Melanie Cole, MS: Welcome to Conversations with MIT Health. I'm Melanie Cole, and joining me today is Jennifer Shark. She's a certified nurse midwife at MIT Health, and we're talking about IUD today. Jennifer, thank you so much for joining us. What is an IUD? Will you explain a little bit about what it is, and how they work?

Jennifer Shark: Sure so an IUD stands for intrauterine device, and it is a small plastic device that is inserted into the uterus to prevent conception. They work in different ways. We have two types of IUDs on the market, the copper IUD, and a hormonal IUD. Copper IUDs work because copper is toxic to sperm. They can't swim in an environment that's fused with copper ions. And so if they can't swim, they can't get up into the fallopian tube to fertilize an egg. Hormonal IUDs contain a synthetic form of progesterone known as Levonorgestrel, and what this does is it creates thicker mucus in the cervix, which prevents sperm from getting into the uterus at all. So if sperm cannot get into the uterus, again, conception cannot occur.

Melanie Cole, MS: How effective are they? I mean, they've been around a long time, right? We've heard about IUDs for quite a long time. How effective are they in preventing pregnancy? How long, once you're using one, does it remain effective?

Jennifer Shark: IUDs are more than 99% effective in preventing pregnancy. So the overall rate is about one in a thousand people using an IUD per year that is similar to the rate of pregnancy after surgical sterilization for women , or vasectomy for men. So it has that same efficacy, but it's reversible so people can have this really awesome contraception so that they can opt into pregnancy when they are ready to be pregnant. IUDs have varying efficacies. The IUDs that we carry at MIT Health are Paraguard, which is the copper IUD.

This is FDA approved for 10 years for contraception. have Marina, which is a hormonal maIUDrina is good for eight years for contraception. It can also be used as a medical treatment for people who have very heavy, painful periods who do not desire pregnancy. We also have kyena, which is another hormonal IUD. It is a smaller framed IUD with a lower dose of hormone, and this one is effective for five.

Melanie Cole, MS: Jennifer, are IUDs safe? Are there issues that people with underlying health conditions should consider before they're getting one? Tell us a little bit about that.

Jennifer Shark: IUDs are one of the safest forms of contraception. There are some conditions where you need to be cautious and consult potentially with a specialist before getting an IUD. So if someone has a copper allergy, they should not get a copper IUD. Also, if someone has a condition called Wilson's disease, they should also not get a copper IUD. Anyone who has had estrogen positive Cancer should talk to their oncologist before considering a hormonal IUD. As far as safety concerns, the biggest risk with IUDs comes from the insertion.

The risk is the main risk that you can associate with an IUD is that it will push itself out. So IUD expulsion is one of the risks that we talk about with patients for what can happen with your IUD. Expulsions can be complete, where comes out, you see it in the toilet , or they can be partial where they just move lower into the cervix as opposed to being in the uterus. And this happens to 5% of users in the first year. If it doesn't happen in the first year, it goes down to less than 1% per year. So that is kind of the most common complication from IUD.

The other complication from IUD use is very, very rare, and this is called a uterine preparation, where the IUD goes through the uterine wall and ends up in the pelvis or abdomen somewhere. This is super rare. It occurs about one in every thousand IUD insertions, which is similar to the rate of pregnancy, you know, for context. And the rate of pregnancy for IUDs is similar to that with surgical sterilization. It is not a common adverse event, but it does require surgery to remove the IUD if this happens. So it's important that people know this is a potential risk when getting an IUD.

Melanie Cole, MS: Well, as you say, it's important that people understand these risks when they're making these decisions. One of the things that I know that people are concerned about is the insertion process. Does it hurt? What's involved in that?

Jennifer Shark: So the insertion process for an IUD is very uncomfortable as a general rule. So what we have done at MIT Health is we have taken a multimodal approach to pain during an IUD insertion. So we typically will give someone a prescription for a nonsteroidal anti-inflammatory medication like naproxen, which they would take before they come in for their IUD insertion. At the time of IUD insertion, we give people a hot pack to put on their bellies, which helps kind of reduce cramping, just generally helps.

It's kind of relaxing. And then we also use a topical gel on the cervix so that you don't feel us poking around your cervix. And we offer everyone who wants one something called a para cervical block, which is an injection of local anesthesia into the cervix, and that numbs the cervix and the lower part of the uterus. So during an IUD insertion, if you've ever had a pelvic exam with a speculum or a pap smear, anything like that's kind of how it starts. Once we have cleaned and numbed the cervix, we're gonna measure the uterus.

If you don't have anesthesia, that can be pretty painful. but with the local anesthesia, most people just find it mildly uncomfortable. Once that's done, we put in the IUD. That will be mildly uncomfortable with anesthesia. It can be pa very painful without the anesthesia. What people feel when they have the local anesthesia with it. They get cramping when we open the IUD in the top of the uterus because the anesthetic works on the cervix and the lower part of the uterus.

So you will get that kind of intense cramp at the last second when the IUD is being put in. But overall, the way we have worked the process here at MIT is to make it as painless as possible. Some people find it painless with this process. Some people find it mildly painful with this process, and there are still some people who find it very painful and it just depends on each individual's unique pain tolerance. But we have found that since we have been using local anesthesia routine, people have been tolerating the procedure far better than they ever did before.

Melanie Cole, MS: Those are great points about the multimodal approach, really what they're doing for so many forms of procedures today. So thank you for telling us about that. As we get ready to wrap up, how soon can one get pregnant after IUD removal? Tell us a little bit about that and summarize an IUD for us, what you would like listeners to take away from this podcast.

Jennifer Shark: You can become pregnant immediately after an IUD removal. So because IUDs do not interrupt normal hormonal processes, as soon as the IUD is removed from the uterus, its contraceptive method is out of your body completely. So people can get pregnant the same day that they take out an IUD if they're about to ovulate. So there is no delay in return to normal fertility. So whatever your normal fertility was before you put in the IUD, the IUD is not going to change it if you've never been. We can't say what your normal fertility is, but if you have trouble getting pregnant, it wouldn't be because of the IUD.

We typically tell people, do not take out your IUD until you are ready to get pregnant, because so often people get pregnant immediately after removing it, and if they wanna wait a few months, you don't wanna take it out yet. So what I want people to take away from this conversation about IUDs is that IUDs are among the safest and most predictable and most effective forms of reversible birth. You should not be afraid of having an IUD put in because we are there with you. We'll work with you to make it as painless as possible.

And we have staff who can sit with you after the procedure to make sure you're feeling okay If you're even considering an IUD, but you're a little bit afraid, please make an appointment to talk to us. It's not as scary as you may have heard on the internet.

Melanie Cole, MS: Great information. Jennifer, you're an excellent guest and a great educator. Thank you so much for joining us today.

Listeners can visit Health.mit.edu for more information and to get connected to one of our providers. That concludes this episode of Conversations with MIT Health. Please remember to subscribe, rate and review this podcast and all the other MIT Health podcasts. . I'm Melanie Cole. Thanks so much for joining us today.