A Guide to Getting an IUD
By Taylor Ciambra
[dropcap background="no" color="#333333"]I[/dropcap] was worried about my birth control pills melting. My multivitamins didn’t make it after one particularly hot day in Northern Arizona when the sun beamed straight through my tent’s mesh ceiling. This wasn’t the first time I worried about my pills surviving my outdoors job. There were times when I was sure I’d accidentally crushed them when I fell with my backpack on or it rained hard and my rainfly failed. That’s how I started to consider getting an IUD. After a quick search on Planned Parenthood’s site, I found myself thinking that sticking this little plastic T up in me was worth trying.
A year in, I can proudly say it’s been one of the best decisions I’ve ever made for myself. There’s nothing to forget or time or include in my daily routine. It’s just there, quietly emitting progestin. Another perk? It stopped my period and the roller coaster of physical and emotional changes that came with it every month.
With the election of Donald Trump and the Republican party gleefully clambering to find something to replace ObamaCare, a lot of ladies are afraid of losing their birth control and are thinking about getting an IUD. In fact, according to Vox, the amount of IUD prescriptions written and procedures administered, has increased 19% between October and December of 2016.
The message is clear: women want birth control that will outlast this president’s term.
Choice is the heart of feminism. Getting an IUD is another choice you can explore and we want to help you do that. We’ll cut through some of the confusion and fear around this acronym so you can figure out if this form of birth control could be right for you.[divider type="dashed" spacing="10"]
The first time I shakily flopped open my legs for my gyno, I asked her why she got into this business. I thought if I knew why she was doing this it would make me feel better. After asking me three times to slide further down on the table, she told me about her aunt. She was having some issues down there but never saw a doctor about it. At that time, all of the gynecologists were men and being a proper, unmarried, celibate, woman of her time, that just seemed wildly inappropriate. She had cancer, a kind that was very curable my doctor told me, after inserting the stainless steel duck lips into my vaginal ones. “If me being a woman can get other women to get the help they need, then I’m happy to do it.”
I was glad she told me that story. It got me to relax slightly but it created a foundation of trust to ask her about getting an IUD a few years later. Turns out, she has ParaGard, a copper IUD but we were going to try Liletta for me. I really, really, really did not want to keep getting my period. I was already living a gross and sweaty life in the woods and I didn’t want to keep adding blood to that when it was so hard get cleaned up on a regular basis. So let’s go over the basics.
IUD stands for intrauterine device. It’s a little plastic T shape that sits in your uterus. Depending on the kind you get, it can last from 3-12 years but you can get it removed at any time and you can get pregnant quickly after removal. There’s no pill to forget or condom to break. Your coverage is 24/7 and 99% effective. Compare that to condoms being 82% effective and birth control pills being 91%. It works by preventing sperm from getting to your egg and depending on the type of IUD you have, that can happen in a couple of different ways. All that also means that IUDs can’t prevent another one of our favorite three letter acronyms, STIs. If you do get an STI when you have an IUD you can keep it in, but if you develop a pelvic inflammatory disease, you might not be able to.[divider type="dashed" spacing="10"]
TYPES OF IUDS
There’s two types of IUDS and five different FDA approved brands featuring girly girl names. Copper (ParaGard) and Hormonal (Liletta, Mirena, Skyla and Kyleena).
For some reason copper is a great sperm stopper. ParaGard is your option here. It’s the familiar T shape but with tiny coils of copper instead of hormones. What’s great is that you can keep it in for 12 years! Not a bad choice if you’re looking for a long term commitment that’s still into keepin’ it casual.
Hormonal IUDs use progestin, a hormone close to the one we already produce- progesterone- to stop sperm in two different ways.
#1 They thicken the cervical mucus to trap the sperm.
#2 They stop eggs from actually leaving your ovaries. So even if the sperm didn’t get stuck, there’d be no egg to fertilize.
Mirena works up to six years, Kyleena works up to 5, Skyla and Liletta work up to 3 years.[divider type="dashed" spacing="10"]
THE DALKON SHIELD’S SHADOW ON IUDs
If you’re wondering why you’ve never heard of IUDs or have some vague sense of “aren’t those really unsafe?” floating around in your mind like I did, it’s because the history of IUDs is full of failed models and frightening side effects. Most recently, that’s due to the horseshoe crab shaped Dalkon Shield IUD that was on the market in the 1970s. It had many horrible complications ranging from infection to loss of fertility, and it caused the deaths of 18 women. It was recalled by the FDA in 1974 and thus began a long moratorium on IUDs useage in the states. In the 1990s, European IUDs began to be manufactured with soft plastic and the T shape we know today which solved many of the problems the Dalkon Shield created. Still, it wasn’t until 2000 that this IUD made it to America and then it was only given to women who had already given birth and were monogamous. Twelve years later, IUDs were deemed both safe and effective for the general population by the American College of Obstetricians and Gynecologists. So when you think about it, it’s only been since 2012 that IUDs have been a safe and available birth control option![divider type="dashed" spacing="10"]
“You’ve never had a baby so you’ve never had anything in that far in there before,” my doctor tells me on the day of insertion. I’m really nervous and she knows it. “But you’re a very reasonable person.” I nod and wonder silently if I really am or not. “So I’m expecting this to go very well.” she says. The nurse rubs one of my knees which was comforting. I was feeling really self conscious that I had my period too. My doctor told me to come in when I had it so we all knew I wasn’t pregnant and the extra fluid would help the procedure go a little smoother. During our small talk, I nonchalantly I ask my doctor what’s the worst that could happen? She tells me that she could puncture my uterus. We both laugh in morbid but bonding kind of way. I remember her aunt and to trust her.
As scary the build up in my mind was, the procedure was totally fine. There were a lot of things holding me open and that was heavy and uncomfortable. I felt a big cramp when my doctor told me I would, which I think was when she actually got into my cervix and opened up the arms of the IUD. But I didn’t feel more pain than that. It was over in a half hour and most of that was my doctor prepping and explaining everything to me, not the actual insertion. I was really tired for a week and got my period for a month, but it was mostly just bleeding. Not cramping or nausea or anything. I tell my friends if they’ve had a pap smear, they can definitely handle this.
At the same time, I know this isn’t the case for everyone. For some women it does hurt quite a lot and they experience rough- though still short term- side effects. In my entirely unprofessional opinion, I’ll say this: You know your body best, and this is a medical procedure with risks and surprises like any other, talk to a doctor you trust.
Here’s the nitty gritty details if you need to know them to wrap your head around what to expect:
The Doctor will Examine You Your doctor is going to put their fingers into your vagina and put another hand on your abdomen to feel your internal organs and determine some important things about your uterus, like position and size.
You’ll get the Duck Lips Then everyone’s favorite tool comes out- the speculum- aka the duck lips. It’s inserted into your vagina to hold it open.
You’ll Get Sterilized Your doctor will then sterilize the cervix and some of the vagina to reduce the likelihood of infection.
There’s Going to be a Few More Tools This is probably why my vagina felt heavy. Not only do you have the duck lips holding you open, but there’s a tool called a tenaculum that slides in too. It helps stabilize your cervix. Then comes a sound, that’s used to measure the length and direction of the cervical canal and uterus. This tool is awesome because it helps reduce the risk of perforation.
The IUD will be Inserted Your doctor will then remove the sound and the IUD from its sterile packaging. The arms of the T are bent back and inserted into a thin tube. Your doctor uses a plunger to push the IUD through the tube to the depth the sound indicated. When the IUD leaves the tube and enters it’s new home, the arms of the T unfold.
You’re All Set! Your doctor will remove everything that was holding you open and the IUD will now stay in place. Your IUD has strings tied to the end of the T that make it easy to remove and to be able to tell if your IUD has moved at all. Your doctor will cut the strings so they hang an inch or two out of the cervix and into the vagina. You won’t be able to see them but they are long enough to be felt with your finger. Then your doctor will give you a card that has the month and year of when you’ll need to get it replaced.
You’ll probably hang out for a few minutes to catch your breath. Some people feel dizzy and some people need a hot compress to help with the cramps. Hopefully you feel as empowered as I did when it’s all over with.
In a couple of months you’ll have an ultrasound to make sure it’s still in place. I even kept my sonogram pictures to celebrate this decision![divider type="dashed" spacing="10"]
Right after the procedure, you might experience cramping, backaches, and irregular periods but that tends to go away as your body adjusts to having an IUD, somewhere around the timeframe of 3-6 months.
There are inherent risks when you have an IUD, we’ve talked about perforation which is most likely to happen during the insertion procedure but there are a few risks to keep in mind as well.
While an IUD is 99% effective, there’s still that 1% chance you could get pregnant. If that happens, your doctor will help you decide the best course of action when it comes to leaving in the IUD or removing it. If you get pregnant with an IUD it’s more likely that it’s an ectopic or tubal pregnancy.
While it expulsion also rarely occurs, it can happen. It’s most likely to happen within the first few months after insertion. Expulsion is when the IUD expels itself from your uterus. You might experience some cramping before finding it outside of your body.[divider type="dashed" spacing="10"]
When we talk about the cost of an IUD we’re talking about: The exam Insertion Follow Up Visit Co-pays
While the cost of an IUD changes depending on the type you go for and the state you live in, under the Affordable Care Act or with Medicaid, the majority of the cost is covered. Which is another reason why the timing of the increase in IUD usage is so poignant. Without the ACA an IUD easily costs around $1000, a price so few of us can afford.
While we don’t know if, how, or when changes to insurance will come, it’s important to be aware of your birth control options and make adjustments that will fit your lifestyle and needs. As this presidency wears on, I’m finding a lot of comfort in my decision to get an IUD as not only a form of birth control but also as a form of resistance to this administration’s values.
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Sources: Planned Parenthood, Vox, Bustle, VeryWell, Business Insider, and SELF.