An intrauterine device (IUD) is a small T-shaped piece of plastic inserted into the uterus through the cervix. The device may be coated with copper or contain a progestin hormone. The copper IUD can safely protect against pregnancy for 10 years. The hormone-containing IUD can remain in place for 5 years.

The IUD is very convenient because it requires little attention after insertion. Even so, it is important to confirm the device is present by feeling the string at the tip of the cervix after menstruation. This lets you know the device is still in place and preventing pregnancy.

Yearly checkups with your medical provider will help to ensure that the device is present and in the right position. Hormone-containing IUDs will need to be removed after five years, and copper IUDs after 10 years. This should be coordinated with your doctor.

Removal is usually quick and pain-free if the strings can be seen and easily grasped. If the strings cannot be seen, removing the device is more complicated and may require minor surgery.

Advantages

• The IUD is highly effective in preventing pregnancy, even more so than the birth-control pill.
• Your health-care provider can remove your IUD quickly and easily at your request.
• Fertility returns as soon as the IUD is removed.

Disadvantages

• Your health-care provider has to insert or remove the device during a scheduled office visit.
• Irregular vaginal bleeding, severe menstrual cramps and pelvic pain are the most common reasons for having the device removed within the first two to three years of use.
• Sometimes the IUD can move out of position and pass out of the vagina; this is known as expulsion. Rarely, the device punctures the uterine wall, passing partially or completely through it. Puncture, which occurs more often during insertion, is rare, one case per 1,000 insertions. If a puncture is suspected and confirmed, your gynecologist usually will need to surgically remove the device.
• Sometimes a sharp tip is created at the end of the string and may be bothersome to your sexual partner during intercourse. This problem is easily resolved by trimming the end of the string.
• Women who use the IUD rarely become pregnant, but if they do, the pregnancy can be ectopic. An occurs when a fertilized egg implants outside the uterus, either inside the fallopian tube, on or near an ovary, or somewhere in the pelvis or abdomen. Although rare, ectopic pregnancies can be serious and must be ruled out should symptoms of pregnancy occur in women who use these devices.
• IUDs do not protect against sexually transmitted diseases (STDs). Women at risk of STDs should use a different method of birth control.