The social science of IUDs

Discuss

82 Responses to “The social science of IUDs”

  1. duc chau says:

    My wife’s got one. We bone all the time and nothin’. Not one baby.

  2. RedShirt77 says:

    Is this X-ray SFW?

  3. RedIndianGirl says:

    Hmmm…. I was about to get fitted with the Mirena when I got drastically sick with a bowel bleed — and subsequently I had all kinds of cascading infections, culminating in hydroneuphrosis which erupted after my ureters got grown over with tissue. I have stents in my ureters on both sides, implanted in November 2010 — the weird thing? These have acted exactly as a Mirena. I don’t bleed and certainly haven’t ovulated. Maybe they don’t have to be in the uterus at all — just some kind of foreign object implanted in abdominal tissues and blam, birth control that you don’t have to think about.

    • Aaron Swain says:

      If that were true, I’d suspect a genital piercing would have the same effect. Hmm…maybe they do. I doubt anyone has ever conducted a study.

    • rebaj says:

       careful, girl. there is no reason for a stent in your ureter to act like an iud, i say this as an OB who has cared for plenty of people with different kinds of hardware in various places in the pelvis.  there’s plenty of reasons why you might not be getting periods, but don’t assume you aren’t ovulating unless you are checking kits. lots of ladies get pregnant during time periods when their periods aren’t happening.  you might be fine, but do use something for birth control if you don’t want to get pregnant!

  4. LikesTurtles says:

    Pay a lot up front or more over time in small payments. Sounds like the cell phone industry but I can’t quite see how Virgin mobile works their way in.

    The birth defect issue with IUDs in the past put an entire generation at unease about them. As each new generation comes along, it’s easier to look at IUDs and their improvements with a rational eye.

    • ryuthrowsstuff says:

      It was actually the daklon shield and similar designs that caused the problems.  Essentially it let bacteria into the uterus causing pelvic inflammatory disease.

      http://en.wikipedia.org/wiki/Dalkon_shield 

      Most women and a fair amount of doctors are still convinced that modern IUDs have the same flaw.

      • Lexica says:

         Of course, since that conviction doesn’t seem to be based on any actual data or evidence, it’s not worth much. (“Data, shmata — my risk-averse innumeracy, let me show you it!”)

  5. Shichahn says:

    A friend of mine has had an IUD for years. About a year ago, she began to feel ill and went to the doctor. Turned out, her IUD had somehow moved out of place, and she was pregnant with twins. Possibly a case of a doctor inserting the IUD wrong? Who knows.

    This isn’t to say that IUDs aren’t a great form of birth control, but even though they are awfully reliable, things can still go wrong. I guess they, too, deserve a little asterisk.

    • Absolutely. But the point is that they’re a lot harder to get wrong. 

    • Antinous / Moderator says:

      I have a friend whose IUD worked perfectly for years.  And when she decided to get pregnant, she did so on the first cycle after having it removed.  She was quite happy with the whole experience.

      • ncinerate says:

        Same basic experience here. The wife used her IUD for years, a few different types, mostly to avoid hormonal versions of birth control that quite frankly made her absolutely crazy. When we finally decided to make babies out went the IUD and bam, baby.

        Really the only downside I saw to the IUD was that I could -feel- it. if I got too excited I’d bump into the bottom of the T and it was rather uncomfortable to do so (ramming the tip of your penis into something sharp and hard very unexpectedly at the height of copulation). This actually limited sex positions as well – certain positions made it almost impossible to enjoy without jabbing the thing repeatedly. There was also some sort of cord attached to it (presumably for future removal) that came a bit further out and was detectable-by-penis-shaft.

        It wasn’t the end of the world, but it did lead to a few annoying moments over the years we used the IUD.

  6. yoshua says:

    -1 point for not defining the acronym IUD in your first sentence (or anywhere else.) I had to look it up. For the record, it stands for intrauterine device.

  7. vance_tam says:

    This phenomena also applies to other mammals. It was once a well known practice to push a pebble into the uterus of a camel to prevent the camel from becoming pregnant. I’m not sure if they made any provision for removal, though.

    Pregnant camels are apparently not well received in a caravan.

    • robcat2075 says:

      I recall the camel anecdote in David Reuben’s “Everything You Always Wanted to Know About Sex * But Were Afraid to Ask”. I wonder if it’s as mistaken as so much other material in that book was.

      • vance_tam says:

        It’s true.  When your livelihood depends on the durability of camels, you don’t want to deal with pregnant camels. Consider that the gestation period can be as long as 15 months, then there’s the period when the calf needs care from the mother. That can eat up traveling time and increase costs.

        The ancient Greeks wrote a good bit on the topic of birth control.

  8. Hannukah Dreidl says:

    And, lost in the only-sluts-use-birth-control debate (which this thread is NOT participating in, thx!) fertility control can be a medical intervention for other gynecological issues. As noted in the post, the Mirena progesterone-releasing IUD can thin the periodic endometric uterine lining build-up – so the Mirena is often useful for treating endometriosis and uterine fibroid growth, as well as the chronic anemia associated with heavy periods. This means lessening not only discomfort and quality of life issues for women, but also invasive procedures including hysterectomy, and also reduced cancer risk due to the additional progesterone being local rather than systemic. However, many health plans refuse to play for the IUD at all, much less for “off-label” use because… birth control.

    Birth control is about taking women’s health seriously.

    • Sure, birth control can be part of women’s healthcare. But isn’t it’s awesomeness as birth control enough enough to run shouting in the streets about how awesome it is.

      Birth control would be pure awesomeness even if it didn’t do shit for anybody’s  health.

    • Laura Harden says:

      Mirena was a horrible experience for me but I am happy to hear that it can be helpful to others. We all have our own unique chemistry. 

      • Rachael Hoffman-Dachelet says:

        I was going to post something similar.  I am the small percentage of people who bleed non-stop 24/7 while on the Mirena.  I thought I was going to die. More power to you if you can tolerate it though.

  9. jonbly says:

    The cost seems pretty bonkers. Is there some patent issue, or could someone just Kickstarter up a low-cost alternative?

    • CH says:

      Well… one reason for not doing devices like this in your basement is that people tend to get a tad upset if your device causes an infection of the uterus that renders them infertile. Or if it turns out that it just doesn’t work.

    • jandrese says:

      The FDA approval process costs are probably a bit too high for your average kickstarter to manage.  I’m guessing the ones on the market now are so obscenely expensive because the problems with the past models made getting FDA approval extremely difficult.  Not fully understanding how they work certainly doesn’t help the case either.

      • ChickieD says:

        Yeah, I work with a company that makes devices that have to be FDA compliant and there is a lot of expertise that goes into filing the paperwork and record keeping. If there is a recall, for example, you have to be able to track down every device sold so you can inform the buyer. Also you have to track all the materials in the device. Say the copper in some batches of the IUD had some kind of problem with it, you have to be able to figure out which specific devices were affected. So, the device might cost pennies to manufacture but the company’s cost also has to cover the expertise to get this through the FDA process, and also there would be marketing costs and probably the company hosts some kind of seminar or education effort to teach doctors how to insert them.

      • jonbly says:

        Ah, didn’t think of FDA (or equivalents). Also didn’t realise that they need some skill to insert, so you can’t dodge doctor involvement and just distribute the physical items.

        Seems to be more variety in the UK, according to Wiki.

    • rebaj says:

      Cost is ridiculous. The paraguard costs literally pennies to make at this point, and developing nations buy them from USAID for under a dollar. It is only in the US and western nations that can/will pay that the price is sitll so high. For Mirena, there is only one manufacturer, so brand name is all you get.  there is a pre-marketing trial for a generic Mirena going on now, but it will take a couple years for that to be on the market. 

    • Loren Pechtel says:

      The cost is testing & liability, not manufacture.

  10. Ashley Reid says:

    I have one and it’s such a relief. After years of trying this pill or that pill, all of which turned me into an absolute lunatic, I got a copper IUD and life is so much more awesome now.  Didn’t realize that ParaGard and Mirena were so expensive – thank goodness for Canadian health care….

  11. awjt says:

    I have never like IUDs.  From a completely selfish standpoint, I never liked the feeling of the IUD’s pull string.  It scrapes and just feels unpleasant.  No matter how unobtrusive of a kind of a thread it supposedly is for her, I can feel it and don’t like it. Go ahead and joke, but I’m being serious.

    • CH says:

      Just think of how much more intrusive a “Daaaaddddyyyyy, I want water!!!” just at a critical moment would be.

      Or put a raincoat on.

    • Lexica says:

       One of the things my doctor told me when I was having mine inserted was “if the strings bother your husband, wait a month or two because they often soften up; if it’s still a problem after a couple of months, come back in and we can trim or adjust them.”

      If it’s causing you problems, she should tell her doctor and have it adjusted.

  12. Donald Petersen says:

    Putting a condom on as soon as I get naked hasn’t been a reliably useful approach for me since I turned, oh, 19 or so.  Putting it on as soon as I get hard has turned out to work better, except in those occasional instances when I was already hard while still fully dressed.  And though plenty of guys bitch about the loss of sensation, I’m not one to complain.  Gettin’ laid in a condom is a hell of a lot more fun than not gettin’ laid at all, and is also vastly superior to unwanted pregnancies and infections.

    But I do like this IUD renaissance.  Science is grand.

  13. jandrese says:

    Ouch, you know you have bad cameltoe when it shows up on the X-Ray.  

  14. D says:

    Sorry no kickstart…. Aside from the R&D for design, ballpark $150 million for clinical study of safety and efficacy to satisfy the FDA. Then there will be a manufacturing facility for the FDA to inspect and  approve. Once approved, manufactured product must pass release test specifications for the product along with various stability studies.

    Lots of employees are needed for qualifying and executing this testing. The cost of materials are  almost inconsequential, although much cost will be incurred from the testing of these in-comming raw materials to assure safety of every batch.

  15. kcmpls says:

    Cost shouldn’t be that big of a deal anymore in the US since IUDs are covered under the Affordable Care Act’s requirement that all insurance providers provide contraception free of cost. Since everyone (except the few exempt groups) will be required to have health insurance by 2014, this will be available to everyone for free at that time.

  16. giantasterisk says:

    I’ve got and IUD and I LOVE it. Not a single problem. The pill really screwed up my sex drive; IUD does not. Plus I don’t even get a period anymore. It’s like being a kid again. Hello, hassle-free camping!

  17. Z3t3tic says:

    As I understand it IUDs are the most common form of reversible birth control in the world due to their near universal use in China. My wife used one for years and found it far superior to the alternatives.

    IUDs, like most other forms of contraception, are provided free here in the UK on the NHS. On some level I still find it hard to believe that the US healthcare system is really real.

  18. Simper says:

    This is good news if you can find a doctor that is willing to put one in.

    A few years ago I gave up after calling probably 10 different ob/gyn’s .

    There is a slightly higher risk of your body rejecting the IUD and of discomfort if you have not already had a baby. Apparently it also takes a more skilled doctor to insert one correctly in a woman who has not had a baby. Since I don’t have kids I just kept getting turned away because the doctors said it was a liability issue. As one doctor put it, she was sick of putting the effort in if they were just going to have to be taken back out because of problems (which I translate as missing a bullet because if she was that bad at it I didn’t want her anywhere near my lady parts)

    I actually had one doctor tell me to my face that I was at breeding age and that I would probably be having a baby soon so she would just put one in then.  Imagine my disbelief because I had just explained to her that I didn’t want children ever at that was the primary motivation of wanting the IUD in the first place and then her trying to convince me that I did want children and that I should probably just go ahead and have one to get it out of the way.

    I think it also has to do with living in a very religious area of the country where most ob/gyn’s work out of religious hospitals that have their own religious belief driven rules.  Nothing like going to a doctor expecting sound medical advice only to learn that no one in the office is educated about the different types of IUD’s and that they would rather talk about why I should want babies instead.

    Maybe there are more available educational resources out there for doctors and I can start looking again.  More than likely I would have better luck just moving.

    • Lexica says:

       Tell your doctor that the American Congress of Obstetricians and Gynecologists says she’s behind the times and needs to get current: http://www.acog.org/About_ACOG/News_Room/News_Releases/2011/IUDs_Implants_Are_Most_Effective_Reversible_Contraceptives_Available

      According to ACOG, IUDs “are safe for the majority of women, including adolescents and
      women who have never had children” and “should be offered as first-line contraceptive methods and encouraged as options for most women.”

      I’m nulligravida and nulliparous and absolutely love my copper-T. According to my doctor, my uterus being tipped was more of a challenge relative to inserting the IUD than the fact that I’ve never been pregnant was.

    • I’m in the deep south and my OB/GYN has mentioned IUDs several times as the first option.  Definitely look around at other doctors.  :)

    • BillStewart2012 says:

      If you ignore the people whose religious objections are about “unnaturalness” or generally about sex, there are still the people who actually care about the fact that the hormone versions of the IUD work by preventing implantation if the spermicidal effects didn’t work.  (That’s also an objection to some versions of birth control pills, though I’m a few decades behind on which types are currently most common.) (And yes, preventing implantation isn’t the same as ending a pregnancy, because pregnancy is the mother’s condition, not the child’s – but it’s the same from the pro-life perspective.)

      With the IUD, there’s also just a lot of concern among people from my generation about problems for the mother’s health – I’m glad to hear that the newer ones are usually a lot safer, but it’s interesting to see comments from people who’ve had both positive and negative experiences with them.

  19. riley says:

    Just as a cautionary addition to the ‘side effects’ side of things – I chose the copper IUD as a 20-something ‘career’ girl get-it-and-forget-it method because of my aversion to hormones.

    A lot changed in the three years I subsequently had it – including a noticeable decline in aspects of my health by the 3rd year.

    I had: low sex drive (what the heck! that was not the point!), worsening complexion, hair that wouldn’t grow, weird fatigue, low functioning immune system and increasing irritability to say nothing of all the side effects that actually had something to do with my uterus directly.

    Long story short, I developed high copper toxicity levels that my body could not balance after such a sustained amount of exposure to those leaching ‘metal ions’.

    Needless to say, it caused a lot of grief and I removed it – not saying this will happen to everyone, but let’s just be honest about the fallout from inserting foreign objects or injecting hormones or whatever else we do to ourselves.  

    Two things – the men could pick up the slack here, and we could get better at this on the whole if we put some energy behind it.  

    Diaphragm anyone?

    • Kludgegrrl says:

       I don’t get why no one seems to talk about cervical caps anymore.  They are much like diaphragms but I believe statistically more effective.  They are certainly more convenient.  And, no hormones!

  20. IronEdithKidd says:

    I have a Mirena that I’ve been suffering with for three years.  I hate the random mini periods, constant excess water retention, mood swings, acne, low sex drive and inability to drop those last 10 lbs of baby weight.  But you know, YMMV.

  21. Susan Carley Oliver says:

    I love my Mirena, but it hurt like a mofo going in.  No side effects to speak of, however, and the mini periods great.

  22. Sofia Ortiz says:

    I believe birth control should be free for women with (non-religious…) insurance in the US as of this week. So you can get one whenver you get your next period! (The easiest time for insertion, I’m told).

  23. fungstyle says:

    Just had one implanted about 2 months ago. So far so good. But I will say there is another great birth control mechanism contained herein: for us ladies who have never had a baby, you basically have 2-3 contractions as this thing is inserted. What a great way to never, ever want to get pregnant. I’m suddenly very much pro-adoption for myself, should I ever decide I want children. 

  24. Beth Brown says:

    I loved my Mirena!  I only got it because I couldn’t find a doctor who would do a tubal ligation on me because of my age/childfree-dom.

  25. Erasorhed says:

    I’m one of those “lucky” women with astronomical odds against getting pregnant with the Mirena (condoms were used, as well). Luck is one of those things that can be good or bad, I suppose. I loved being period-and-PMS-free for several years, until I started having symptoms that prompted me to look into the possibility of Ovarian Cancer.
    I didn’t realize I was pregnant until I was into my 2nd trimester (thanks to never having a period). Also, I found out that pregnancy symptoms aren’t necessarily the same if you also have an IUD.

    Thankfully, the pregnancy went well, and I found a wonderful open-adoptive family for my son, who is now 3mos old. They waited 10 years to see their baby dreams come true, so my unexpected pregnancy turned into a win-win. :)
    I would advise any woman with a Mirena to be cautious about pregnancy-testing if they lose their period with the Mirena. I just barely knew about my pregnancy in time to have been afforded the option for an abortion (if I had wanted one).

  26. taghag says:

    i am on my second copper IUD in 14 years – best thing that ever happened to me!  hormonal birth control didn’t agree with me and condoms were frustrating (and not 100% effective) in my long-term monogamous relationship.  the copper IUD works for me + i still have my period as regular as clockwork, which is fine.  i recommend it unreservedly to any woman looking for a good contraceptive option (unless sleeping with new partners, in which case condoms are also necessary).  so sad to hear that it’s so expensive in the US!

  27. I lost 30% of my uterus because the wall was punctured. Might not be able to have kids because of it. If you dig into the statistical reliability of the non-hormonal IUD (one I had), they are less reliable than they seem. The statistics are reported on a different scale. My gyno that removed the rupture, who is the head of a hospital OBGYN unit, nearly refuses to insert the non-hormonal anymore because he has delivered too many babies with women who go it. He did not give me mine. I also know a lot of woman who have not had a problem with their IUD’s. I just wish I had the information I have now because I would have chosen the one with hormones. I was told there is no difference between IUD’s. I had it 6 months when it failed.

  28. Laura Harden says:

    I’m the product of an IUD accidental conception. I’m fairly sure it was a copper IUD since the year was 1975. I tried the Mirena IUD and for me personally it was horrific in many ways, I will spare you the details. I am fairly sensitive YMMV.  I paid 600 to have the dang thing inserted, I was very pissed at having it removed 6 months later and it took me 6 months to recover.

    • Chris Rogers says:

      That really sucks. Definitely one of the reasons why IUDs need to be 100% covered. The pain of dealing with horrible complications doesn’t need to be compounded by watching $600 being lost in the process. :(

      • Laura Harden says:

        Thanks, and yeah…. Not to discourage anyone else. I have heard lots of positive stories from others about their experiences with IUD’s. Many people are great with them. I am very sensitive to hormonal changes. I can’t take birth control pills of any kind. They make me sick or nuts or a combination of both depending on the pill. So we continue on with our trusted, tried and true friend, Trojan.

        I also agree that the copay should be covered 100%.

  29. I’ve been the proud, happy owner and operator of a Paragard copper IUD for over three years now. At the time of insertion, I was uninsured and underwent the procedure free of charge courtesy of Planned Parenthood. Please, please look into these family planning facilities if you’re in need. During the sizing of my uterus, my amazing nurse even made a point of telling me, “Gotta make sure it’ll fit! This is a $500 piece of equipment we’re installing!”

    I can’t predict what your experience will be, but mine has been virtually painless. Insertion was uncomfortable, but the pain lasted no longer than two minutes and subsided immediately upon removal of the speculum. Occasionally, I’ll spot and cramp more in between periods than I had before, but my periods are no longer or heavier than they once were. I’d experienced nothing but trouble with other methods of contraception, from bacterial vaginosis to intense mood changes. Nothing like that with Paragard.

    Viva la IUD! When you get yours, be sure to name it. I’ve dubbed mine John Constantine, because he’s my personal demon slayer.

  30. Velocirapt42 says:

    I work in a pediatric gynecology clinic, and we are nuts about the Mirena IUD (Paragard is nice too, but makes periods worse, which teens rarely want.) Not only is it rilly rilly effective birth control, but it makes periods lighter and sometimes they go completely away. New research shows it is not only just fine for women who have never given birth, but it’s okay for teens with menstrual problems at any age (youngest I’ve seen is 11.) If someone is developmentally delayed, or too anxious to have it done in clinic, we can insert them when someone is sedated (after a conscious consent process, natch.) 

    Uterine perforation is a risk, but the risk decreases with the experience of the practitioner. The GYNs I work with have inserted literally hundreds of IUDs and never had a perforation. What’s more common is an IUD being expelled (the uterus contracts and pushes it out) and sometimes people don’t notice. Of course, there are no 100% effective methods of birth control (not even sterilization), so we always tell patients if they have symptoms of early pregnancy to go to their doctor and get tested. And use condoms to protect against STDs, of course. 

    Here’s what getting an IUD is like if you’ve never given birth:

    You go to the GYN who takes some urine to make sure you’re not pregnant. She (or he) performs a basic pelvic exam to make sure all is in working order and also swabs for gonorrhea/ chlamydia (if you prescribe antibiotics when the results are back, it prevents the bacteria from proliferating in the uterus.) Then she puts 1-2 fingers in your vagina and presses on your abdomen to feel what direction your uterus tips in. It can be neutral, forwards, or backwards. That helps with “aiming” the IUD. 

    Then she numbs the cervix with lidocaine (sometimes, depends on the GYN). Then  she puts a tenaculum, aka a clamp, on your cervix to hold it in place. She dilates your cervix with a plastic rod. Then she has to measure your uterus, which is often the most painful part, to see how deep the Mirena will go. The “sounder” has to touch the top of the uterus, which makes it cramp. Then she inserts the Mirena with a little inserty-plastic-tube thingie (the medical term) and you are done. She’ll trim the strings and tell you to come back for a check.

    There are three painful points- dilation, measuring the uterus, and the Mirena insertion. If you can get a Vicodin/ Percocet and/ or Ativan it helps, but in the clinic we use mostly ibuprofen and the teens do fine. 

    For 1-6 months you’re in for some spotting and cramping which is worst the first day and gets progressively better. Then after 5 years you do it all over again (7 for the Paragard.)

    If you’ve given birth before, you’ll barely notice it because your cervix is wider and stretchier.

    Ta-da. The Mirena. Highly recommended. 

  31. hab says:

    Pro tip!

    Do not allow the IUD filaments (like a nylon line) to be trimmed back too far right away after placement. The IUD often settles a bit after placement–often higher up in the uterus. Too short = cervix fangs. Ouch. (Not to mention difficulty removing the IUD later on.) They can always be trimmed back later.

    I have placed dozens of Mirenas and fewer Paragards (the copper one) over the last 10 years and most women are satisfied, although a few have had problems (cramping or unsatisfactory pattern or level of bleeding), but you cannot beat the efficacy. IUDs are definitely underutilized in the US–mostly because of bad PR, but I think that it is changing. My wife had one placed after each of our 4 kids (1 copper, then 3 successive Mirenas.)

  32. Chris Rogers says:

    Big fan of my copper IUD. Hormones from the pill (and I tried many) were messing me up. It is strange to consider that my alternative is to stick copper into my body (condoms aren’t enough IMO). But it works, and the side effects are thankfully manageable. Yes, heavier bleeding and a few cycles had some serious cramping. It’s not for everyone, and insertion is not pleasant. But I’d recommend it to any woman…but the price is definitely a deterrent b/c if it doesn’t work (rejection, severe side effects, etc) then that’s a lot of money to have spent, not to mention going through the procedure.

    Best part was picking up the pill that is used to prepare the cervix and uterus for insertion. The pharmacists gave me the “BABY KILLER” look. B/c it’s one part of  what’s used in a chemical abortion. So ladies, prepare to be judged by The Pharmacists Who Know All.

    • Laura Harden says:

      Seriously, fruck the judgement. If you only knew what those guys are doing when they go home at night. If they were good people, they wouldn’t be taking the time to throw stones. Seriously, fruck em’ all!

  33. Kelsey Cornelius says:

    I have ParaGuard, because I always felt like hormones made me feel crazy. It was over$500.00 (with installation). The gyno that did the procedure encouraged me NOT to get it.. saying its an expensive upfront cost and was concerned about my not having had any children yet. But I had done my homework and I insisted. In hindsight, I should have found a different gyno. I think she probably didn’t know what she was doing because it hurt so terribly when she inserted it. I went white, saw stars.. thought I was going to vomit. My current gyno has apologized FOR her, saying it should have been a slightly uncomfortable procedure akin to a pap smear. 

    Knowing that the procedure should be painless, even for women who have no kids, I would wholeheartedly recommend it.

  34. Payne Hertz says:

    Anyone in the know have scientific references to the potential side effects of these devices? I am really curious what the effect of leeching copper and hormones into the bloodstream  might be on a woman’s short term and long-term health, particularly given some of the negative reports from women here. Is it healthy to stop periods? They are there for a reason, so I should think not.

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