiveinreducing unplannedpregnancies,there’salevelofpaternalisminassumingallyoungwomenneedthis formofcontraception.Yes,40%ofpregnanciesintheU.S.areunintended—butwemuststill considerindividualpatientneeds.”
PublicHealthvs. PersonalRisk
WeighingPopulationBenefitsvs.IndividualRisk
•Preventingunintendedbirths=publichealthwin
•Smallbutrealrisktofertility
•Personallossescanbesignificant
“Fromapublichealthstandpoint,reducingunintended pregnanciesisseenasavictory—evenifafewindividualssuffer complicationslikeinfertility.Butforapatientwhoendsupwith tubaldamageduetoanIUD-relatedinfection,that‘smallrisk’ becomeslife-changing.Wemuststrikeabalancebetweenpublic healthgoalsandpersonalized,ethicalcare.”
Infection& FertilityConcerns
TheSTIRisk:WhatYouShouldKnow
•IUDscan“wick”infectionsupward
•Riskincreaseswithchangingpartners
•Idealcandidate:post-childbirth,monogamous
“Duringmytraining,weweretaughtthatthebestIUDcandidateswere womenwhohadalreadyhadachildandwereinastable,monogamous relationship.Inyoungerwomenwhomaypractice‘serialmonogamy,’ theriskofSTIexposureincreases.Ifaninfectionlikechlamydiatravels upviatheIUD,itcandamagethefallopiantubesandimpactfertility.
That’saseriousriskmanywomenaren’tfullyinformedabout.”
HormonalIUDs–HowTheyWork
HormonalIUDMechanism
Containslevonorgestrel(aprogestin)
Thickenscervicalmucus
Thinsuterinelining Doesn’treliablystopovulation
“HormonalIUDsreleaselevonorgestrel,asyntheticprogestin.Itworksprimarilybythickening cervicalmucus—makingitharderforspermtoreachtheegg—andthinningtheendometrial lining,makingimplantationunlikely.Unlikebirthcontrolpills,theseIUDsdonotconsistently preventovulation,andtheywon’tregulateestrogeninperimenopausalwomen.Thoughoften describedas‘local,’someofthehormoneisabsorbedsystemically,whichwe’llexplorenext.”
HormonalSideEffects eastCancerRisk
HormonalIUDs:What’sAbsorbedMatters
•Someprogestinentersbloodstream
•Danishstudy:slightincreaseinbreastcancer
•Possiblesideeffects:bloating,acne,breasttenderness
“AlargeDanishstudyinvolvingnearly80,000womenfoundasmall butrealincreaseinbreastcancerriskamonghormonalIUD users—confirmingthatthehormoneisn’tentirely‘local.’Some womenalsoreportprogestin-relatedsideeffectslikebloating,acne, orbreasttenderness.Whilerare,theseeffectsareveryrealtothe womenexperiencingthem.It’simportantthatpatientsunderstand boththebenefitsandtherisksbeforechoosingthisoption.”
TheCopperIUD–A Hormone-FreeOption
TheNon-HormonalChoice
•Nohormonesinvolved
•Approvedforupto10years
•Worksviauterineinflammationtoxictosperm
“Forthosewhopreferahormone-freeoption,thecopperIUD isagreatchoice.Itcreatesaninflammatoryresponseinsidethe uterus,whichistoxictosperm.It’seffectiveforupto10years. However,somewomenmayexperienceheavierperiodsormore cramping—soagain,it’snotone-size-fits-all.”
WhoShouldConsideranIUD?
IdealIUDCandidates
Womenfinishedwithchildbearing
Stable,monogamousrelationships
Understandrisksvs.benefits
DrGoldstein,aleadingGynecologistinManhattansays“Inmyclinicalexperience,women who’vealreadyhadchildrenandareinstablerelationshipsareoftenthebestcandidatesfor IUDs.Butmoreimportantthanageormaritalstatusisbeingfullyinformed.Patients mustunderstandhowthedeviceworks,whatthepotentialrisksare,andhowitfitsintotheir long-termreproductiveplans.”
WhentoReevaluate
HavingSideEffects?TimetoCheckIn
•Hormonalsymptoms?Don’tignorethem
•Individualizedcareiskey
•Consideraconsultation
“IfyoualreadyhaveanIUDandareexperiencingsymptoms— especiallyhormonalones—itmightbetimetoreevaluate.Every woman’sbodyreactsdifferently,andwhatworkswellforonemay notbeidealforanother.That’swhypersonalizedcareisessential.I alwaysencouragemypatientstocomeinifthey’reunsureor uncomfortable.”
FinalThoughts
InformedChoicesMatter
•IUDscanbesafeandeffective
•Notrisk-free
•Knowyouroptions,knowyourbody
Ifyouareconsideringusingbirthcontrolorhave gynecologicalissuesthatwarrantaconsultation, thenseeDrStevenR.GoldsteinaGynecologistinNYC.
“IUDsareamongthemosteffectiveformsofcontraception,butthey’re notwithoutrisks.Thekeyisinformeddecision-making—knowingwhat you’reputtinginyourbody,andwhy.Whetheryou’reconsideringa copperIUDorahormonalone,makesureitalignswithyourhealth goalsandyourstageoflife.”