Easy birth control?

After a medical tragedy in the 1970s, women are again turning to IUDs

IUDs may have recovered from the negative publicity of the defective Dalkon Shield to become the leading form of birth control for women.

IUDs may have recovered from the negative publicity of the defective Dalkon Shield to become the leading form of birth control for women.

Photo By David Robert

Say the letters “IUD” to some women, and they shudder. Say it to others, and they may tell stories of their own or their friends’ successes with the contraceptive method.

IUDs—intra-uterine devices—have been on the contraceptive market since 1909. Although they may not have looked then exactly as they do now, the concept was the same. An IUD is inserted into a woman’s uterus and prevents semen from reaching a woman’s egg in a timely manner and stops the egg from settling in the womb.

In recent years, the IUD has been returning to popularity after a mammoth setback laced with tragedy.

There are many reasons why there may be a resurgence in IUD use—cost effectiveness (many insurance companies cover it in full), ease of use (it’s always functioning, no daily pills), or security (failure rate is extremely low).

“The concept,” as Reno gynecology nurse practitioner Laurie Smith says, “is actually very simple.” She says this while holding a basic drawing of the female reproductive system, using a small dry-erase marker to draw a T to show where the IUD is inserted.

“It doesn’t perform an abortion on a monthly basis, like some people think,” she says. “It simply prevents the sperm from reaching the egg. That’s it.”

Smith’s comment about abortion touches on only one of the controversies surrounding IUDs. In the early 1970s, IUDs earned a terrible reputation in the United States. An IUD called the Dalkon Shield was sold from January 1971 through June 1974 and was widely used. The Shield had a terrible defect, a fabric string that allowed bacteria to migrate into the woman’s uterus, causing infections, miscarriages, loss of organs, infertility and even death.

According to a pamphlet put out by Berlex Laboratories, a pharmaceutical company that produces IUDs, the Dalkon Shield was associated with 12 deaths due to miscarriage-related infections in the 1970s. Granted, those 12 deaths were among 2.8 million users.

Moreover, there were hundreds of thousands of victims injured in ways that fell short of death, and as many lawsuits. The Shield’s manufacturer, A.H. Robins, went bankrupt.

The regulation and design of IUDs have changed since the Dalkon Shield.

In design, they have lost their spider-like shape and now look like a T. This new shape was the first step to a safer IUD. Currently, two types of IUDs are available on the U.S. market—the copper-wired T-shaped IUD sold under the name ParaGard and the progesterone-impregnated IUD called the Progestasert or Mirena. The ParaGard is slightly more popular, probably because of its lower failure rate of .08 percent compared to the 3 percent rate of its counterpart.

The second step to making IUDs safer was to use greater care in deciding what type of patients would be good candidates.

“The ideal candidate for an IUD,” says Smith, “is over 30 [and has] completed child bearing, so she has one or two children, wants reliable contraception and is in a mutually monogamous relationship.”

The last, as Smith emphasizes again and again, is most important. Many complications with IUDs are associated with patients who have multiple partners. An IUD can trap the bacteria that cause sexually transmitted diseases. This is what leads to pelvic infections and infertility.

“It is the STD that causes the infection and the infertility, not the IUD,” Smith emphasizes.

As medical professionals became better at deciding on good candidates for IUDs, the devices caused fewer and fewer complications. (IUDs are available only by prescription.)

This is not to say that if patients didn’t fit the exact criteria they would be denied the IUD. There are many patients who found success with IUDs without fitting the exact criteria, like Nikki Pirrodi, of Fernley. Pirrodi chose to get an IUD when she was 23, after her first child.

“I never liked birth control,” says Pirrodi. “I found out about IUDs, and I’ve been happy ever since. No messy contraceptive, no brainer.”

Pirrodi did have some complications with her first IUD, but they were easily remedied. Pirrodi chose to have her second child when she was 26. She had her IUD removed and was able to have a baby right away. She had her second IUD inserted shortly after the birth.

Some women have strong feelings about their choice of the IUD over oral contraceptives, including Robin, who spoke on condition of anonymity. Robin had been using oral contraceptives starting at age 17. Growing up in a rural area, it was difficult for her to find an ample supply of birth control pills. In fact, she said it proved next to impossible, since there was no clinic in her town. At 19, she became pregnant, and she had her first child at 20. Later, she married and had a second child. It was then that Robin chose to use oral contraceptives again.

“I just didn’t like the way they made me feel,” she recalls. “It just didn’t feel right, so I stopped taking them.” Robin then became pregnant with her third child while she and her husband were separating. They decided it wasn’t the best time to have a child and chose to have an abortion. The clinic’s health care professionals were the first to tell her about IUDs as an option for contraception.

“The IUD seemed to be the best option because it was so much more effective,” says Robin. “… I didn’t have to worry about the hormonal and chemical effects of the pill.”

Robin feels strongly that many women aren’t properly educated about the virtues of IUDs and that the marketing surrounding oral contraceptives is why so many women choose to use the pill. “Oral contraceptives are marketed publicly and as having side benefits, such as clearer skin.”

Robin speaks positively of her IUD experience. She even goes so far as to call the IUD one of the greatest inventions of the 20th century, saying that a safe, effective, passive form of birth control is a key feature of women being able to function in today’s society.

Whether IUD use is on the rise is difficult to tell. Several media entities, such as CBS News and the Wall Street Journal, have recently said it is but cited no figures or studies to show the increase. The Journal did quote a Planned Parenthood spokesperson saying IUDs are now the most common form of birth control, with 85 million women using them.

Although nurse practitioner Laurie Smith doesn’t advocate one method over the other, she does have a theory about why the pill is so popular. “We are a pill-taking generation. You have a problem, you take a pill. To some, the IUD seems like a very invasive method of birth control.”

For those thinking about changing contraceptive methods, Smith has some advice: "If it isn’t broken, don’t fix it. If you’re satisfied with your method of birth control, there is no reason to change. You may not get the satisfactory results you’re looking for."