Category: Health Issues Topic: The evolution and improvement of the IUD as a contraceptive method Although the first contraceptives date back millennia, it was not until the 196s that their use became widespread and normalized in many societies. When its prohibition ended and birth control measures began to be offered on a regular basis, contraceptive methods underwent a great evolution that is still ongoing. The IUD has been one of the contraceptives that best represents this evolution, and for this reason it is considered one of the safest and most effective. The placement of a foreign body in the uterus as a contraceptive method is attributed to Hippocrates and dates from the 4th century BC, but the first time that a great advance is seen is in 1928, thanks to Richard Richter, who presents a system based on a loop of silk thread.

History of the Copper IUD and Mirena IUD

  • It will be a year later when Ernest Grafeberg devises a system already very similar to the current copper IUD, with a system that uses an alloy of copper and silver. With various refinements, the copper IUD began its journey in the 1970s, with improvements that managed to improve its effectiveness and reduce the risk of side effects.
  • The Mirena IUD adds the function of hormones to the mechanical operation of the IUD, so it is understandable that its development was later, and happened in parallel to that of the contraceptive pill, the vaginal ring and other systems based on the same principle.
  • As such, the hormonal IUD was developed in Finland during the 1970s, and introduced in 1989. The aim was to perfect the system used by the copper IUD, eliminating some of its most harmful side effects and risks, such as hypermenorrhea, ectopic pregnancy or allergy to copper, also increasing its effectiveness by regulating the menstrual cycle.
  • Although the first Mirena IUD devices, like other hormonal methods, contained a high amount of progesterone and other hormones, advances have made it possible to maintain and even increase their effectiveness by reducing their amount, which is why current IUDs are found among the most recommended methods for women as long as they are not among the risk groups.
## How modern IUDs work: types, mechanisms and relative effectiveness The word “IUD” covers two broad categories: **copper (non-hormonal) IUDs** and **levonorgestrel-releasing (hormonal/LNG) IUDs**. Both work primarily in the uterine cavity but by different mechanisms: - Copper IUDs: Copper ions create a local inflammatory environment that is toxic to sperm, inhibits sperm motility and viability, and prevents fertilization. They also may prevent implantation in a very small proportion of cases. - LNG IUDs (eg, Mirena, Kyleena, Skyla/Jaydess, Liletta): These release levonorgestrel locally into the uterine cavity at low doses, thickening cervical mucus (reducing sperm entry), impairing sperm function, and causing local endometrial changes that reduce the chance of implantation. Systemic hormone levels are much lower than oral contraceptives. Common modern devices and practical distinctions: - Copper T 380A (often called ParaGard): FDA-approved for up to 10-12 years depending on country guidance. Very effective non-hormonal option. - Levonorgestrel IUDs: - Mirena (52 mg): approved for up to 5–8 years depending on indication; common for contraception and for treating heavy menstrual bleeding. - Liletta (52 mg): similar to Mirena in dose and duration but produced by different manufacturers. - Kyleena (19.5 mg) and Skyla/Jaydess (13.5 mg): smaller devices with shorter licensed durations (3–5 years), designed for nulliparous people and those preferring lower hormone dose. Relative effectiveness (typical-use first-year failure estimates, approximate): - **LNG-IUDs:** 80% and her iron studies normalized at 6 months. - Example 3: A 21-year-old with a single sexual exposure presented for emergency contraception. A copper IUD was placed within 72 hours and provided ongoing contraception thereafter. Special scenarios and actionable steps: - **Pregnancy with IUD in situ**: If pregnancy occurs, assess location (ultrasound). If IUD strings are visible, consider removal to reduce risk of miscarriage and infection. If strings not visible, counsel about risks and monitoring — removal may not be possible without disrupting pregnancy. - **IUD and infertility concerns**: Fertility typically returns quickly after removal; IUDs are reversible and do not adversely affect long-term fertility. - **Breastfeeding**: Both copper and LNG-IUDs are safe during breastfeeding; consider timing (often placed at 6 weeks postpartum or earlier if needed). ## Advanced clinical tips for providers (two actionable recommendations) ### 1) Reducing insertion pain and minimizing perforation risk — evidence-based steps - **Pre-procedure assessment**: Ask about past cervical surgeries, uterine anomalies, known fibroids and prior difficult insertions. History of difficult cervical access → plan for paracervical block or outpatient hysteroscopic placement. - **Use of intrauterine sound**: Sounding is standard to measure uterine depth and orientation. If the uterine sounding depth is 10 cm or the angle is unusual, consider ultrasound-guided insertion. - **Ultrasound guidance for high-risk insertions**: For postpartum, post-cesarean, or known distorted cavities, ultrasound guidance during insertion reduces malposition and perforation risk. - **Mechanical technique**: Stabilize cervix carefully with tenaculum; avoid excessive traction. If resistance is felt during insertion, stop and reassess rather than forcing the inserter. - **Analgesia algorithm**: - Routine: NSAID 1 hour pre. - If anxious or nulliparous with history of dysmenorrhea: add paracervical block. - For failed office insertion due to pain or anatomy: offer hysteroscopic or outpatient operative insertion under local sedation. ### 2) Managing unscheduled bleeding and bleeding disorders — clinic protocol - **Initial assessment**: Ask timing, amount, pattern, and rule out pregnancy or infection. - **First-line measures**: NSAIDs (naproxen or ibuprofen) during bleeding; tranexamic acid 1 g three times a day during heavy days for copper IUD users. - **When to switch**: - If heavy bleeding persists beyond 3–6 months on copper IUD despite medical therapy and affects quality of life → counsel for removal and consider LNG-IUD replacement or surgical options. - For LNG-IUD users who develop bothersome irregular bleeding initially: reassurance for up to 6 months. If persistent bleeding after 6 months, consider evaluation for anovulatory cycles, structural causes (polyps, submucous fibroids), or hypothyroidism; treat accordingly. - **Real-world clinic example**: - A patient with a copper IUD using tranexamic acid with good symptom control and returns to normal activity levels—demonstrates importance of targeted medical therapy before device removal. ## FAQ ### What are the main differences between copper IUDs and hormonal (LNG) IUDs? Copper IUDs are non-hormonal, work by creating a spermicidal uterine environment, and can last up to 10–12 years depending on the device. They are appropriate for people who wish to avoid hormones, including breastfeeding patients. Typical side effects are heavier and more painful periods, especially in the first 3–6 months. Hormonal (LNG) IUDs release levonorgestrel locally, reduce menstrual bleeding, and often cause lighter periods or amenorrhea; they are highly effective for contraception and are also used therapeutically for heavy menstrual bleeding. Hormonal IUDs have low systemic hormone exposure but can cause hormonal side effects (breast tenderness, mood changes) in a minority. ### How painful is insertion, and how can I minimize the discomfort? Most patients feel cramping similar to strong menstrual cramps during insertion, with discomfort usually lasting minutes to hours afterward. To reduce pain: take an NSAID (eg, ibuprofen 400–600 mg) about one hour before insertion; consider a paracervical block for anxious or nulliparous patients; use lidocaine gel for local comfort. Communicate clearly during the procedure, use gentle technique, and stop if severe pain or unexpected findings occur. For patients with previous difficult insertions, ultrasound-guided or hysteroscopic placement under sedation can be offered. ### Can teenagers or women who have never given birth safely get an IUD? Yes. Current evidence supports offering both copper and LNG-IUDs to adolescents and nulliparous women. Choose device size appropriately and counsel on the slightly higher expulsion rate and potential for cramping; provide effective analgesia and clear follow-up instructions. ### What should I do if I think my IUD has come out or the strings feel different? If you feel the IUD is missing or strings shorter/longer than usual, avoid intercourse or use backup contraception and see a clinician promptly. An exam and possibly pelvic ultrasound will determine whether the device has been expelled, is malpositioned, or remains in place. If expelled, replace it same-day or at next visit if desired. If missing and not found, evaluate for possible perforation (rare) and provide appropriate imaging. ### If I want to get pregnant, how long after I remove my IUD will it take to conceive? Fertility typically returns rapidly after IUD removal—often within the first cycle for most women. If your IUD is hormonal, there is no evidence of long-term delay in fertility after removal. If you have concerns about fertility or are older with known diminished ovarian reserve, start preconception planning and testing as appropriate when removing the device. --- If you would like a printable insertion checklist, patient counseling scripts, or references for device-specific indications and removal technique, visit our [related topic](/blog) or find aftercare supplies at our [shop](/shop).