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Contraception, medical mythbusters

IUD mythbusting: no increased risk of pelvic inflammatory disease

LoveMyLARC-PNG-Vertical-300-White_0This week is LARC Awareness Week, which is devoted to raising the awareness about the safety and efficacy of long acting reversible contraception. LARC includes IUDs and the etonogestrel implant marketed under the name Implanon in the United States.

Why promote LARC? Well…

There are three big reasons that LARC is used less in the United States

  • Cost
  • Misconceptions among providers about safety, especially a concern regarding infection and infertility
  • Misconceptions among women about safety

The IUD has long been a favorite among personal injury lawyers for fear mongering. This is not really unique, lawyers are looking to sue doctors and manufacturers over NuvaRing and countless other prescription medications. Sadly, this affects practice because doctors don’t want to be sued. In fact, 63% of OB/GYNs report having changed their medical practice in some way to avoid lawsuits (honestly, I think that number is on the low side).

Unfortunately, many health care professionals still buy into the “IUDs cause pelvic inflammatory disease” when the only proven infection issue is a minor risk (in the 1% range) of post insertion infection in the first three weeks. A recent study (Berenson et al. Obstet Gynecol 2013;121:951–8) tells us that the rate of pelvic inflammatory disease is no higher even for teenagers who get an IUD, and teenagers are the group at highest risk for PID.

While the Dalkon shield, an older IUD that was poorly designed and bears no physical resemblance or really any similarities to modern IUDs, was associated with serious pelvic infections the issues with the Dalkon shield should not be projected onto modern IUDs. It would be like comparing the Hindenberg to a modern airplane. Evidence based medicine tells us that women and their providers should feel confident that outside of a very minor increase in the first 3 weeks after insertion, an IUD will not lead to an increase in pelvic infections.

And lawyers, well, why can’t they be sued for spreading misinformation?

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Discussion

3 thoughts on “IUD mythbusting: no increased risk of pelvic inflammatory disease

  1. Planned Parenthood Advocates of Arizona recently received a tweet in response to a blog post about IUDs: “IUDs cause death and ectopic pregnancy for women, lacerated penises for men.” I had NEVER heard the lacerated penis claim! Tried to find a case report, or some kind of basis for the myth, but was unsuccessful. Have you heard of that?

    Posted by Anna | November 19, 2013, 12:28 pm
  2. It kind of makes me laugh…

    Ten years ago I wanted off hormonal birth control pills; for personal reasons, but also because the pill was causing multiple side-effects including what turned out to be minor strokes. I tried to talk to my doctor about IUD’s but he refused POINT BLANK to let me have a IUD because he said they’d make me infertile, thus I either had to use condoms (led to chronic infections, and I didn’t trust them) or the pill (my strokes were increasing). I went onto FAM a little later, but about five years after that I got my copper IUD and I’ve had it ever since without any problems.

    Now IUD’s are recommended to all sorts of women, in fact I’ve seen a lot of talk about IUD’s being recommended to teens as they’re more effective – e.g. less risk of improper use, forgetting pills, taking conflicting medication, etc. I didn’t doubt the safety of IUD’s ten years ago, left-over fears from when IUD’s were not as safe I suppose, but it’s just strange that in such a short space of time the medical community has taken such a 180….it REALLY shows how vitally important it is for doctors to keep up to date, and for their patients to do a little research on their own too.

    Posted by Jay | November 19, 2013, 7:14 pm
  3. Thanks for your posts regarding IUDs. I was nervous to get one b/c of all the scary stuff on the internet. After I read some of your previous posts on IUDs, I decided to give it a try. I did the Mirena a few months ago and I love it. Easy, easy, easy!

    Posted by Emily | November 19, 2013, 8:30 pm

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