Dr. Swiner’s Medical note of the month-Is an IUD right for me?

This is a question I deal with often, as I counsel frequently on contraceptive methods with my female patients. There are multiple methods, including family planning (rhythm method), birth control pills, barrier methods (male and female condoms, diaphragms), the patch, the shot, implants and IUDs.

f the Mirena type, which is a five-year long, progesterone-releasing method. There are other types of IUDs, such as the copper-T and Paragard, that do not contain hormones and last longer than 10 years. IUDs are not only used for birth control, but also potentially to control heavy menstrual bleeding, severe menstrual cramping, and conditions such as ovarian cysts, endometriosis and other female organ disorders.

This is the general information I give female patients when they’re considering this method: We are placing an IUD today, and I hope that you’ve had a chance to review either the brochure or research online about this birth control method. Feel free to ask whatever questions you may have before our procedure.

  • Benefits. We hope that you’ll be able to keep the IUD for as long as you want, for up to five years. If older than 35, it’s a good idea to make sure you include a good amount of vitamin D and calcium in your diet as the IUD may stop your periods, which equals a sort of early menopause. These vitamins help protect your bones. As long as you have not had any ectopic (tubal) pregnancies or recurrent STDs (gonorrhea or Chlamydia), there is little reason not to have an IUD. It does not, however, protect from STDs, so condoms must still be used.
  • Risks and possible complications. Anytime outside objects are introduced to our insides, there is always the potential for infection and discomfort. We do our best to keep the procedure sterile (gloves, cleaning solutions, instruments, IUD), but it is still possible. You also should have taken the medicines I have given you beforehand to reduce discomfort, which can feel like strong menstrual cramping. Also, most of the instruments used are metal but, fortunately, not all are sharp. There is the potential for bleeding. The most concerning risk is for the instrument to break through the tissue or muscle of the uterus causing hemorrhage, which is life threatening.
  • What to expect after the procedure. We will make sure you feel OK before leaving. Please ask for Tylenol if you feel you need it before discharge. You can expect some vaginal bleeding during the first 24 to 48 hours afterwards with menstrual discomfort. You can use your Ibuprofen every eight hours as needed. Bed-rest is not required, but I would defer from strenuous activity. Going to work from here is fine.

Some women experience irregular bleeding for three to six months after placement. After then, you’ll join one of three groups: one-third of women continue irregular bleeding for the duration; the second group continue their normal monthly cycles; and the latter one-third stop having their periods altogether. Everyone responds differently, and we don’t know which group you’ll fall into until the IUD is placed. The good news is you can return to have it removed whenever you want.

If you feel back to normal after 24 to 48 hours, resume normal activity, which includes sexual intercourse and tampon use if desired. However, you can also wait to see me at your one-week followup to check the string and make sure things are stable.

Call us here if you have any questions during that week or problems like fever, severe stomach pain, extremely heavy vaginal bleeding or foul-smelling vaginal discharge.

  1. Nicole Price Swiner, MD, works for the Durham Family Practice in Durham. Contact her at 220-9800.
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