The risk of PID with IUD use is highest in those with multiple sex partners or with a history of previous PID. Therefore, the IUD is recommended primarily for women in mutually monogamous relationships.

In addition to PID, other complications include perforation of the uterus (usually at the time of insertion), septic abortion, or ectopic (tubal) pregnancy. Women may also experience some short-term side effects--cramping and dizziness at the time of insertion; bleeding, cramps and backache that may continue for a few days after the insertion; spotting between periods; and longer and heavier menstruation during the first few periods after insertion.

Periodic Abstinence

Periodic abstinence entails not having sexual intercourse during the woman's fertile period. Sometimes this method is called natural family planning (NFP) or "rhythm." Using periodic abstinence is dependent on the ability to identify the approximately 10 days in each menstrual cycle that a woman is fertile. Methods to help determine this include:

The basal body temperature method is based on the knowledge that just before ovulation a woman's basal body temperature drops several tenths of a degree and after ovulation it returns to normal. The method requires that the woman take her temperature each morning before she gets out of bed. There are now electronic thermometers with memories and electrical resistance meters that can more accurately pinpoint a woman's fertile period.

The cervical mucus method, also called the Billings method, depends on a woman recognizing the changes in cervical mucus that indicate ovulation is occurring or has occurred.

Periodic abstinence has a failure rate of 14 to 47 percent. It has none of the side effects of artificial methods of contraception.

Surgical Sterilization

Surgical sterilization must be considered permanent. Tubal ligation seals a woman's fallopian tubes so that an egg cannot travel to the uterus. Vasectomy involves closing off a man's vas deferens so that sperm will not be carried to the penis.

Vasectomy is considered safer than female sterilization. It is a minor surgical procedure, most often performed in a doctor's office under local anesthesia. The procedure usually takes less than 30 minutes. Minor post-surgical complications may occur.

Tubal ligation is an operating-room procedure performed under general anesthesia. The fallopian tubes can be reached by a number of surgical techniques, and, depending on the technique, the operation is sometimes an outpatient procedure or requires only an overnight stay.
 

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