Megan Carpentier of Jezebel says
Slate’s Kate Klonick wonders why more American women don’t use IUDs. As the recipient of one of the devices as well, I sometimes wonder the same thing.
Carpentier’s a good writer. IUDs are amazingly effective but pretty misunderstood. She does a great job laying out the many pros, laying out the few cons, and laying to rest some of the seriously out of date and never all that true myths about them. I’d say go read it even if you’re not in the market for a different, highly-effective, low-maintenance form of birth control. Because you might know someone who is.
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By the way, is it just me or does it seem like the standard “yeah but” objection about how you still need to use condoms to prevent STIs comes up sooner in discussions of IUDs? I mean, yeah, duh, but it’s just as true of every other non-condom form of contraception from the Pill to sponges to vasectomies to… oops… “abstinence-only” activities like oral and anal contact. But why let that be an objection at all? Not to sound too pundit-y but pregnancy and STIs are two different issues both in theory and practice: not everyone who needs to worry about STIs needs to worry about pregnancy, and not everyone who needs to worry about pregnancy needs to worry about STIs. And, again not to sound too pundity-y but STIs can be transmitted a lot more ways than pregnancy can. And not to sound too contrarian but very high-reliability contraceptive measures like sterilization and IUDs might make it easier for heterosexuals to pay closer attention to avoiding giving each other STIs.
Upate: About that STI link: In comments here Sugarmag explains that possibly dated information associates IUDs with greater chances of STI-derived pelvic inflammatory disease. But further down in comments here Kaija says more recent research says STI-related complications seem to come mostly from pre-existing STIs rather than infections transmitted after the IUD is in place.
[Note: 24 hours later I realize the title sounds awfully insistent. My titles are often a bit goofy or free-associative — possibly because I do them last thing after I’ve written the post. In this case I was thinking about the subject matter and the English vowel sounds, AEIOU, kept coming up, and then AE-IUD, then Hey Hee-IUD, and then Hey You IUD. So it was totally random but, I realize now, it sounds awfully bossy too. If it’s just me then forget about it, if it bugged you too then my apologies. —fl]
Submitted by 3094 (not verified) on Fri, 2009-07-31 04:01.
Well said and good topic. I have a Mirena IUD and it's the best birth control I've used so far. It's good for five years and the only "side effect" is that I have no periods, which for me is THE thing I've been looking for. I understand that its a very individual thing, and some women like the reassurance that they are not pregnant or view it as a feminine/Goddess marker, but ever since I hit puberty, I've been thinking that there has to be a way to turn this OFF if it's not needed! I like not having to work around it (OMG, I'm going to have my period during my vacation!), no need to buy/use feminine sanitary products, no PMS/mood cycles, and no systemic side effects from circulating hormones as with the Pill.
Some of the stigma/weirdness about the IUD is a holdover from the 70's when that Dalkon shield IUD was a hazard that was removed from the market. But it's nearly 40 years later, people! Medicine and science have advanced quite a bit since then. The new IUDs are very safe and effective.
Of course, the "no-period" BC methods bring up all kinds of discussion and even controversy as to whether its "natural" to not menstruate, whether its safe, or whether it changes a woman's femininity. I think the latter is tied up with the view of women primarily as breeders...we make teh babiez, and as such, our periods are crucial to that function and if we don't have them (the periods OR the babies), are we "real" women?!? Seems silly to me, but then I have no interest in reproduction and I still feel 100% ass-kicking female :)
Lots of social/biological/political/historical stuff tied up with contraception in general and certain forms in particular...
Submitted by 3094 (not verified) on Fri, 2009-07-31 05:28.
Ok, I did not read the article you cited, too lazy, bite me. But in response to what you said about people thinking they need to be more careful about STIs with IUDs, I will say that according to the manufacturer, IUDs are most recommended for women who have had a child and who are in a monogamous relationship because for most women, dilating the cervix enough to insert the IUD is difficult when the woman has not had a child (yes the cervix is dilated for an abortion too but that is different becasue it is done under anesthesia, where an IUD should be a simple doctor visit with no anesthesia), and secondly, according to the manufacturer, if a woman with an IUD gets a bacterial infections such as gonorrhea or chlamydia, the infections can travel beyond the vagina and cervix into the uterus and other organs in the reproductive system. If not treated quickly and appropriately, PID can lead to serious problems, including infertility, ectopic pregnancy or constant pelvic pain. Serious cases of PID may require surgery. A hysterectomy (removal of the uterus) is sometimes needed. In rare cases, infections that start as PID can even cause death.
I have an IUD and having the darn thing inserted hurt like hell, and after that I had a period that would not end for a couple weeks after. It finally stopped and now, nearly a year later, my periods are lighter but I have occasional spotting, which is annoying.
IUDs are not for everyone. It is a good thing there are so many different forms of birth control out there because there is no one size fits all.
Submitted by 3094 (not verified) on Fri, 2009-07-31 15:08.
I was going to pop in to explain the PID issues as well, but sugarmag seems to have it covered already pretty well.
Long story short, that IS a very real issue and is not an issue with other methods.
Of course, one thing I'd add to that is that I'm not a fan of how, or more accurately, to whom, those STI concerns are often addressed. It often is presumed that if a woman is married, she doesn't need to be told about PID risks or safer sex even though she's far less likely to use safer sex, or for herself and her spouse to get tested.
What I usually say when doing BC consults with clients and others around that and an IUD is to explain the PID risks and then just say that, no matter their model of relationship, if both a woman and her partner practice safer sex well and are good about testing and treatment for any infections, it's all good. And that if someone is in a relationship with a monogamy agreement, they remember that that doesn't make testing every year or two a non-issue.
Also, it should be noted that it's not having had a child that makes insertion easier or expulsion risks lesser, but having been PREGNANT, regardless of the outcome of the pregnancy, though ideally that pregnancy went well into the first trimester. However, plenty of women who have not been pregnant do just fine with insertion, retention and comfort per IUDs.
And one more correction to sugarmag: abortion is not always done under sedation -- many are done with a local and an oral analgesic the same way you do with an IUD insertion -- and sedation doesn't change how one does dilation, really. The issue with IUDs and nulliparous women is less about cervical dilation and more about comfort with an IUD and retention of the device because of the flexibility of the uterus (previously stretched a bit = more flexible), rather than the cervix.
[Yes, age and especially prior pregnancies seem to be big factors in how well IUDs work. I think I've mostly internalized that not every relationship is heteronormative. Possibly ironically because I think people over 30-35 are so underrepresented in conversations about sex I'm not thinking enough about people younger than that. Anyway, Heather, yes, we obviously agree that long-term relationships don't mean there's nothing to worry about in terms of transmittable illnesses. --fl]
Submitted by 3094 (not verified) on Sat, 2009-08-01 05:38.
This discussion certainly underscores the fact that BC and experiences with different methods are SO individual. Everyone's body/body chemistry varies widely and unfortunately, finding a method that works well for YOU can be a bit of trial and error. :(
As for the much-discussed link between STI/PID/IUD, the newest studies coming out are finding that the risk of women wth IUDs developing PID from STIs is lower than commonly believed.
Link to one such study here (includes WHO guidelines and recs): http://www.infoforhealth.org/pr/b7/chap3.shtml
Main findings:
1) PID risk probably is related to having an STI at IUD insertion (patients should be tested for STIs beforehand, esp since some STIs can be asymptomatic "silent" infections).
2) Except for the first few weeks after insertion, an STI may be no more likely to progress to PID in an IUD user than in another woman.
3) No significantly increased risk of infertility with IUDs.
Also, http://www.fhi.org/en/RH/Pubs/Briefs/IUD/IUD+safe+effective+underused.htm
I'm in the biomedical field AND have an IUD myself, so I tend to keep up on these things as a matter of both personal and professional interest.
I got my Mirena IUD shortly after it became available in the US, after many years of successful,safe, and popular use in Europe and Canada. My ob-gyn gave me lots of background info and was very skilled in insertion (many docs get little or no training in this!) so it wasn't too painful. Taking painkillers ahead of time is recommended too if pain is a concern. Info on US/Europe/Canadian use of and attitude about the IUD here: http://www.guttmacher.org/pubs/gpr/10/4/gpr100419.html
I'm in the biomedical field AND have an IUD myself, so I tend to keep up on these things as a matter of both personal and professional interest.
[Wow, thanks for the more up-to-date info, Kaija! Especially about caregiver skill making a difference. Concern about initial discomfort is one of the inhibiting factors for a lot of the women I've talked about their decision not to try it. --fl]
Submitted by 3094 (not verified) on Sat, 2009-08-01 05:53.
I've had 3---had to stop to count, BC doesn't like me---abortions. No local, no anesthesia, no analgesic, no nothing. Maybe I have the world's highest pain tolerance, but it really wasn't that bad.
My daughter has asked several docs for an IUD---19, responsible, sexually active for YEARS---and even post abortion, they said no. Now the military gyn's won't even consider it.
Luckily, I finally talked my doc into a hysterectomy, and feel a hell of a lot more "female" and sexual than I ever did with those bits.....go figure.
[Yeah, things have obviously changed since I volunteered with abortion patients back in the 1970s but first-trimester procedures were often done with little or no anesthetic or analgesia. When my partner needed an emergency vacuum extraction after a gruelling 14th-week miscarriage the Ob/Gyn said she'd have to admit her to the hospital in order to give her more than a "twilight" sedative. It, um, still hurt. Thanks, A. --fl]
Submitted by 3094 (not verified) on Sat, 2009-08-01 06:12.
Ok I kind of understood these issues because I read about IUDs when I was thinking about getting one, but your understanding is better than mine. I read horror stories about some women who had never had a child having a terrible time with insertion in the doctor's office and I misunderstood why that was.
Submitted by 3094 (not verified) on Sat, 2009-08-01 09:12.
Hey, thanks for some of that new info! Going to pass it on to the providers at the clinic where I work.
I would add to all, in response to what you said, that how painful insertion is certainly has to do with individual pain thresholds, but also has to do with the skill of the provider doing the inserting. And by all means, plenty of docs really don't do it all that well.
Submitted by 3094 (not verified) on Sat, 2009-08-01 13:29.
I should have qualified that when I was talking about the assumptions often made around STI risks with IUDs, I was talking not about you, figleaf, but about the attitudes of many healthcare providers.
In other words, if someone is in a long-term relationship or married, there usually is NO discussion about STIs or the risks they can present with IUDs. It's just kind of an "Oh, okay, you're married, all good!" That conversation often seems to only be had with those NOT in those models (and is one reason some women will be refused IUDs), even though we know marriage = monogamy often is not true, and that many people NOT in those models actually use safer sex more often and get tested more frequently, so some of their risks may be lower than the marrieds.
[Great points, Heather. And thanks for clarifying. --fl]
Submitted by 3094 (not verified) on Sun, 2009-08-02 14:30.
At age 45 I had a period that just wouldn't stop. We tried surgery to remove uterine polyps, which helped for about four months--long enough to get some blood count back--and then stopped helping. After 27 straight days of bleeding in that particular bout, I was in very bad shape, near fainting. (My husband says, if this had happened last century I'd be dead now.)
Tried progesterone pills, which stopped it briefly, but not permanently. Tried the Pill (progesterone/estrogen). That cut the bleeding to a trickle but made me intensely depressed, paranoid, and anxious.
The month without bleeding due to the Pill allowed us to try a Mirena IUD. The next alternative was going to be hysterectomy. Insertion hurt like hell, worse than I expected. None of the printed material I was given mentioned this at all! But my MD did a good job briefing me, so that wasn't so bad.
After a few days' worth of spotting I stopped bleeding, and now have prolonged spotting but no more when my period should fall, and have nearly recovered my blood count.
The thing that is very strange is, I have a weird reaction to hormones. I've always been intensely depressed and agitated at ovulation (I could use it as a fertility timer, except I don't want sex then anyway) and horny from 2 days before my period and on into the period. On the Pill, as I mentioned, I was depressed and agitated all the time. So apparently that's an estrogen reaction.
The Mirena releases progesterone. Supposedly it's a tiny dose and just topical to where it's needed. But on that--as on the progesterone tablets--I am pretty horny all the time, and when my period ought to fall, I'm *obnoxiously* horny. As in, sitting up all night reading porn and masturbating horny. It's not actually much fun; it's really distracting. I have a nice relationship but I also have an emotionally needy adopted child; I don't have the time or privacy for sex three times a day.
And it's weird to feel yourself so much at the mercy of hormones, especially when they aren't yours.... I mean, I've known for years that external meds can make me depressed, but I thought aphrodisiacs were a myth!?
[Thanks, Mary Kaye! --fl]