IUDs: Now for Emergencies?


According to the results of a study undertaken in China by the National Research Institute for Family Planning, the Copper IUD (sold under the name ParaGard in the United States) can be an excellent emergency contraceptive if inserted within five days of unprotected sex.

Researchers followed 2000 women who came to eighteen different clinics around the country for emergency contraception, within the five day window, and then were implanted with the Copper IUD. Women returned for follow-up visits, according to the study published in BJOG (an international journal of obstetrics and gynecology), at 1, 3 and 12 months post-insertion. Prior to or at the first follow-up visit, not one woman (all but 70 women returned) had become pregnant.

Women involved in the study did report some side effects: increased menstrual bleeding and menstrual disturbances (however vague that might be). Twenty-nine women “experienced a difficult IUD insertion process, requiring local anaesthesia or prophylactic antibiotics,” notes the study.

It’s an interesting find.

The old kid on the block, Plan B, the brand name for the emergency contraceptive (EC) pills sold in the United States, is effective at preventing pregnancy in 1 out of 100 pregnancies. Women have been encouraged to keep them “on hand” or in their medicine cabinet so, if there comes a time when they do need them, they do not need to struggle with finding a pharmacy open and available as soon as possible or finding a pharmacy that won’t judge or refuse to sell the pills to you. A recent study concluded that though women who keep EC on hand are not as likely to use the pills as previously thought, it is still an important option for women to have.

But how likely is it that a woman who is in immediate need of emergency contraception would actually choose to undergo insertion of an IUD into her uterus, have access to a health provider in a timely manner or be able to afford the “option,”  in order to make use of this successful form of emergency contraception?

From a Reuters article on the study:

“…despite the benefits of Copper T, it’s not easy to get for many women seeking emergency contraception in the United States. One deterrent is that while women 17 and over can buy Plan B over-the-counter at a pharmacy, Copper T must be inserted by a doctor – an extra step for women who only have a window of time when emergency contraception can work.

“The issue,” Godfrey said, “is immediate access. In the U.S. it’s easier just to go to a pharmacy.”

And while Plan B runs for about $50 off the shelf, Godfrey said that depending on her insurance a woman could pay more than $500 to have Copper T inserted. “Cost could certainly be prohibitive,” she said.”

There are two different IUDs sold in the United States, currently. The hormonal IUD, sold under the brand name Mirena continually releases hormones into your body for up to five years; and the Copper IUD. Both work to prevent fertilization of an egg or to create an inhospitable environment for a fertilized egg to attach to the uterine wall.

The IUD is a more permanent form of birth control so if you use have one inserted, it’s a one-time only occurrence (or at least a one-time every 5-10 years occurrence). While these sorts of studies are important from an efficacy perspective, they don’t take into account the reality of women’s lives. What are the real benefits of a study such as this one if most women cannot ultimately make use of the results?

Dr. James Trussell, a long-time proponent for emergency contraception, and head of the Office of Population Research at Princeton University was quoted as saying,

“It’s too bad it’s [Copper IUD] not used more often…If there were many, many more IUD insertions rather than emergency contraception pills (used), it certainly would have an impact on lowering pregnancy rates and abortion.”

And while I cannot argue with his logic, it’s the realistic implementation in women’s lives with which I take issue. It seems to me that if we look at women’s lives first and see how we can best address unplanned pregnancy rates given, well, the givens then we can “impact” said rates much more effectively.

I’m sorry if I’m short sighted here but the IUD, while effective at preventing pregnancy, is not the right method of birth control for every woman. Here’s a basic run-down, from Planned Parenthood, on when you shouldn’t use the IUD:

You should not use an IUD if you:

  • have had a pelvic infection following either childbirth or an abortion in the past three months
  • have or may have a sexually transmitted infection or other pelvic infection
  • think you might be pregnant
  • have cervical cancer that hasn’t been treated
  • have cancer of the uterus
  • have unexplained bleeding in your vagina
  • have pelvic tuberculosis
  • have a uterine perforation during IUD insertion

There’s a lot of room between thinking “you may have” an STI and finding out for sure. Would a doctor insert an “emergency” IUD in that case? What about not knowing if you have cervical cancer or not? Would a woman be honest about her symptoms if she were so intent on preventing pregnancy and getting an IUD put in place? This is a long list of “ifs” to me. I’m not discounting the IUD as a form of EC but I’m not sure this study would be enough to persuade me that inserting an IUD so swiftly is a bright idea, unless the woman has already done her research and was planning on having one inserted anyway.

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  • alison-cole

    At Aurora Medical Services where I’ve worked for seven years, we’ve been using copper IUDs as EC for as long as I can remember. They’re not for everyone, for sure, but when a woman comes in wanting an IUD but hasn’t been using birth control consistently for the previous two weeks, with the Mirena (hormonal IUD) she has to come back another time because we don’t want to insert an IUD if she might become pregnant from the recent sex. With the Paragard, she can still have her IUD if the unprotected sex was within 5 days, because we know the IUD will act as an emergency contraceptive. This has the effect of increasing access for women who want Paragards, and that’s great. However, we certainly do not suggest Paragard as the first option for EC for most women. I like to have lots of tricks up our sleeves for outwitting those pesky gametes, and this is another one. As long a it isn’t pushed on women who didn’t really want an IUD in the first place, I think it’s a good thing to know that copper IUDs can act as EC.

  • amie-newman

    This is so helpful! I think it makes sense, of course, if it’s a method that a woman has considered and it’s one she & her provider have decided upon, given her health and lifestyle. And, yes, it’s great to know that another method of BC can act as an emergency contraceptive. Thanks for the info, Alison!