Tubal Ligation No Better Than Iud At Preventing Pregnancy
Both Methods Fail to Prevent Pregnancy More Often than Expected
IUDs work at least as well as tubal ligation, while causing fewer side effects, according to a new study.
The analysis, based on six years of Medi-Cal claims data, is the first rigorous look at how long-term birth control methods perform in the real world.
This study overturns the widely held assumption that tubal ligation, which requires surgery and is permanent, is more effective than an IUD, which can be easily removed when pregnancy is desired.
Published Feb. 22, 2022, in the Journal of General Internal Medicine, the study found that hormonal IUDs were more effective than tubal ligation at preventing pregnancies, while copper IUDs were as effective.
Tubal ligation is really no longer the gold standard for pregnancy prevention, said Eleanor Bimla Schwarz, MD, professor of Medicine at UC San Francisco and chief of the Division of General Internal Medicine at Zuckerberg San Francisco General Hospital.
Researchers examined claims data from more than 83,000 Medi-Cal recipients who received either a tubal ligation or an IUD between 2008 and 2014 to see how many became pregnant within a year. They found that 2.40 percent with levonorgestrel IUDs and 2.99 percent with copper IUDs got pregnant, compared with 2.64 percent of those who underwent laparoscopic tubal ligations.
These turned out to be good questions, and Schwarz said both providers and patients should heed the answers.
Con: Iuds Dont Protect Against Stds
The IUD works by creating an environment in your uterus thats inhospitable to sperm and conception. Depending on the type of IUD, your uterine lining thins, your cervical mucus thickens, or you stop ovulating.
However, the IUD doesnt block semen and sperm from passing into your vagina and uterus during ejaculation. If you have sex with someone who is infected with a sexually transmitted disease , you could get infected, too.
If you or your partner is at risk for STDs, always use a condom in addition to your IUD. Condoms lower, but dont eliminate, the risk for STDs, so ask your OB/GYN about other safer-sex practices, too.
You Can Get Pregnant With An Iud But It’s Extremely Rare
- Your chance of getting pregnant with an IUD is 0.1% to 0.2%. So, for every 1,000 women with an IUD, one to two of them will become pregnant.
- If you get pregnant with an IUD, it’s usually because the IUD was not properly inserted or it’s become dislodged from your uterus.
- If you have an IUD and suspect you’re pregnant contact a doctor immediately because you’re at a higher risk of a life-threatening condition called an ectopic pregnancy.
- This article was reviewed by Karen Duncan, MD, who is an assistant professor with the Department of Obstetrics and Gynecology at NYU Langone.
The intrauterine device, or IUD, is considered to be one of the most effective methods of contraception. These devices boast a 99% effective rate when it comes to preventing pregnancy, but no method is completely foolproof.
Though rare, you can get pregnant with an IUD. Here’s what you need to know about the risks.
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What Causes An Iud To Fail
Your IUD may not prevent pregnancy if it:
- Falls out. If the IUD falls out of your vagina, you arenât protected against pregnancy anymore. Itâs important to check for the strings connected to the IUD to make sure itâs still inside you.
- Moves out of place. An IUD can also be in the wrong position. It wonât properly protect you if it isnât correctly fitted inside your uterus.
- Expires. IUDs have expiration dates. If you keep one in longer than the suggested amount of time, you have a slightly higher chance of pregnancy. But itâs still less than 1%. You probably wonât have any side effects if you keep an IUD in after it expires, but we need more research to safely recommend this option.
- Hasnât started to work. A copper IUD, like Paragard, begins to work right after the doctor inserts it. But hormonal IUDs, like Mirena, donât start to work for 7 days. Use backup birth control, like condoms, for those 7 days to prevent pregnancy.
What Happens If I Get Pregnant While Im Using An Iud
If you become pregnant while you are using an IUD, it is important that you see a doctor or nurse as soon as possible and have the IUD removed. The doctor or nurse will also need to rule out a pregnancy in your fallopian tubes .
If the IUD is removed, you can choose to continue or terminate the pregnancy . If the IUD is not removed and you continue with the pregnancy, there is a higher risk of losing the pregnancy or delivering the baby early.
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Does Effectiveness Vary Among The Different Iuds
Effectiveness does vary slightly among all the currently available IUDs however, they all have an effectiveness rating of above 99% .
Good quality trials have reported the following:
- Paragard IUD: chances of pregnancy 0.8%
- Mirena IUD: chances of pregnancy 0.2%
- Skyla IUD: chances of pregnancy 0.4%
- Copper T 380A: chances of pregnancy 0.6%
- LNG-IUC: chances of pregnancy 0.2%.
Learn More About Period Changes With The Iud
After two years, about half of people using the 52 mg hormonal IUD will stop experiencing periods . Lower doses of hormones impact monthly bleeding less . If you are using the IUD, itâs helpful to track your bleeding patterns so you can evaluate how itâs working for you. Read more about bleeding on the IUD here.
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The Truth About Getting Pregnant When You Have An Iud
Getting pregnant with an IUD is exactly how things arent supposed to go. After all, if you decide to get an IUD, the entire point is to have an incredibly reliable form of contraception that allows you to control whenif everyou get pregnant. But getting pregnant with an IUD can happen in some extremely rare occasions.
Track athlete Sarah Brown knows this firsthand. In July 2016, just four months after giving birth, Brown was training in hopes of making the U.S. Olympic track team for the 1,500 meter run. Brown didnt plan to be pregnant while training for the Olympics, but her copper IUD failedjust as she was running her best race times ever.
I went from crushing workouts to, all of a sudden, in the second interval of a workout, I thought I was running in sand. Racing wasnt fun anymore, Brown told New York magazines The Cut in 2016 when she was training. It was really frustrating because we had concentrated so hard on doing things right, and I didnt feel like I had overtrained. It was like, Why is this happening? Whats wrong with me?
Brown eventually took an at-home pregnancy test that was negative, but a few weeks later, she went to see her doctor who determined that Brown was, in fact, pregnant. Browns IUD was removed, and her daughter was born in March 2016.
So, how likely is it that getting pregnant with an IUD will happen to you the way it happened to Brown?
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Can I Be Pregnant With Iud
Likewise, people ask, what are the chances of becoming pregnant with an IUD?
Is it possible to get pregnant with the IUD?
pregnancypregnancyPregnancyIUDbecoming pregnantIUDgetting pregnantIUD
How effective is the Mirena birth control?
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Is There A Higher Risk Of Pregnancy Complications After Iud Removal
Every form of birth control comes with some risk, which is why you may wonder if theres a higher risk of pregnancy complications after IUD removal.
The good news, says Zaher Merhi, MD, board certified OB-GYN and fertility expert at New Hope Fertility Center, is theres no increased risk of ectopic pregnancy after IUD removal.
However, he does point out that if you get pregnant while the IUD is still in the uterus, you have a higher chance of having an ectopic pregnancy.
And if youre hoping for twins, dont count on prior use of an IUD to increase your chances. Merhi says there are no higher risks of having twins after IUD removal.
Difficulty getting pregnant after IUD removal may often have nothing to do with an IUD. In most circumstances, birth control methods dont delay fertility.
According to a 2018 review of studies , contraceptive use regardless of duration and type doesnt have a negative effect on the ability to conceive after removal or discontinuation. The researchers also found that it doesnt delay fertility.
In fact, of the 14,884 women included in the study review, 83 percent were able to get pregnant within the first 12 months after contraceptive discontinuation. This includes the removal of IUDs, with 2,374 women making up the group of IUD users.
Anyone with irregular cycles, heavy, painful menses, or who has been trying to conceive for 12 months without success or 6 months without success should see a physician, explains Scotchie.
Iuds Do Not Give Protection From Stis
Neither type of IUD gives protection from sexually transmissible infections . Its important to practise safer sex, as well as to prevent an unintended pregnancy. The best way to lessen the risk of STIs is to use barrier methods such as condoms for oral, vaginal and anal sex with all new sexual partners. Condoms can be used with IUDs.
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How Much Does An Iud Cost
The hormonal IUD prescription is covered by the Pharmaceutical Benefits Scheme in Australia. It costs around $6.50 if you are a Health Care Card holder and around $40.00 if you are not.
The copper IUD is not covered by a Health Care Card The cost in pharmacies can be around $70 to $120. There may also be an insertion cost from the health professional.The overall cost of the procedure will vary depending on whether you attend a private or public provider. If you dont have a Medicare card or private health insurance, it will be more expensive.
Is It Actually Possible
Yes, you can get pregnant while using an IUD but its rare.
IUDs are more than 99 percent effective. This means that less than 1 out of every 100 people who have an IUD will become pregnant.
All IUDs hormonal, non-hormonal, or copper have a similar failure rate.
Read on to learn why this happens, your options for emergency contraception, when to take a pregnancy test, and more.
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What Is A Miscarriage
A miscarriage happens if a pregnancy ends spontaneously before its 20th week. At that point, the fetus isnt developed enough to survive outside the uterus.
If you get pregnant while using an IUD, the device increases the risk of miscarriage. If you want to stay pregnant, its important to remove the IUD early in pregnancy.
Sometimes, an IUD can slip out of place. If that happens, the risk of pregnancy is higher.
To check the placement of your IUD:
Contact your doctor if:
- you cant feel the IUD string
- the IUD string feels longer or shorter than it used to
- you can feel the hard plastic of the IUD coming out of your cervix
Your doctor can use an ultrasound exam to check the internal positioning of your IUD. If it has slipped out of place, they can insert a new IUD.
Why Are Condoms Not 100 Percent Effective
People are not perfect, which is why condoms are not 100% effectivethis goes for other birth control methods too. Condoms can also fail as an effective method by breaking or being put on incorrectly.
The above information is for general informational purposes only and is NOT a substitute for professional medical advice. Always seek the advice of your doctor/primary care provider before starting or changing treatment.
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The Chances Of Getting Pregnant With An Iud Are Small
Your chance of getting pregnant with an IUD is 0.1 to 0.2 percent. That means, for every 1,000 women with an IUD, one to two of them will become pregnant, says Thomas Ruiz, MD, Lead OB-GYN at MemorialCare Orange Coast Medical Center.
Most of the time, if you get pregnant with an IUD it’s because of one of the following three factors:
- The IUD is not properly placed in the uterus.
- The IUD is properly places, but your uterus contracts and dislodges the device, which you’ll probably notice either because the IUD will fall out or the IUD strings will feel out of place. That’s why a follow-up appointment to check placement is important, Ruiz says.
- A woman has a uterine abnormality that neither she nor the doctor knows about until it’s too late.
But even with proper placement and no abnormalities, the IUD, like any other form of birth control, does not completely guarantee pregnancy prevention. “We don’t always know why it happens, but it can fail,” Ruiz says.
You Can’t Feel The Iud Strings
Your IUD is shaped like the letter T, with thin strings at the bottom that are used to ensure that it can be removed easily when you decide you do want to get pregnant. But it can also act as a guide to show you that itâs in its proper place. Now, if you canât feel the strings, that doesnât mean that your IUD has moved it could be that theyâve curled up, Self explained. But in cases whereyour IUD has undergone expulsion or perforation, you might not be protected against pregnancy, especially if youâve had sex. If youâre unsure if your IUD is still in place, you can schedule a sonogram with your ob/gyn, who can confirm its location â and if you might be pregnant.
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What Are The Signs And Risks Of Pregnancy With An Iud Inserted
As with other forms of birth control , you typically still get your regular period while using a non-hormonal copper-releasing IUD, so a missed visit from Aunt Flo may be the first sign youre pregnant, says Dr. Culwell. But the signs might not be so blatant if youre using a progestin-releasing IUD, as they can often cause light, irregular, or absent periods, she says. Relying on your period to be sure you are not pregnant may not be possible, she says. In both cases, youll also want to watch for symptoms such as nausea, bloating, tender breasts, fatigue, and pelvic or abdominal pain if you think you may be pregnant, she says. The catch: These symptoms arent specific to pregnancy, so if you are concerned at any point about pregnancy, you should take a home pregnancy test and/or contact your health-care provider, says Dr. Culwell.
If your IUDs strings have traveled up from the vagina into the uterusand your provider determines they cant be safely retrieved, removing the device while pregnant may not be an option, says Dr. Culwell. In those cases, your doctor may leave the IUD in place, as searching for the strings could inadvertently injure the expectant parent, according to The University of Texas Southwestern Medical Center. They will typically advise you to seek medical care if you have heavy bleeding, cramping, pain, abnormal vaginal discharge, or fever potential signs of miscarriage, sepsis, or premature labor or delivery, according to the CDC.
Myth: Health Risks And Side Effects
Some women do not want to use the IUD because they incorrectly believe that IUD causes side effects or health risks such as cancer, sexually transmitted infections, or birth defects.
Fact: IUDs are safe!
Infection related to IUD insertion probably occurs because the instruments or IUD carry with them organisms from the lower genital tract. If the organisms are bacteria normally present in the genital tract, then it seems that some mechanism automatically eliminates this contamination from the uterus soon after the insertion process without infection occurring. Risk of infection can be further reduced by following routine infection-prevention procedures including the no-touch insertion technique .
The IUD never travels to the heart, brain, or any other part of the body outside the abdomen. The IUD normally stays within the uterus like a seed within a shell. Rarely, the IUD may come through the wall of the uterus into the abdominal cavity. This is most often due to a mistake during insertion. Proper insertion technique can help prevent many problems, such as infection, expulsion, and perforation. If uterine perforation is suspected within 6 weeks after insertion or if it is suspected later and is causing symptoms, refer the client for evaluation to a clinician experienced at removing such IUDs. Usually, however, the out-of-place IUD causes no problems and should be left where it is. The woman will need another contraceptive method.
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You Missed Your Period
If you have an IUD, then you know some of its less than thrilling side effects, the biggest one of which is bleeding. And if your IUD is copper, it can cause heavy bleeding, as was found in the study, âSide effects from the copper IUD: do they decrease over time?â But while your period might get heavier , a missed period is often a marker of pregnancy, the Cleveland Clinic reported, whether you have an IUD or not.