A gynecologist breaks down the connection between pelvic inflammatory disease and the intrauterine device (IUD).

By By Emily Shiffer
February 25, 2019
Photo: JPC-PROD / Shutterstock

It feels like the intrauterine device (IUD) is the Queen Bee of birth control these days. And for good reason. It's one of the most effective options out there, with 99 percent success in preventing pregnancies, according to the Centers for Disease Control. (Other popular methods like birth control pills, the patch, and the ring clock in at 91 percent.) Other perks? IUDs offer long-term birth control (up to 10 years), and according to a 2017 study, may even decrease your risk for cervical cancer.

Its popularity can be contributed, in part, to the 2016 election, when women's health advocates suggested that women get an IUD ASAP before Trump took office, potentially making an IUD inaccessible for many. And, apparently, women listened: A study released earlier this month in JAMA Internal Medicine found that there was a sharp increase-21.6 percent to be exact-in the rate of women who chose to insert long-acting reversible contraceptive (LARC) methods-aka intrauterine devices and implants-in the 30 days after the 2016 presidential election, as compared to the 30 days before.

But there's one lingering fear that has kept some women from making the switch: IUDs have been connected to a higher risk of pelvic infections and pelvic inflammatory disease (PID), an infection of the female reproductive organs that is usually caused by sexually transmitted bacteria. In addition to long-term pelvic and abdominal pain, it can cause infertility and ectopic pregnancy (pregnancy outside the womb) if not diagnosed and treated early on, according to the CDC-which also lists the IUD as a risk factor for PID.

The connection was first made back in the 1970s, when the CDC found that women who used a specific kind of IUD called the Dalkon Shield (an IUD marketed in the early 70s) had pelvic infections at a higher rate-and also experienced higher risk for more complicated pregnancies. In 1983, they also found that women who used this IUD had higher rates of pelvic inflammatory disease than women who used other IUDs or birth control methods. The CDC and FDA suggested women have them removed and they were withdrawn from the market.

Clearly, the IUD has come a long way in safety and effectiveness since it made its debut in 1960, but "many women still believe that IUDs can cause pelvic inflammatory disease. If you were to Google IUDs, you'd probably be really concerned about the risk of infection if you read its historical background," says Neha Bhardwaj. M.D., gynecologist and obstetrician at Mount Sinai Hospital.

So what's the truth? "IUDs have had a long, sordid past, but we've moved past a lot of our initial concerns," says Dr. Bhardwaj. "Having an IUD does not increase your overall risk of pelvic inflammatory disease." OK, so there you have it. (FYI, here are six IUD myths, busted.)

However, while the IUD itself may not be to blame, there *is* one major reason why you might be at an increased risk for infection after having one inserted. "The risk of developing PID is increased after the first 20 days of having an IUD put in," says Dr. Bhardwaj. "We believe it could be due to the fact that you may be newly exposed to sexually transmitted diseases (like gonorrhea and chlamydia), as some women may stop using condoms (the only contraceptive method that prevents STDs) and therefore may develop PID during that time frame." (FYI, beyond preventing STDs, condoms are also healthy for your vagina.)

Also of note: Some women mistakenly believe they have an infection after having an IUD inserted due to changes in vaginal discharge, which is actually a totally normal reaction. (Related: What Does the Color of Your Discharge Really Mean?)

"With an IUD, your vaginal flora can change, and some women may notice an increase in vaginal discharge," Dr. Bhardwaj explains. "That's actually one of the ways we know the IUD is working. It changes your cervical mucus, so if you do notice changes, it's very normal and not cause for concern."