An intrauterine device (IUD) is a long-term form of contraception. The small, T-shaped device is placed into the uterus by a healthcare provider and can remain in place for 3 to 10 years, depending on the specific device. An IUD is highly effective at preventing pregnancy, and this form of contraception is immediately reversible upon removal. Unlike early IUDs of the 1960s and 1970s, currently available IUDs do not appear to substantially increase a woman's risk for reproductive tract infections other than perhaps during the first month after placement. However, IUD users -- like women using other forms of contraception -- can develop reproductive tract infections at any time. So it's important to be aware of the signs and symptoms.
Modern IUDs and Pelvic Inflammatory Disease Risk
When discussing IUDs and infections, pelvic inflammatory disease (PID) is often the elephant in the room. PID refers to an infection of the upper female reproductive tract, typically involving the uterus and ovarian tubes. PID usually develops as a complication of a sexually transmitted infection (STI), such as chlamydia, gonorrhea, or both. Obviously, all sexually active women are at risk for STIs that could potentially progress to PID.
Early versions of the IUD were associated with a significantly increased risk for PID, which was largely attributed to design flaws. With modern copper and hormonal IUDs, however, there appears to be only a slightly increased risk for PID -- at most. Moreover, this potential risk appears to be limited to the first month after the IUD is placed in the uterus. Thereafter, the risk of PID appears to be equivalent between IUD users and women without an IUD, as noted in a research analysis published in December 2016 in the journal "Contraception."
Signs and Symptoms of PID
Women with PID can experience a range of signs and symptoms, from mild to severe, or no symptoms at all. Unfortunately, even women with severe PID might experience only mild symptoms, so it's important to be vigilant. Possible signs and symptoms of PID include:
-- lower abdominal and/or pelvic pain
-- increased vaginal discharge
-- irregular menstrual bleeding
-- pain with intercourse
-- painful, frequent urination
-- abdominal tenderness
-- unexplained fever of 100.4 F or higher
IUD users are urged to watch for PID symptoms, particularly in the month following placement of the device. Doctors theorize that there might be a slightly increased risk for PID during this period among women with an unrecognized STI at the time of IUD placement. After the first month, IUD users should remain vigilant for PID symptoms, although the device itself does not increase a woman's risk.
Signs and Symptoms of Other Reproductive Tract Infections
An IUD does not increase a woman's risk for an STI -- but it also does not protect against an STI. Therefore, IUD users remain vulnerable to STIs, particularly women whose partners do not use condoms. Women with an IUD can also develop non-sexually-transmitted reproductive tract infections, such as a vaginal yeast infection. Signs and symptoms of STIs and other reproductive tract infections vary, depending on the specific infection, and might include:
-- change in vaginal discharge amount, consistency or odor
-- genital itchiness or burning
-- painful urination
-- pain with intercourse
-- rash, sores or growths in the genital area
-- irregular vaginal bleeding
Warnings and Precautions
An IUD does not increase your risk for STIs or other reproductive tract infections, outside of perhaps the first few weeks after placement. Nonetheless, these infections require prompt treatment. See your doctor as soon as possible if you develop any signs or symptoms of an STI or other reproductive tract infection. These infections can usually be successfully treated without removing the IUD.
Seek immediate medical care if you develop any warning signs or symptoms that could signal a severe infection that has spread to the abdomen or bloodstream, including:
-- high fever or chills
-- severe or worsening abdominal pain
-- severe or worsening abdominal tenderness
-- nausea and vomiting
-- rapid heart and/or breathing rate
-- dizziness, lightheadedness or fainting
Reviewed and revised by: Tina M. St. John, M.D.