Intrauterine Devices (IUDs): Access for Women in the U.S.

Intrauterine devices (IUDs) are one of the most effective forms of reversible contraception. IUDs, along with implants, are known as long-acting reversible contraception (LARCs) because they can be used to prevent pregnancy for several years.  IUDs have been used in the U.S. for decades, but a safety controversy in the 1970s prompted the removal of all but one IUD from the U.S. market by 1986. The first new generation IUD was introduced to the U.S. market in 1988, following revised Food and Drug Administration (FDA) safety and manufacturing requirements.1 Recent controversies have focused on the mechanism of action of IUDs, the high upfront costs for the device, and variability in insurance coverage and access.

This fact sheet reviews:

What is an IUD?

IUDs are small devices placed into the uterus through the cervix by a trained medical provider to prevent pregnancy. A follow up visit is recommended post-insertion to confirm placement, and a visit to the provider is required for removal.2 IUDs are effective for 3 to 10 years, depending on the type of IUD. There are two major categories of IUDs – copper and hormonal- and within those categories, there are currently five IUDs approved by the FDA (Table 1).  IUDs work by affecting the ovum and sperm to prevent fertilization and are more than 99% effective at preventing pregnancy. They do not protect against HIV and other sexually transmitted infections (STIs). IUDs do not affect an established pregnancy and do not act as an abortifacient.

Non-Hormonal Copper-T Intrauterine Device

The copper IUD is a hormone-free T-shaped device wrapped in copper wire and is effective for up to 10 years.3

Hormonal Intrauterine Devices (LNG-IUD)

There are currently four hormonal IUDs available on the US market, also known as LNG-IUDs because they contain the progestin hormone levonorgestrel, which is released in small amounts each day. Today, most women who use IUDs use one of the hormonal products.  Hormonal IUDs are not effective as emergency contraception.

Table 1: Types of IUDs
Copper IUD Available Since Years Effective Use and FDA Approval Possible side effects
Copper IUD (Paragard) 1988 10 years Approved only in parous women, but available to all women regardless of parity.

Can be used as Emergency Contraception when inserted within 5 days.

  • Abnormal menstrual bleeding.
  • Higher frequency or intensity of cramps/ pain.
Hormonal IUDs Available Since Years Effective FDA Approval Possible side effects
Mirena 2001 5 years Approved only in parous women, but available to all women regardless of parity.
  • Inter-menstrual spotting in the early months.
  • Reduces menstrual blood loss significantly.
  • Hormone-related: headaches, nausea, breast tenderness, depression, cyst formation.
Skyla 2013 3 years Approved for women regardless of parity.
Liletta 2015 3 years Approved for women regardless of parity.
Kyleena 2016 5 years Approved for women regardless of parity.

Use, Awareness, and Availability of IUDs

Use of IUDs in the U.S. has been increasing substantially since the early 2000s, but is still lower than other methods.  Attitudes regarding safety of IUDs are beginning to shift and interest is growing, especially among younger providers and younger women who have less knowledge of the IUD controversies of the past.17

Use

Figure 1: Share of Women using IUDs in the past month by Age, 2011-2013

Figure 2: IUD Utilization over time among women ages 15-44 who used contraception within previous 30 days, 1982-2013

Awareness
Post pregnancy
Availability

Insurance Coverage and Financing of IUDs

The costs of IUDs have been a barrier to its use, for both patients and providers.  Prices for an IUD typically range between $500 and $1,000, in addition to provider visits for insertion, removal and confirmation that the device was properly placed.33 While many insurance plans have covered IUDs for years, prior to the passage of the Affordable Care Act (ACA), women were likely to have out-of-pocket charges for the product as well as the associated visits. The ACA has eliminated these costs for many women.

Private Insurance
Medicaid
Uninsured

Conclusion

IUDs are one of the most effective forms of reversible contraception and interest in them is growing among women and their providers. While use of IUDs is still relatively low, the ACA’s requirement for coverage of contraceptive services and supplies without cost-sharing removes cost barriers for millions of women with private coverage. The elimination of the cost related barriers along with greater awareness and acceptance of IUDs among providers and women will likely increase the use of one of the most effective methods of contraceptive available to women with the potential to reduce unintended pregnancies in the U.S.

Endnotes
  1. Xu, X., et al. (2011). Revival of the intrauterine device: increased insertions among US women with employer-sponsored insurance, 2002-2008. Contraception 85.

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  2. Yoost, J. (2014). Understanding benefits and addressing misperceptions and barriers to intrauterine device access among populations in the United Sates. Patient Preference and Adherence 2014(8).

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  3. The American College of Obstetricians and Gynecologists (ACOG), (2011). Long-Acting Reversible Contraception: Implants and Intrauterine Devices. Practice Bulletin Number 121.

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  4. Teva Pharmaceutical Industries, Paragard- Direct. FAQs.

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  5. Yoost, J. (2014). Understanding benefits and addressing misperceptions and barriers to intrauterine device access among populations in the United Sates. Patient Preference and Adherence 2014(8).

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  6. ACOG (2011). Long-Acting Reversible Contraception: Implants and Intrauterine Devices. Practice Bulletin Number 121.

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  7. Cleland, K, et al. (2012). The efficacy of intrauterine devices for emergency contraception: a systematic review of 35 years of experience. Human Reproduction 27(7).

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  8. Kaiser Family Foundation. (2014). Emergency Contraception

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  9. ACOG (2011). Long-Acting Reversible Contraception: Implants and Intrauterine Devices. Practice Bulletin Number 121.

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  10. Ortiz, ME & Croxatto, HB. (2007). Copper-T intrauterine device and levonorgestrel intrauterine system: biological bases of their mechanism of action. Contraception 75.

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  11. Bayer Healthcare Pharmaceuticals, Mirena, Frequently Asked Questions.

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  12. Ibid.

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  13. ACOG (2011). Long-Acting Reversible Contraception: Implants and Intrauterine Devices. Practice Bulletin Number 121.

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  14. Yoost, J. (2014). Understanding benefits and addressing misperceptions and barriers to intrauterine device access among populations in the United Sates. Patient Preference and Adherence 2014(8).

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  15. Medicines360. (February 27, 2015). Press release: Actavis and Medicines360 Announce FDA Approval of LILETTA (levonorgesrel-releasing intrauterine system) 52 mg to Prevent Pregnancy for up to Three Years.

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  16. Bayer Pharmaceuticals, Kyleena Information Website

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  17. Hubacher, D. (2002). The checkered history and bright future of Intrauterine Contraception in the United States. Perspectives on Sexual and Reproductive Health 34(2).

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  18. Centers for Disease Control and Prevention. (2015). Health, United States, 2014.

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  19. Branum, A.M. & Jones, J. (2015). Trends in long-acting reversible contraception use among U.S. women aged 15-44. NCHS Data Brief 188.

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  20. Xu, X., et al. (2011). Revival of the intrauterine device: increased insertions among US women with employer-sponsored insurance, 2002-2008. Contraception 85.

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  21. ACOG. (2012). Committee Opinion: Adolescents and Long-acting reversible contraception: Implants and Intrauterine Devices.

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  22. American Academy of Pediatrics. (2014). AAP updates recommendations on teen pregnancy prevention.

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  23. Luchowski, A.T., et al. (2014). Obstetrician-Gynecologists and contraception: long-acting reversible contraception practices and education. Contraception 89.

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  24. Luchowski, A.T., et al. (2014). Obstetrician-Gynecologists and contraception: practice and opinions about the use of IUDs in nulliparous women, adolescents and other patient populations. Contraception 89.

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  25. Whaley, N. & Burke, A. (2015). Contraception in the postpartum period: immediate options for long-acting success. Women’s Health 11(2).

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  26. Chen BA, et al. (2010). Postplacental or delayed insertion of the levonorgestrel intrauterine device after vaginal delivery: a randomized controlled trial. Obstet Gynecol. 116(5):1079-87.

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  27. Luchowski, A.T., et al. (2014). Obstetrician-Gynecologists and contraception: long-acting reversible contraception practices and education. Contraception 89.

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  28. ACOG (2011). Long-Acting Reversible Contraception: Implants and Intrauterine Devices. Practice Bulletin Number 121.

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  29. Sober, S. & Schreiber, C.A. (2014). Postpartum contraception. Clinical Obstetrics & Gynecology 57(4).

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  30. National Health Law Program, et al. (2015). Intrauterine Devices and Implants: A Guide to Reimbursement.

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  31. Luchowski, A.T., et al. (2014). Obstetrician-Gynecologists and contraception: long-acting reversible contraception practices and education. Contraception 89.

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  32. Wood, S., et al. (2013). Health Centers and Family Planning: Results of a Nationwide Study. Health Policy Faculty Publications. Paper 60.

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  33. Yoost, J. (2014). Understanding benefits and addressing misperceptions and barriers to intrauterine device access among populations in the United Sates. Patient Preference and Adherence 2014(8).

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  34. Centers for Medicare and Medicaid Services. (2015). FAQs about the Affordable Care Act Implementation (Part XXVI).

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  35. Sonfield, A, et al. (2014). Impact of the federal contraceptive coverage guarantee on out of pocket payments for contraceptives: 2014 update. Contraception 91.

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  36. Becker, N. & Polsky, D., (2015).  Women saw large decrease in out-of-pocket spending for contraceptives after ACA mandate removed cost sharing.  Health Affairs 34(7).

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  37. Kaiser Family Foundation. (2015). Medicaid and Family Planning: Background and Implications of the ACA.

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  38. Ibid.

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  39. Rodriguez, M.I., et al. (2009). Cost-benefit analysis of state- and hospital-funded postpartum intrauterine contraception at a university hospital for recent immigrants to the United States. Contraception 81.

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  40. Kaiser Family Foundation. (2015). State Health Facts: Expanded Eligibility for Family Planning Services Under Medicaid.

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  41. Medicines360. (February 27, 2015). Press release: Actavis and Medicines360 Announce FDA Approval of LILETTA (levonorgesrel-releasing intrauterine system) 52 mg to Prevent Pregnancy for up to Three Years.

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  42. Bayer Healthcare Pharmaceuticals, Skyla- Getting Skyla.

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  43. Teva Pharmaceutical Industries, Paragard- What it costs.

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  44. Secura, G.M., et al. (2010). The Contraceptive CHOICE Project: Reducing Barriers to Long-Acting Reversible Contraception. American Journal of Obstetrics and Gynecology 203(2): 115.e1-115.e7.

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  45. McNicholas, C., et al. (2014). The Contraceptive CHOICE Project Round Up: What we did and what we learned. Clinical Obstetrics and Gynecology 57(4).

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  46. Ibid.

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  47. O’Neil-Callahan, M., et al. (2013). Twenty-four-month continuation of reversible contraception. Obstetrics & Gynecology 122(5).

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