IUDs: Issues and Information

The IUD is on the rise once more as a long-term form of contraception. This is a good thing. IUDs are safe, effective, and they are particularly cost-effective over other forms of birth control.

There are two predominant form of IUD in the United States: the copper-T Paragard, which has no hormones, and the Mirena IUS, which has low levels of progestin. Historically, IUDs have been marketed to women who were done having children as an alternative to tubal ligation or hysterectomy, largely because it's easier to insert an IUD into a stretched cervix; however, this is changing as more nulliparous women are demanding access to this form of birth control.

Five years ago, I had a Mirena inserted, and I am planning on having another inserted this spring. It was a godsend for me, as I had crippling menstrual cramps, and because of the local dose of hormones, I no longer get a period. I did my research ahead of time, and was fortunate to find that my PA was very willing to do it. While insertion was painful, the long-term benefits I've received from the Mirena have made it absolutely worth any temporary pain.

Five years prior to that, I had asked and been turned down because I wasn't in a stable relationship at the time; the prevailing attitude then was that due to the risk of STIs from not having one set partner, I was also at a higher risk of pelvic inflammatory disease should I have an IUD inserted. However, the American College of Obstetricians and Gynecologists has changed that view since then; now, counseling for condom use is recommended instead of turning away a patient, and it is understood that the highest risk of infection actually comes during insertion.
Adolescents and Long-Acting Reversible Contraception: Implants and Intrauterine Devices - ACOG

Additionally, because of changes in insurance plans thanks to Obamacare, most insurers are now covering the cost of IUD insertion completely. Basically, getting one--which used to cost hundreds of dollars--is now free.

And to clarify one issue that keeps popping up in the press: IUDs are not abortifacients. While, yes, functionally they may prevent implantation, prevention of implantation does not meet the technical definition of what an abortion is. Here's some science as to why the IUD is contraception and not an abortafacient: http://www.popcouncil.org/uploads/pdfs/Sivin.pdf Technically, if someone has a Mirena, their cervical mucous is so thick that sperm are unlikely to make it into the uterus in the first place (and man, when that mucous plug decides to regenerate spontaneously, that's a mess). If someone has a Paragard, the chemical composition of the uterus changes, making it extremely hostile to sperm in the first place.

So why this now? Because states are realizing that providing long-term contraception, like IUDs to adolescents is a win-win for everyone, but politicians are dumb.

Colorado Debates Whether IUDs Are Contraception Or Abortion : Shots - Health News : NPR

 

I am curious what your take is on the increased chance for ectopic pregnancy and other fertility concerns following prolonged use of IUDs. I would be concerned that a teenager who chooses an IUD would not be informed or would make light of this possibility. Ectopic pregnancies are dangerous and will impact future fertility at the best and maternal death at the worst.

This risk alone makes me wary of the procedure. Though my sister's very negative experience with an improperly inserted copper IUD and subsequent pregnancy complications and eventual miscarriage also tends to make me exclude it as a viable option.

 

To quote the piece from the ACOG:

Furthermore, the risk of ectopic pregnancies for someone using an IUD is lower than it is for someone using no form of birth control. Most studies show a ridiculously low rate of accidental pregnancy--it's pretty much on par with being sterile. The risk of ectopic pregnancy via use of an IUD only increases with accidental pregnancy, which is very unlikely in the first place.

I would say anyone who chooses to get one should also choose an experienced practitioner.

 

That does make a lot of sense. Thank you for sharing it.

My sis had an issue with the misplaced IUD rupturing her uterus, so after it was removed and she got pregnant, the baby was lost due to the rupture. It eventually healed and she was able to have another child, but it was quite literally a pain in her side for several years.

The problem with it being available for free to people in her situation - dependent on free clinics, medicaid/ medical - is that experienced practitioners are not performing the procedure. Such errors are then more common for the lower-income patients with few to no options.

 

For me, the Mirena means that I don't have to take at least two days off every month. That's huge.