Sungold of Kittywampus has some interesting, and cool, news about new uses for IUDs
Actually, this isn’t a truly new option, just one that has gotten no press up to now: using an IUD for emergency birth control:
“A copper intrauterine device was 100 percent effective at emergency contraception in a study of almost 2000 Chinese women who had the device implanted up to 5 days after unprotected sex.”
Sungold adds that she thinks IUDs would be…
Especially for anyone who’s a repeat customer for EC, the IUD seems like a highly sensible choice. While IUD insertion can cause cramping (which can persist for a few days), Plan B can inflict pretty intense nausea. Having to chase down EC repeatedly is stressful for body and soul. Where 1 in 100 women will still get pregnant on Plan B, it’s fewer than 1 in 1000 with the IUD as EC. And in the long run, a woman who chooses the IUD is highly unlikely to face an unwanted pregnancy.
That’s not a panacea. But it’s a pretty excellent option.
I think that’s about right. But then of course I’ve always been a big fan of post-Dalkon-Shield-debacle IUDs, going back to the original low-impact copper Ts of the 1970s. But then there’s the bit about how healthcare providers remain reluctant to provide IUDs… even caregivers who use and swear by them personally. And since I’ve got a vasectomy I’m not exactly a candidate for IUDs, and so my enthusiasm has always been muted with a great deal of deference.
Which is why I was happy to see Sungold’s update based on comments on her post by MomTFH. MomTFH said
According to a midwife who taught me about birth control, the reason why IUDs were not recommended for women [who haven’t been pregnant] were because so many of them successfully sued over the Dalkon shield. The company had to pay a much higher settlement to women who never got to have children due to their injuries than they did to those who already had children. The indications for the newer IUDs, including the copper T, originally said the ideal candidates were parous women, but that is no longer the case. New recommendations say that pretty much any woman who does not have active pelvic inflammatory disease is a good candidate.
The Dalkon shield was a completely untested, unresearched, unregulated piece of scrap metal. The copper IUD is a much more carefully created and substantiated device. It has a higher rate of continuance of use than any other form of birth control. Not only do I have an IUD, but the IUD is an incredibly popular form of birth control among female ob/gyns I have very unscientifically surveyed.
That makes a little more sense. Not in the conspiracy-theory sense, just in the practical institutional-memory-informs-practice sense. With the benefit that institutional memory will shift as people in the medical industry, like MomTFH, begin speaking out.
Final note: I’m not sure anti-choice wingnuts are going to be cheery about IUDs as emergency contraception. But then again they already oppose IUDs anyway. So… cry wolf much?
Thanks for the signal boost.
Submitted by Sungold (not verified) on Sun, 2010-08-15 18:46.Thanks for the signal boost. Just want to clarify one thing that came out in comments on my post: One woman wondered if Mirena (the IUD that also releases small amounts of progesterone) could similarly be used as EC, and though I did a little research, I couldn’t find an authoritative answer. So I should stress that the IUD from the study was a copper one – ParaGard – which is the other main model on the U.S. market today.
But some folks really love their Mirena! If my partner hadn’t taken care of the fertility issue already, I’d probably give Mirena a whirl – despite my lingering unease from the Dalkon Shield era. All that bad press came exactly when I was coming of age sexually.
Based on what I’ve read in
Submitted by figleaf on Sun, 2010-08-15 22:06.Based on what I’ve read in the past about a) the way IUDs are supposed to mechanically prevent implantation and b) the fact that Mirena IUDs contain small but highly-local doses of hormones my guess would be that if they did clinical trials the answer would be yes, they too would work as EC. But yeah, both patient and caregiver would probably want to know those trials had been done before taking that chance.
Thanks for the update, Sungold.
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Thanks for the info/update on
Submitted by Kaija (not verified) on Mon, 2010-08-16 05:23.Thanks for the info/update on how things got to be the way they are at present. I was aware that the Dalkon Shield debacle had cast a long shadow over the use of IUDs in the US but this fills in that picture.
I have a Mirena IUD (and I had a copper T before that) and it’s the best b.c. I’ve ever used. I had a young progressive female ob-gyn recommend it to me after talking broadly with me about my options and my non-plans for having kids/my difficult periods, etc. and gave me a ton of info to read (since she correctly figured out that I’m an analytical type who adores sorting through info!) before I made my decision. The IUD is safe, effective, and is a no-maintenance form of contraception that should be more widely offered to women. I have no periods on the Mirena and no hormonal ups and downs like I had on the Pill. The more information and the more options freely available to women, the better women will be able to make good choices that fit their individual needs!
I don’t know about in the
Submitted by FD (not verified) on Mon, 2010-08-16 05:26.I don’t know about in the states, but in the UK Mirena is not used as emergency contraception. Levonorgestrel is the hormone used in it here, (synthetic form of progesterone), which generally works by thickening cervical mucus and preventing implantation. In some women it may also prevent ovulation. The coil or IUD works differently – the copper acts as a spermicide and the presence of the device in the body of the uterus also acts as a barrer to fertilization and mechanically prevents implantation.
I’m not a nurse, but I would guess that there would be a higher failure rate if Mirena was used as EC, due to it taking varying periods of time in different people for the body to respond to the change in hormones present.
Over here, personal anecdata suggests that people are less likely to consider the IUD/IUS because it has to be fitted by a doctor, which is less than pleasant and b) there is a slight negative association with heavier periods.
I have to say getting an IUD
Submitted by Anonymous (not verified) on Mon, 2010-08-16 15:22.I have to say getting an IUD as a female who has not had children was very tricky. The women’s health centre where I went was very reluctant, but it was about the only option I had after the cevical cap was discontinued in Canada.
I will say this, while an IUD may seem like a great alternative to the morning after pill (Plan B), getting one inserted when you are not menstruating is extremely painful. The most pain I have ever experienced (obviously having not given birth I wouldn’t equate it to that). Nausea is nothing compared to the pinching and radiating pain.
As someone who has experienced IUD insertion in the ideal situation, meaning while menstruating, and while not, there merely discomfort during menstruation. Obviously, if this is to be an emergency form of birth control, then this proceedure would be far more painful than is mentioned here.
But, in saying all this, my IUD is one of the best methods of birth control available to women today. I do not use the Mirena version, because I have some problems with hormonal forms of birth control, but, a regular copper IUD should be easier to get for all women.
Giving birth isn’t a panacea
Submitted by Dw3t-Hthr (not verified) on Tue, 2010-08-17 11:25.Giving birth isn’t a panacea for difficult insertions either – I had scarring on my cervix and even with the dilation pill to loosen things up the nurse wasn’t sure she could get the thing in place.
Aside from that it’s been awesome, though.
It’s poignant to read that
Submitted by longboatgirl (not verified) on Fri, 2010-08-20 20:49.It’s poignant to read that those results were from a Chinese study. This is quite a different world out east. If I’ve read it right over the years, in sparsely populated America women have to battle with crazies right left and centre to get hold of anything that will stave off unwanted motherhood and let them own their own bodies. By contrast, here in China women who work in official work units are actually monitored to make sure they are using safe contraception and have no more than one child. I’ve seen the lists my colleagues have to sign to verify about themselves – woman’s name, spouse’s name, national identity numbers, number of children, method of contraception used. The list was IUD all the way down. But like I said, that’s the women who work in state-regulated work units, where you’re still kind of supposed to be married before procreating etc. For migrant workers, women in the growing private sector and the burgeoning bourgeois “ladies who lunch” classes, things aren’t so tightly monitored.
All the other contraceptive options are readily available too. Almost too readily, considering the lack of education so many women show regarding their own bodies. Levonorgestrel single-pill emergency contraception, for instance, costs 18 yuan (about $2.60) from every chemist everywhere in the whole country. Last time I bought it – my third and hopefully last time, since I don’t much like it – I asked the chemist lady whether it was true what I’d heard, that some Chinese girls use it as their principal contraceptive solution. She sighed sadly and said she had girls coming in and buying it three times a month, and she had basically given up trying to tell them there were better options because they just didn’t listen. She said their sexual partners simply refuse to use condoms, and it obviously broke her heart. In a quaint outdated turn of phrase, she expressed concern that my “male comrade” might also be of this bent. I reassured her he was very cooperative. The fact is that my beautiful, sweet, kind boyfriend hates using condoms, but he puts up with it after I tried the Pill for three months and became a blubbering psychotic shadow of my real self.
But when it comes down to it, the ready availability of contraception and absence of religious nuts is kind of sadly wasted on Chinese women – so far, anyway. The saddest is the Pill. It should be such a liberating influence in Chinese society, yet no-one I know uses it, and statistics online seem to show that a tiny percentage of even those Chinese women who use contraception at all use the pill. Since I’ve had a hard time with it myself, I understand if a certain percentage find it doesn’t suit them – but most have never tried or considered it. Why? The answer I get when I ask is that “It makes you fat.” And for this and other reasons, one of the most popular birth control methods is in fact abortion. There are adorable ads for abortion clinics in all the public buses and big billboards for them, with “Gynaecological Hospital” in big characters and “Fast-Track Unwanted Pregnancy Solutions” in small print showing prices, and usually a cartoon nurse in a pink outfit. I’ve spoken to waitresses, migrants to the big city, whose friends have had so many cheap abortions they’re permanently infertile. The link below offers some other cultural reasons for why this might be.
http://www.echinacities.com/expat-corner/good-girls-needn-t-apply-china-s-relationship-with-the.html
(N.B. that link isn’t mine)
Submitted by longboatgirl (not verified) on Fri, 2010-08-20 20:50.(N.B. that link isn’t mine)