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The ins and outs of the IUD

Intrauterine devices, or IUDs, are not new birth control options — but their popularity is rising. 8% of women aged 15-44 in the U.S. choose IUDs to keep watch over their uteruses. And in the last year, there’s been a rather, well, interesting spike in IUD use. According to both Athena Insight and Planned Parenthood, IUD demand has increased exponentially since November 2016.

Hmm... wonder why.

Rise in IUD requests

Many say that IUDs are the most effective form of birth control on the market today — and study after study deems them safe for women of all childbearing ages. A 2015 study even showed that women’s healthcare providers use IUDs more than any other form of contraception. (We’ll have what they’re having!)

Why are IUDs so popular?

  • They're 99% effective. Studies have even shown that the IUD is comparable to female sterilization (which is crazy) with cumulative pregnancy rates at five years of <0.5%. Plus, they can even act as emergency contraception up to five days after unprotected sex.
  • They last. Your IUD can stay in your body 3-10 years, depending on the type you get. Think set it and forget it — crockpot style.
  • They’re reversible. Once you decide you’re ready for something new, you can have it removed and you should be able to return to your normal cycle.
  • They don’t mess with estrogen, which means fewer side effects than the pill. Hormonal IUDs release a localized hormone (the synthetic progestin) and copper IUDs don’t contain hormones at all. More on that later.
  • They’re safe to use while breastfeeding.
  • They won’t be noticed by any sexual partners (if inserted properly).
  • They’re sometimes free (at least for now). In May 2015, the Obama administration stated that under the Affordable Care Act, at least one form of all 18 FDA-approved methods of birth control, including the IUD, must be covered without a co-payment — even if you haven’t met your deductible. We’re hoping that despite some recent developments, it stays that way.

Ok, awesome. Why has it taken so long for IUDs to hit the big time?

If you live in the U.S., you might vaguely remember hearing something about IUDs and abortions and infertility. (Don’t worry, IUDs do not cause abortions or infertility.) But there was a big controversy — call it the IUD version of “Serial” — in the ‘80s that gave them a pretty bad rep. It all had to do with the release of the Dalkon Shield — one faulty IUD that let bacteria into the uterus causing inflammation, infection, and infertility. Not good. The incident ruined our IUD trust in the U.S. for years to come. Meanwhile, the rest of the world charged ahead. China, France, and Scandinavia (Fun fact: 25% of Scandinavian women rely on IUDs!) kept on using their safe and effective IUDs.

We now have nearly 30 years of science (and we like our science) to back up the truth of the IUD on the market — proving that they’re safe and effective. Now that doesn’t mean there aren’t risks (we’ll get into those a bit later). But all IUDs recommended by doctors today are FDA-approved and are quickly overcoming the incorrect label placed on them so many years ago.

So, how does the IUD work?

The IUD is a small T-shaped device (adorable, really) that takes about five minutes to place inside your cervix. There are two types of IUDs: hormonal and copper (non-hormonal).

Hormonal IUD: sperm shall not pass

Mirena, Skyla, Liletta, and Kyleena are not just adorable names for your new puppy — they’re the four brands of hormonal IUDs currently available. (Also, please let us know if you name your dog after an IUD — because that’s awesome.) Hormonal IUDs block sperm from getting to the egg by:

  • Releasing levonorgestrel (a progestogen) to keep ovaries from releasing eggs. (Unlike birth control pills which release hormones into your bloodstream, this is a localized hormone release — i.e. just in your uterus.)
  • Thickening the cervical mucus so the sperm can’t reach the egg.
    Inhibiting the sperm’s ability to swim toward the egg.

The differences between these three puppies are:

  1. The amount of hormone released (Kyleena, for example, releases 17.5 micrograms/day while Mirena releases 20).
  2. The size: Skyla and Kyleena are slightly smaller and have a narrower inserter, so insertion may be a bit more comfortable–which is all kinds of good.
  3. The approved length of use: Mirena is effective for up to five years, Skyla is effective for up to three, Liletta for up to five, and Kyleena also for up to five . Since all four release a progestogen, they may lead to lighter and shorter periods — or no period at all.

Copper IUD: not a sperm favorite

The other IUD option is the copper IUD (brand name: ParaGard). It works by releasing copper ions into your cervix — no hormones here. Copper makes your uterus a pretty hostile environment for sperm for up to 10 years. Your cervix begins to produce a thick mucus that sperm can’t navigate through to get to your egg.

(FYI: Conception is defined as a fertilized egg implanting in the uterine wall. So, the abortion fear of IUDs isn’t an issue because conception never actually occurs.)
And on top of all that, copper actually, um… decapitates sperm. So yeah, no fertilization.

Okay so which IUD to choose? Let’s talk side effects first.

The fine print

IUDs are not the magical answer (even if they might seem that way) — they do have listed side effects. Paragard lays out side effects like anemia, backaches (interesting), cramping, irregular periods, and pelvic inflammatory disease (pelvic infection). Although there aren’t hormonal side effects, women report heavier periods and cramping with this bad boy. Mirena, Skyla, Liletta, and Kyleena all cite risks of nausea, ovarian cysts, and mood changes.

Both forms of IUD come with the risk of accidental “perforation,” or, well, a hole in the uterus and “expulsion” of the IUD. Expulsion, you ask? Yeah. There is a small chance that the IUD can slip out of your uterus. Planned Parenthood assures us that this is very rare (occurring between 2 and 10% of women), usually due to improper insertion. Doctors do a “string check” about six weeks after insertion (there are little teenie strings on the bottom of the IUD for removal) to make sure it’s in there nice and snug. (You can even check it yourself!)

To IUD or not to IUD

Despite the warnings, studies have deemed both IUD types as “highly acceptable with few unanticipated side effects.” And although the copper IUD is slightly more effective (with pregnancy rates between 0.3% and 0.6%), the hormonal IUD is only slightly less effective (<0.5%). So which to choose? Talk to your doctor and she’ll walk you through it:

  • She’ll make sure you’re a great candidate by ensuring you’re not already pregnant and don’t have any infections.
  • She’ll then ask you about your sexual history and check the position of your uterus.
  • If you want to avoid hormones, she may suggest you choose copper or, since the hormones are localized and don’t have as broad of an impact as the pill, she may still recommend a hormonal IUD. If you have heavy bleeding, she may have you avoid Paragard, which can make things really flow.

Who should and shouldn’t get IUDs

Though IUDs are a great birth control option for many women, according to Planned Parenthood, those who have STIs, pelvic infection, think they may already be pregnant, or have untreated cervical cancer or uterine cancer should find alternative contraception. If you’re allergic to copper, the non-hormonal Paragard IUD (made from copper) won’t be right for you.

Similarly, if you have Wilson’s Disease (high amounts of copper accumulated in the body) or any clot-preventing blood disorders, stay away from copper IUDs. If you’ve had breast cancer in the past, you should avoid hormonal IUDs. In some rare cases, uterine size or shape could make it difficult to insert an IUD. Luckily, like we mentioned earlier, your doctor will walk you through whether or not the IUD will work for you — and there are plenty of other choices if it won’t!

If your doctor does deem IUDs as appropriate for you, there’s a huge perk for anyone suffering from PMDD, or Premenstrual Dysphoric Disorder — studies show that IUDs, among other forms of contraception, may be very helpful in treating the symptoms.

A hot topic

IUDs are front and center in the birth control conversation and more and more women are talking about the liberation they promise and the hesitation they provoke (IUDs have definitely been a conversation piece at our book club over the last few months). For all the women who love them, there are still women who loathe them.

Christine calls her Mirena IUD “a godsend.” She needed a birth control method that made “less of an impact” on her hormones, and “as someone who is massively impacted by hormones, it’s been a breeze. Not getting a period is the best.”

Sarah had similar feelings: “My periods are light to non-existent. I never have to think about taking a pill. I haven’t experienced any weight gain or heightened emotions. I feel steadier than ever, as if PMS has been mitigated.”

Shannon didn’t end up getting an IUD because she didn’t like that she may not get a period. “For me, I like knowing that everything’s working. It’s not that I love getting my period, but I don’t actually mind it. Makes me feel like a woman."

And for some women, like Kate, the IUD just straight up wasn't right. Kate says, “My copper IUD made me bloated and gave me a heavier period than ever. I had it removed a few months in. I may try a hormonal one down the road, but I’m not sure it’s the right thing for my body."

And finally... what’s it like getting the IUD inserted

This part we can fill you in on from personal experience. Here’s how it goes down.

Your gynecologist “installs” (not the medical term, but that’s definitely what it feels like) the IUD into your cervix using a device that can only be described as a vaginal electric toothbrush. There is speculum action. There is cramping action. There is spotting. It’s not I-need-to-lie-in-my-bed-right-now cramping, but almost. And how to describe the feeling? It’s not a tampon in your vagina feeling — it’s an “oh… oh okay, that’s different,” kind of feeling. Overall it’s not excruciating, but it’s not comfortable. Your doctor may recommend taking an ibuprofen or two one hour before your appointment. And then you’ll go about your life (and sex life,) enjoying the perks of sexual empowerment knowing you’re locked and loaded with safe, effective contraception. (Check in with your doctor monthly to make sure everything’s working as it should!)

Okay, one last thing

Remember. remember, remember that IUDs protect against pregnancy, but not in the slightest against STIs. If you and your partner haven’t been tested for all of the things, keep the condoms handy. One last thing we’re here to arm you with info. But only your doctor can give you medical advice. If you're thinking through BC options, talk to her first.

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