Evaluation of the IUD Paragard

IUD Paragard

Introduction

According to Paragard’s official website, “Paragard is a small, hormone-free IUD made of soft, flexible plastic wrapped with a thin layer of copper” (Paragard, 2019).  Its stem is 1.42 inches in length and its arms spread to 1.26 inches in width. The thin layer of copper wraps around the arms and the stem of the device. “The copper in Paragard works to prevent sperm from reaching the egg and fertilizing it and may also prevent implantation” (Paragard, 2019). A healthcare provider is able to place this IUD in your uterus during an office visit, which takes just a few minutes to do. Once placed in the uterus, the patient shouldn’t be able to feel the device at all.

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Reliability

The IUD Paragard is over 99% effective at preventing unwanted pregnancy, which makes this a reliable form of birth control. It is more effective than the other types of hormone-free birth control, such as condoms, cervical cap, withdrawal method, spermicide, diaphragm, sponge, and fertility awareness-based methods (Paragard, 2019).  It’s also more effective than most hormonal birth controls such as injections, pills, patches, and rings. The American College of Obstetricians and Gynecologists (ACOG) claims that Paragard is one of the most reliable methods of preventing pregnancy (Paragard, 2019).

Cost

This form of birth control is also most of the time covered by insurance so there are usually no costs at all. Some additional fees may occur for the Paragard placement procedure may apply. Without insurance, the IUD can cost between $500-1000 but most Planned Parenthood centers are willing to work with their patients and make it more affordable for people who can’t or don’t have insurance.

Pros and Cons

Some of the pros of Paragard are that it prevents pregnancy without the use of any hormones. This means that there are no hormone-related side effects. According to Planned Parenthood, birth control pills, a hormonal method, cause side effects such as nausea and headaches, as well as increase your risk for a few health problems (Planned Parenthood, 2019). Instead of artificial hormones that cause such side effects, the active ingredient of Paragard is copper. Copper is a naturally according mineral that is proven to be safe as well as effective at preventing pregnancy, and has been approved by the FDA for over 30 years (Planned Parenthood, 2019). Another pro is that it is low maintenance. Paragard continuously prevents pregnancy without the need for a daily routine. It can prevent a pregnancy for close to up to ten years. This is twice as long compared to the longest lasting hormonal IUD, making “Paragard the longest lasting prescription birth control method” currently available (Paragard, 2019). Although this device can last up to ten years, it may be removed at any time or at any convenience. This is yet another pro because if you decide you want to get pregnant or simply stop using it, your health care provider is able to take it out right then and there. Unlike hormonal birth controls, Paragard does not prevent ovulation each month. What this means is that once the IUD is removed, your ability to get pregnant will return instantly (Planned Parenthood, 2019).

This leads us to the cons of Paragard. Since this form of birth control does not prevent ovulation you will still get your period monthly, which for some women may be a con. According to the safety information provided by the Paragard’s official website “less than 1% of users get a serious infection called pelvic inflammatory disease (PID)”. This is a con of this birth control method, although unlikely to develop PID through the use of Paragard, it is a possibility. Another con, although rare, is that the device may attach or go through the uterus. This may cause other problems and complications. Since Paragard is highly effective, pregnancy is not common but could be life threatening and can cause a loss of pregnancy or infertility. One other con is that the IUD may come out, in that case you would have to resort to other birth control methods as a backup (Planned Parenthood, 2019). Along with these complications other cons include the possible side effects listed below. Like almost all birth control methods, this method does not protect against HIV or STDs so other protection should still be used as well (Paragard, 2019).

Patient Teaching

It is important to inform your patient of all the information stated above as well as the side effects so they understand both the benefits as well as the negative possibilities of using Paragard as their main birth control method. You should also explain to your patient that there should be an initial follow-up about a month after placement with their health care provider to make sure the Paragard is still in place in the uterus. It is also important to inform your patient that they should get in the habit of doing a monthly thread-check of their Paragard to make sure it’s still in the proper place. To explain how to do this, inform the patient that they should use clean fingers to reach the top of their vagina to feel for the two threads, while making sure not to pull on the threads (Planned Parenthood, 2019). If they have trouble finding the threads or feel more than just the threads, they should call their health care provider and use an additional form of birth control as backup (Paragard, 2019).

Side Effects

Side effects that can be expected from the use of Paragard include longer and heavier periods as well as spotting in between periods (Paragard, 2019). For most, this side effect goes away after the first two to three months. If switching from hormonal to Paragard, periods may seem heavier than normal. Other more serious side effects may also occur, including Pelvic Inflammatory Disease (PID) which is an infection that affects the uterus, tubes, and nearby organs (Paragard, 2019).

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PID is most likely to occur within the first 20 days of placement and your chances of PID increase if your partner is having sex with more than one person. PID itself can cause serious problems such as infertility, atopic pregnancy, and chronic pelvic pain. More serious PID can cause death or a need for a hysterectomy. Sometimes Paragard can be hard to remove if it has become stuck to the uterus, in this case surgery may be needed to remove the IUD. Rarely, Paragard perforates the uterus during placement which can cause infection, scaring or damage to other organs. If perforation occurs, pregnancy is not prevented. There is a possibility that Paragard may partially or completely fall out of the uterus, which is more likely to occur in women who have never been pregnant before. “Other side effects include anemia, backache, pain during sex, menstrual cramps allergic reactions, vaginal infections, vaginal discharge, faintness, or pain” (Paragard, 2019).

Conclusion

Although Paragard is a reliable birth control, it is not for everyone and this should be taken into consideration when determining what is best for the patient. As nurses, it is expected that we understand how there are many types of birth control that effect the body differently. It is important that we are knowledgeable of this information so that we are able to properly inform and provide the best treatment for our patients.

References

• Paragard. Birth Control that's 100% Hormone-Free. (2019, January). Retrieved June, 2019, from https://www.paragard.com/what-is-paragard/
• Parenthood, P. (2019). Are Birth Control Pills Safe & Are They Right For You? Retrieved from https://www.plannedparenthood.org/learn/birth-control/birth-control-pill/how-safe-is-the-birth-control-pill