I'm going to ask this at my IUD consultation later this week, too, but tell me anyway: What do I tell my mom who's worried about my getting the device because of dangers and class-action lawsuits from 30 years ago? Or someone who was warned away by a doctor because of the hormones and wanting to get pregnant in the near future after having an IUD removed? Planned Parenthood and other resources summarily discount these concerns, but (informed) people still have 'em. Thoughts?
So, few things first: obviously there are going to be pros and cons to any medical procedure or device (right down to blood draws!), so to be concerned about something is good, and the advice that I’m giving here is general, rather than specific. You and your practitioner should work together to find the best thing for you.
As far as your mom goes, most concerns re: IUDs come from people who were around in the 70s, where the IUD of choice was the Dalkon Shield. The Dalkon Shield was known to have several issues, including four women who had it inserted and died, and many women who got pelvic inflammatory disease and lost fertility.
However, the issue with the Dalkon Shield was a multifilament string, where bacteria could travel into the uterus and cause sepsis, injury, miscarriage, and death. Modern IUDs use a monofilament string which doesn’t pose that risk, which scientists and the FDA now confirm was the biggest issue.
There are still risks associated with IUDs, and that’s mostly uterine perforation and ectopic pregnancy, though both are relatively rare.
As far as timing goes, an IUD starts working when it’s inserted, and stops working when it is removed. There are two types of IUDs, hormonal and copper.
Copper IUDs are branded in the US as paragard, and they are FDA approved to last for 10 years, though there is evidence to suggest that they might be effective for 12 years. Copper IUDs can also be used as a form of emergency contraception if placed within three days of unprotected sex, and can be used with women whose BMI might otherwise disqualify them from effective hormonal emergency contraception. Copper IUDs are a good fit for many women who shouldn’t be on hormonal birth control due to elevated heart attack and stroke, such as women who are smokers, as well as women who suffer from certain types of migraines.
The other kind of IUD is a hormonal one that provides progesterone localized to the uterus. In the US, there are three: Mirena and Skyla (both manufactured by Bayer) and Liletta, which is manufactured by Allergan. Mirena is approved for use up to five years and Skyla and Liletta are approved for use up to three years (though Liletta contains the same 52mg of levonorgestrel that mirena does and will likely be approved for five year use soon).
Hormonal IUDs secrete the same hormones that are present in birth control pills, patches, and the ring, but in a much lower dose localized to the uterus. They can also be used to tread menorragia, endometriosis, and anemia.
There are pros and cons to each type: copper lasts longer and doesn’t have hormones, but often leads to heavier periods. Hormonal IUDs often lead to lighter periods or missing them altogether, but last shorter periods of time and contain hormones.
The best part of IUDs in particular is that they reduce user error, which is the single greatest cause of unintended pregnancy in people who are using birth control.
IUDs are covered at 100% per the affordable care act, so get them while you can. Doctors can get IUDs for $500-$850 depending on the type, and they will also charge for insertion. With the ACA, insurance pays for them and you don’t see a penny.
Insertion can be uncomfortable, as the cervix has to be opened. I recommend taking 600-800mg of ibuprofen and trying to relax as much as possible. Then putting on a heating pad when I get home. But I’ve seen women going on vacation to a beach later in the day after having an IUD put in, so every person is different.
As far as having it put in if you’re just going to have it removed in a couple of years, that seems like a silly argument. I wear my seatbelt when I’m on my way home after I pick up my clothes from the dry cleaner even though I’m planning on taking it off and putting the clothes in the house in 5 minutes. If you have to pay for it on your own, I can see some apprehension, but there’s no reason to do so if you don’t have to pay the up front cost on your own. If you are self-pay, check out your local sexual health clinic and see sliding scales and payment plans.
One last thing: if you use an IUD and aren’t in a monogamous relationship, PLEASE make sure to use condoms. The risk of pelvic inflammatory disease caused by chlamydia and gonorrhea in people who use IUDs is very real.
Thanks for asking, and good luck!
