ChatterMoms

We've got the surprising new facts on the device that could change how women handle contraception in the next decade

By Cara Birnbaum

If you're like most of us, when you hear the letters "IUD" you think of either (1) something Saddam has been hiding; or (2) a birth control device that's equally scary. Well, it's time you rethought both of those. The IUD, short for intrauterine device, is a small, T-shaped piece of soft, flexible plastic that a doctor places in the uterus (womb) to prevent pregnancy. Maybe the most useful fact worth learning about the IUD is that 18 percent of female gynecologists of childbearing age use it, whereas only 2 percent of American women do. Which made us wonder: What do they know that we don't?

First of all, you can blame the IUD's sketchy reputation on an old version called the Dalkon Shield. It caused major health problems about 30 years ago, when 2.2 million American women were already using it. A.H. Robins Company, the Shield's maker, pulled it from the market in 1974 because it played a role in thousands of infections, such as pelvic inflammatory disease (PID) and sepsis. The conditions caused infertility for some women and have been linked to at least 17 deaths. Yeah, it's enough to scare Paris Hilton celibate. But in 1974, the pocket calculator was considered high-tech — so comparing the old IUD with today's versions is like pitting Pong against Halo.

"Those of us who are familiar with the newer IUDs realize this is a safe and effective form of contraception," says Susan Loeb-Zeitlin, M.D., assistant attending obstetrician-gynecologist at NewYork-Presbyterian Hospital. She believes the IUD's recent surge in popularity came about because younger doctors, who didn't deal with the Dalkon debacle, are more willing to give the new models a chance.

The newer IUDs, called ParaGard and Mirena, offer a staggering list of pros. They allow you to be completely spontaneous — no fiddling with goop or wrappers. Unlike pills or patches, they're virtually impossible to screw up. They cost less than any other birth control method — insurance usually covers the entire expense, but at full price, an IUD averages out to about $3 per month if you leave it in for 10 years, versus up to $35 per month for the Pill. They don't affect fertility; you can become pregnant immediately after having an IUD removed. And then there's their close-to-perfect antipregnancy power. With a failure rate of less than 1 percent, IUDs are more effective than the Pill — and, some studies say, more foolproof even than having your tubes tied. (Some methods of sterilization can fail and allow eggs to reach the uterus.) No wonder 99 percent of women who have tried an IUD are "very satisfied" or "somewhat satisfied" with it, compared with 91 percent of those on the Pill, according to the Association of Reproductive Health Professionals.

Both kinds of IUD work by releasing substances that prevent pregnancy. ParaGard, made by Barr Pharmaceuticals, slowly releases copper ions for up to 10 years — copper inhibits sperm and eggs' ability to fertilize. Mirena, made by Berlex, discharges small amounts of a synthetic form of the hormone progesterone for up to 5 years. Progesterone thickens the cervical mucus (a usually runny fluid that helps sperm travel), which keeps sperm from reaching an egg. The hormone also thins the uterine lining, preventing eggs that do end up fertilized from implanting.

The design of these new IUDs makes them a huge improvement over the Dalkon Shield: They are safer, more comfortable — and have names that don't sound like Star Wars weapons. They're both made of pliable plastic and are just over an inch long, with a single plastic thread attached at the end. (This "tail" allows you to check the placement of the IUD and helps your doctor remove it.) Compare that with the large Dalkon Shield, which looked like a spider and had a multi-strand fabric tail. Many scientists believe this twisted tail allowed bacteria to breed and travel up into the reproductive organs and cause PID, which can lead to infertility. The Shield's large leg-like protrusions also made it more likely to embed in the uterine wall. A 2005 report in the American Journal of Forensic Medical Pathology found that the risk of infection and perforation from new IUDs is less than 1 in 1,000, and several studies have failed to find any link between them and PID.

Yes, it may sound creepy to leave a piece of plastic in your uterus for up to 10 years. But you're at the same risk of infection with extended-wear contacts as you are with IUDs: less than two infections for every 1,000 users. Still, there are some potential health complications. While IUDs rarely cause infections, they can make existing ones — specifically, chlamydia and gonorrhea — much nastier, warns Hope Ricciotti, M.D., assistant professor of obstetrics and gynecology at Harvard Medical School. Women who've never been pregnant could possibly expel the IUD. Reason: Before pregnancy, your uterus and cervix are smaller and less pliable, so your body might resist having a piece of plastic resting in its soft parts. But only about 2 percent of women have this problem. Also, IUDs offer absolutely no STD protection. So unless you're in a monogamous relationship, you'll still need to suit up his member when you want to play.

About 1 in 100 women report infections in the first 20 days after they get an IUD, usually because bacteria have crept in during insertion. (Those infections can generally be treated with antibiotics.) So finding a skilled doctor to perform the procedure is crucial. While all gynos are trained to do it, it's a good idea to ask how often she inserts IUDs — two or more a week is reassuring. She will use a long, thin, straw-like device to push the IUD through your cervix into your uterus. Yes, it hurts: Women usually rate the pain about 7 out of 10. "It was more painful than I expected," says Jessica Small, 25, a magazine copy editor in New York City, who got a ParaGard a month ago. "I had pretty bad cramps for about a week, but it wasn't anything some extra Advil couldn't handle." And now she says it was a small price to pay. "With the Pill I had major mood swings and bloating every month. At least this hassle was a one-time deal — and not having to think about birth control anymore is a huge relief."

Which is better, ParaGard or Mirena? It depends. If you crave a lighter, and possibly nonexistent, period, Mirena may be the way to go. Because it thins the uterine lining, there's less blood, says Ross Marchetta, M.D., an obstetrician-gynecologist in Akron, Ohio. By contrast, the copper ParaGard can make bleeding and cramps worse by irritating the uterine lining (the hormones in Mirena make cramping less of an issue). So ParaGard might not be for you if your period already makes you curse your ovaries as you double over in cramps. However, if you want to avoid pumping artificial hormones into your body, ParaGard is a more appealing option.

For Katie Grimes, 35, a writer in Los Angeles who got an IUD in June, one of the best things about it is that she and her man can get busy whenever the mood strikes. "I didn't want any type of birth control that would interfere with sexual spontaneity, since having two kids already does that enough," she says. "You really can forget about the IUD, no strings attached — except for the actual string."