What are the pros & cons of using an IUD for birth control?

Q. I am a young woman who has never used contraceptives. I have heard a lot about intrauterine devices (IUDs). How do they work?

A. There are two types of intrauterine devices currently available: the copper IUD, which contains copper, a type of metal, and the hormonal IUD, which contains the hormone progestogen.

Both the hormones and the copper prevent the sperm from reaching the egg. Sometimes there is fertilisation. In that case, the IUD stops the egg from implanting to the wall of the uterus. The copper and hormonal IUDs are at least 99% effective.

Some preferred times to insert them are while you have your period or just after, six weeks after your baby is born, at the time of a surgical termination, or as emergency contraception.

ADVANTAGES

• Some advantages of the IUD are that one doesn't need to think about contraception every day and it does not affect breastfeeding.
• Most people can use an IUD, including those who are young and those who have not had children.
• The return to fertility post removal of the IUD is immediate.

DOWNSIDES

• There might be changes to the menstrual cycle, depending on the method - periods may become lighter with spotting and eventually stop.
• With a copper IUD, your periods might be longer, heavier and more painful, especially in the first few months. This usually gets better with time.

CONCERNS

There are some myths about how the presence of strings on the device would affect sexual partners. The strings come out of the cervix and curl up inside the vaginal canal at the top - they don't hang outside. It is important to check for the presence of the string after a bleed to ensure the IUD is still in place.

The common sexual concerns are about arousal, lubrication and orgasm. Even with the great efficacy of the IUD, these concerns with sexual satisfaction can affect the uptake, adherence and continuation. The use of condoms to protect yourself from sexually transmissible infections (STIs) and the use of lubricant to enhance pleasure are recommended. Remember to always consult your doctor for medical advice.

• Dr Tlaleng Mofokeng (MBChB), sexual and reproductive health practice, Disa Clinic, safersex.co.za.

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