June 1st 2010

Could The IUD Be Right For You?

I decided to get the Mirena, a hormonal IUD, in October of 2009 because my sex drive had been waning for months after I switched to a new prescription of the Pill. I wanted a low-hassle, low-hormone solution, ideally one that would serve me well for the long-term, since I was tired of hopping from brand to brand like Goldilocks after the elusive goal of finding the perfect birth control. I was also hoping for something that would make my period less of a pain. I had previously tried Seasonale, an extended-cycle combined oral contraceptive, which allowed me to skip my period for three months at a time. But even though I really liked the convenience, I winced at paying $20 each month for brand-name contraception. I learned that the Mirena IUD could drastically decrease menstrual flow and eliminate nasty period symptoms, such as cramps. It is also many times less hormonal than the Pill, the Ring, or the Patch and, best of all, my health insurance paid for both the procedure and the device in full.

Eight months later, I've become an IUD evangelist. The IUD has the lowest failure rate of any reversible birth control and is covered, at least in part, by most health insurance plans in the U.S. So why aren't more women using it? The Dalkon Shield, a defective model, rendered thousands of women infertile or worse before getting recalled in 1980. Though the copper ParaGard was made available in 1984, IUD usage rates remained in the single digits until very recently. For years, IUD usage was associated with a heightened risk for pelvic inflammatory disease (which, in turn, causes infertility). In an apparent attempt to protect the nation's limited supply of uteri, the FDA restricted the IUD to women who had previously given birth, effectively eliminating it as an option for students and young adults. But by the 2000s, several studies had found that today's IUDs are not only perfectly safe for users, but that the hormonal IUD may even protect against the transmission of some STIs, though this finding is definitely still up for debate. Then in 2001, the hormonal Mirena was introduced and by 2005, the FDA began to allow never-before-pregnant women to use IUDs. Since then, the IUD has made a comeback in a big way.

Copper IUDs, such as the ParaGard, are perfect for women who want to avoid hormones altogether. The metal's spermicidal properties make the uterus inhospitable to fertilization. IUDs with progestogen, like the Mirena, are basically hormonal cock blocks. They release progestogen, which reduces ovulation, inhibits sperm's movement, and prevents access to the egg. (For more detail on the two types of IUD, check out this "Provider's Perspective" post.) The IUD is inserted into the uterus through the cervix by a doctor and is attached to a string that can be felt in the vagina and used for removal. An advance warning: the insertion and aftermath can really hurt, especially for those who have never given birth or become pregnant (which changes the shape of your cervix). Though I had a tough time during my appointment and hard sex was out of the question for the first month afterward, some of my friends felt practically nothing and bounced right back. If you ever want to get your IUD removed, it's a simple procedure that hurts much less than putting it in.

There are so many things I love about the IUD, but the major benefit is that it reduces the chance of human error. Efficacy rates of different types of contraception are measured in terms of "perfect use" and "typical use". Here's an example to illustrate the difference between the two: birth control pills are supposed to be up to 99 percent effective if they are taken consistently and correctly, but given the typical usage patterns of the average user, they are only 92 percent effective. In the case of the IUD, perfect use and typical use are essentially the same thing. Once the IUD is inserted, there is a small chance of expulsion within the first year (which is why it's important to periodically check to make sure only the strings can be felt). Beyond that, however, IUD users don't have to remember to do anything on a daily, weekly, or even monthly basis. The ParaGard lasts for up to ten years and the Mirena for up to five.

Whether you're looking for birth control for the first time or unhappy with your current option, you may want to talk with your doctor about the IUD now that it's becoming more widely available. Not all health providers are comfortable prescribing the IUD to women who have never been pregnant, so if you encounter problems with access, contact your local Planned Parenthood. And if you have an IUD yourself or are curious about getting one, please share your thoughts and questions in the comments.