What is the best Intrauterine Device (IUD) for a female with children?

Best IUD for Women with Children

For parous women (those who have had children), both the levonorgestrel IUD and copper IUD are Category 1 (no restrictions), making either option excellent, but the levonorgestrel IUD is generally preferred due to its additional therapeutic benefits including reduced menstrual bleeding and treatment of dysmenorrhea. 1, 2

Why Parity Matters

• Women who have had children are classified as Category 1 for both IUD types, meaning there are no restrictions on use and they are ideal candidates 1
• Parous women have lower expulsion rates compared to nulliparous women, making IUD placement more successful 1
• The concern about expulsion that exists for younger nulliparous women (Category 2) does not apply to women with children 1

Levonorgestrel IUD: The Preferred Choice

The levonorgestrel IUD offers contraceptive effectiveness plus therapeutic benefits that make it particularly advantageous for parous women:

Contraceptive Efficacy

• Failure rate less than 1% with both typical and perfect use 2
• Multiple formulations available: 52 mg versions (Mirena, Liletta) approved for 5 years but effective up to 7-8 years, and 13.5 mg version (Skyla) approved for 3 years 2
• Cumulative failure rate of only 0.68% during years 6-8 of extended use 2

Therapeutic Benefits Beyond Contraception

• Reduces menstrual blood loss by 90% from pretreatment levels during the first year 3
• Many women experience lighter periods or complete amenorrhea 2
• Effective treatment for menorrhagia, serving as first-line medical management before considering surgical interventions 2
• Therapeutic effect on dysmenorrhea (painful periods) 4, 3
• Can replace more invasive surgical methods like hysterectomy or endometrial resection for heavy bleeding 5

Mechanism and Safety

• Works primarily by preventing fertilization through inhibiting sperm motility and thickening cervical mucus, all before implantation 2
• Contains only progestin (levonorgestrel), no estrogen, making it suitable for women with estrogen contraindications 2
• Rapid return to fertility after removal 2
• Small risk of pelvic infection only during first 20-21 days after insertion 2

Common Side Effects to Counsel About

• Irregular spotting and bleeding common during first 2-3 months after insertion 5, 3
• Some women may develop functional ovarian cysts (typically benign and self-resolving) 4
• Amenorrhea, while medically beneficial, may be concerning to some women and requires counseling 4

Copper IUD: The Hormone-Free Alternative

The copper IUD is the best choice for women who prefer hormone-free contraception or have contraindications to progestins:

Advantages

• Approved for 10 years of use, with effectiveness demonstrated for at least 12 years 6
• Failure rate less than 1% throughout duration of use 6
• No hormonal side effects 6
• Can serve as emergency contraception when inserted within 5 days of unprotected intercourse 6

Disadvantages

• May increase menstrual blood loss and dysmenorrhea 7
• Does not provide the therapeutic benefits for heavy bleeding that levonorgestrel IUDs offer 7

Clinical Decision Algorithm

Choose levonorgestrel IUD if:

• Patient has heavy menstrual bleeding or dysmenorrhea 2, 3
• Patient desires lighter or absent periods 2
• Patient has no contraindications to progestins 2
• Patient prefers potential non-contraceptive health benefits 4

Choose copper IUD if:

• Patient specifically desires hormone-free contraception 7
• Patient has contraindications to hormonal methods 6
• Patient needs emergency contraception (can be inserted up to 5 days post-intercourse) 6
• Patient has normal or light menstrual bleeding and no dysmenorrhea 7

Important Counseling Points

• Both IUDs can be inserted at any time during the menstrual cycle if pregnancy is ruled out 7
• For postpartum women, insertion is safe at ≥4 weeks after delivery (Category 1 for both types) 1
• Counsel that irregular bleeding with levonorgestrel IUD typically resolves after 2-3 months 3
• Advise that device removal is available at any time if bleeding patterns or side effects are unacceptable 2
• Women in stable, monogamous relationships are ideal candidates; those at risk for STIs require additional counseling about condom use 7