Monique Rainford

Of the many contraceptive options available, the intrauterine device (IUD), commonly called the coil in Jamaica, has been surrounded by controversy. The controversy is that it is believed, by some, that the IUD mainly prevents pregnancy by causing pregnancy loss or an abortion. However, despite this, it is the most common method of reversible contraception used in the world.

The two brands of intrauterine devices available in Jamaica are the copper T380A (copper-T) and the levonorgestrel intrauterine system (a hormone coated IUD) sold as Mirena. Both are shaped like 'Ts' with the former being effective for 10 years and the latter for five. They are inserted into the womb by physicians or other health professionals who are trained to do so.

Effect on fertilised egg

The IUDs prevent pregnancy by different mechanisms. These include blocking and killing the sperm, affecting the movement of the egg and damaging or destroying the egg. However, there is some evidence that it may damage or destroy the fertilised egg.

The Mirena also affects the lining of the womb and the cervical mucus. Despite the potential effect on the fertilised egg, studies have not shown any increase in miscarriage rate in women with IUDs and have shown fewer sperm and eggs in the fallopian tubes on these women. Women with IUDs also have lower rates of tubal or ectopic pregnancies. Therefore, its major mode of action is preventing the fertilisation of the egg and the evidence does not suggest that fertilisation occurs.

The women who are best suited for an IUD are women who are in a stable, monogamous relationship and thus are at low risk for a sexually transmitted infection. Women with certain medical conditions can also use the IUD. These include women with diabetes, a history of blood clots in their veins, breast cancer or liver disease. Women with the latter two conditions should only use the copper-containing IUD. However, if a woman has heavy or painful periods, the Mirena may be a better choice.

The advantages of IUDs are that they are long-term reversible methods. They are safe and effective and both types have a low failure rate (that is, the number of women becoming pregnant with this method) of less than one per cent.

There are risks

The risks of IUDs include a higher risk of pelvic inflammatory disease (infection of the uterus, tubes and/or the ovaries) during the first three weeks after it is placed. This is believed to be associated with the placement process. The risk decreases substantially after that time period. Nevertheless, women who are at higher risk for pelvic infections, such as those with many sexual partners, should avoid using an IUD. Unfortunately, even women with only one partner could be at a higher risk if their partner has other sexual partners.

Another disadvantage of the copper-T IUD is heavier menses and bleeding between periods. Certain medications can help to treat these symptoms. The Mirena, on the other hand, is associated with lighter periods and this is usually seen about three or more months after insertion. However, since it does contain a small amount of hormones, it may have other side effects such as headache, nausea, breast tenderness and depression.

With both types a woman has the ability to get pregnant quickly after each is removed.

Women who get pregnant with an IUD in place do have a higher risk of miscarriage and it is recommended that the IUD be removed as soon as possible. They also have a higher risk of an ectopic pregnancy. However, the overall rate of ectopic pregnancies, as mentioned previously, is much less than for women who do not use contraception.