WOMEN: USING INTRAUTERINE DEVICES (PREGNANCY, PELVIC INFECTIONS)

Pregnancy

If pregnancy occurs with an IUD in place, there is a high risk of miscarriage, which may be further complicated by infection (septic abortion). If you become pregnant you will be advised to have the device removed (which reduces the risk of miscarriage) or, if this isn’t possible, to have the pregnancy terminated. However, many pregnancies have continued successfully to term with an IUD in the uterus, though any woman who decided on this course would be advised to watch carefully for symptoms of miscarriage or infection. The device can’t harm the foetus, which develops in a different compartment (the IUD lies outside the foetal membranes). Stories about babies born clutching an IUD are untrue!

IUDs have also been associated with ectopic pregnancy. The device does not cause ectopic gestation; but IUDs are better at preventing pregnancy in the uterus than in the tube, so that pregnancy, if it occurs, is more likely to be ectopic with an IUD than without. Even so, for every 1000 women using IUDs there will be fewer ectopics than among 1000 women using no contraception.

Pelvic infection

Pelvic infection (also called PID, or pelvic inflammatory disease) is the most publicised complication of using an IUD. But IUDs don’t cause infection: germs do. However, if you get an infection while using an IUD, it’s more likely to spread quickly and widely and cause damage.

The latest studies indicate that the risk of infection is greatest during the 20 days after insertion of an IUD. After that the chance of infection depends on the woman’s risk of sexually transmitted infection. Women at no risk of STD have no increased risk of PID.

Untreated pelvic infection can lead to pelvic abscesses, chronic ill-health and scarring that may block the tubes and result in decreased fertility or an increased risk of ectopic pregnancy. One attack of PID carries a one-m-eight risk of infertility due to scarring of the tubes.

Most experts believe that the risks of IUD users getting pelvic infection have been exaggerated. Nevertheless, the greatest anxiety about using IUDs is the risk of infection and its consequences for fertility (see Fiona’s story below).

Fiona’s story

Fiona is aged 20; when she was 18 she used the Pill for six months. While using it she developed pigment marks on her face and neck (chloasma). She stopped the Pill when she broke up with her boyfriend, and the marks have faded since. Now she is planning a long working holiday overseas and wants to try an IUD. She has regular periods with no problems.

Fiona’s story poses a problem. Most studies have shown that young, unmarried women are more likely to have troublesome side-effects and infections with IUDs. If she has a whirlwind love affair while she’s away, sexual intercourse might happen before she knows all about her partner’s background, which could put her at risk of infection. The Pill is ruled out because of chloasma, and an IUD may in future be a good contraceptive choice for Fiona. But because she doesn’t know when, how much or in what circumstances she may need contraception during her trip, condoms (which also protect against STD) may be a better choice for her now.

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