Advantages and disadvantages of IUDs

Advantages and disadvantages of intrauterine contraceptive devices are listed in Advantages and disadvantages of intrauterine contraceptive devices. Also consider other factors affecting choice of contraceptive method.

Table 1. Advantages and disadvantages of intrauterine contraceptive devices
Advantages
extremely effective (copper IUD: 99.5%; LNG-IUDs: 99.7 to 99.9%) minimal user involvement—beneficial if compliance may be difficult (eg in adolescence) long-acting (copper IUD: effective for 5 or 10 years; both LNG-IUDs effective for 5 years) high continuation rates (83 to 88% at 1 year) cost-effective safe during breastfeeding few contraindications or precautions, and few serious risks associated with use no drug interactions may be of particular benefit postpartum and in those who may benefit from extended use (see advice in females aged 40 to 49 years and females aged 50 years and older) rapid return of fertility after removal 52 mg LNG-IUD: improves dysmenorrhoea and endometriosis is indicated for heavy menstrual bleeding [NB1] is indicated for prevention of endometrial hyperplasia (for up to 5 years) in individuals using estrogen for menopausal hormone therapy [NB2] 19.5 mg LNG-IUD: improves dysmenorrhoea decreases menstrual bleeding [NB3] LNG-IUDs are available on the PBS, but cost of insertion varies with the provider copper IUDs provide highly effective emergency contraception if inserted within 5 days of unprotected sexual intercourse
Disadvantages
harmful to an ongoing pregnancy; pregnancy must be excluded before starting (not suitable for Quick Start) requires pelvic exam and a procedure for insertion altered bleeding patterns adverse effects and complications: vaginal discharge uterine perforation IUD expulsion, malposition or embedding pelvic inflammatory disease (within the first 20 days of insertion) additional adverse effects with LNG-IUDs [NB4]: benign ovarian cysts headaches mood changes [NB5] weight gain breast tenderness loss of libido acne
Note: IUD = intrauterine contraceptive device; LNG-IUD = levonorgestrel-releasing IUD; PBS = Pharmaceutical Benefits Scheme; TGA = Therapeutic Goods Administration NB1: The 52 mg LNG-IUD causes amenorrhoea or infrequent bleeding in up to 49% of users by 1 year. NB2: The 19.5 mg LNG-IUD is not indicated for prevention of endometrial hyperplasia in individuals using estrogen for menopausal hormone therapy; it is not recommended for extended use beyond 5 years. NB3: Although the 19.5 mg LNG-IUD causes amenorrhoea or light bleeding in up to 38% of users by 1 year, it is not registered for heavy menstrual bleeding by the Australian TGA. NB4: These adverse effects have been reported by users of all forms of progestogen-only contraception, but evidence is insufficient to prove a causal effect. Many resolve within 3 months of starting the contraceptive. NB5: An association between first prescription of an antidepressant and contraceptive use has been seen, but a causal link is not proven.