DRHOOK- Insert here: IUDs experiencing a comeback

the handsome doctor John Hong

Are you sponge worthy? If you watched Seinfeld, you have to remember that before Elaine interviewed "gentleman callers" she would use her favorite method of contraception: the sponge. Elaine's buddy George asked to borrow one because all of NYC was out of sponges, but no, no, no– Elaine worked very hard to buy the last box. No amount of dishwashing detergent could pry those sponges out of her hands. 

What's a girl to do if her favorite contraceptive is gone?

In the 1970s, the Dalkon Shield brand of IUD (intrauterine device) was hot, hot, hot– about 2.8 million American women used it for contraception. 

But then it became hot, hot, hot– in litigation. Over 300,000 lawsuits were filed against the makers of the Dalkon (sounds like an Asian radish) Shield because the makers ignored scientists' warnings about its safety.

The Dalkon Shield had a braided string that acted as a portal of infection into the pelvis. So PID (pelvic inflammatory disease) hurt quite a few women. The Dalkon Shield was linked to infertility, hysterectomies, ectopic pregnancies, and even deaths. These bad things made IUDs disappear ASAP, like OMG. But are they now BRB?

It appears so, because since 2002, IUD use has tripled. Now about 2.1 million Americans are choosing this type of contraception. In Asia, almost 50 percent of women choose the IUD for birth control (although I wonder if China forces women to use it). 

The safety profile appears to be good, and so more gynecologists are inserting IUDs into women. Reports state that IUDs now do not increase the risk of PID or ectopic pregnancy. Because there's no increased risk of infertility, the IUD is being used in women who have never had children but want them in the future. 

In fact, I guess for marketing reasons some are now calling IUDs IUCs (intrauterine contraception) because the devices have copper or a progesterone hormone to prevent pregnancy. (IUC? Why not IOU or IUWe? C'mon!)

ParaGard and Mirena are the two types of IUDs used in the US. ParaGard lasts for about 10 years. The efficacy is comparable to having the tubes tied. It doesn't protect against STDs and HIV, so advice to all single ladies is still, "Use Protection." 

The cost of the IUD ranges between $400 and $900 plus the doctor's charge. So compared to oral contraceptives that are often not covered by health insurance (really, what is covered by health insurance?), the IUD is downright economical. Plus the women never forget taking their birth control pill because "Prego!" it's in there.

About 1 in 50 women expel the IUD (meaning it spits out). The IUD can't be put in for at least a few months after an STD is treated (you don't want to contaminate the oven with the kitchen counter). Menstrual periods as well as breast tenderness, mood swings, and acne can be better or worse depending on the type of IUD and the woman. Women with breast cancer shouldn't be on the progesterone IUDs. 

A trained gynecologist inserts IUDs, which have to be placed into the lining of the uterus. So there's a small risk (1:1000) of perforation, meaning poking a hole through the uterus. Ow! 

"Love Makes the World Go Round"– I used to play that song on the electric organ all the time. It seems contraceptives go round as well. Time will tell how things go.


Dr. Hook cracks a joke or two, but he's a renowned physician with an interesting website, drjohnhong.com. Email him with your questions.