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Contraceptive Pearl: Do You Under Use IUDs?

In most developed countries, 10-25% of women of reproductive age use intrauterine devices (IUDs) – yet in the United States, only 2% of reproductive-age women use IUDs. Why the discrepancy? Many Americans remember an older, poorly engineered version of the IUD, the Dalkon Shield. This device had an open-ended string that increased the risk of ascending infection. Current IUDs cut this risk by using a closed-ended, monofilament string.

Many clinicians don’t consider IUDs for teens, for nulliparous women, or for those who had a sexually transmitted infection (even in the distant past). By relying on restrictive eligibility guidelines, these clinicians unwittingly contribute to Americans’ prejudice against a highly effective contraceptive method. IUDs are safe and well tolerated. Their high efficacy doesn’t depend on users’ diligence. And after IUD insertion, women and teens have reliable contraception for 7 to 12 years, regardless of insurance status, income, or employment.

Keep these IUD facts in mind when counseling patients who need a new contraceptive method:

  • Nulliparous women can use IUDs.
  • Teens can use IUDs.
  • IUDs lower the overall risk of ectopic pregnancy (even though the rare pregnancies that happen with an IUD in place often occur outside the uterus).
  • IUDs raise the risk of pelvic inflammatory disease only transiently, and only for women with active gonococcal or chlamydial cervicitis at the time of insertion.
  • IUDs can be inserted at any point in the menstrual cycle.
  • Most HIV-infected women can use IUDs.

By broadening your use of IUDs, you can do your part to decrease unintended pregnancy in the U.S.

Helpful Resources

IUD Fact Sheet

Medical Eligibility for Initiating Contraception 

For low-income patients, here are links to manufacturers’ Patient Assistance Programs for the IUD:
ARCH Foundation: Patient Assistance Program for Mirena IUD
Paragard IUD Patient Assistance Program



And check out our own government’s take on IUD eligibility, courtesy of USAID:



The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or contraception. The information in the Contraceptive Pearls is unbiased, based on science alone.

Contraceptive Pearls

This monthly clinical e-newsletter highlights evidence-based best practice for contraceptive care

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